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Murhekar MV, Kamaraj P, Kumar MS, Khan SA, Allam RR, Barde PV, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Kumar CPG, Sabarinathan R, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM. Immunity against diphtheria among children aged 5-17 years in India, 2017-18: a cross-sectional, population-based serosurvey. THE LANCET. INFECTIOUS DISEASES 2021; 21:868-875. [PMID: 33485469 DOI: 10.1016/s1473-3099(20)30595-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/27/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diphtheria is re-emerging as a public health problem in several Indian states. Most diphtheria cases are among children older than 5 years. In this study, we aimed to estimate age-specific immunity against diphtheria in children aged 5-17 years in India. METHODS We used residual serum samples from a cross-sectional, population-based serosurvey for dengue infection done between June 19, 2017, and April 12, 2018, to estimate the age-group-specific seroprevalence of antibodies to diphtheria in children aged 5-17 years in India. 8309 serum samples collected from 240 clusters (122 urban and 118 rural) in 60 selected districts of 15 Indian states spread across all five geographical regions (north, northeast, east, west, and south) of India were tested for the presence of IgG antibodies against diphtheria toxoid using an ELISA. We considered children with antibody concentrations of 0·1 IU/mL or greater as immune, those with levels less than 0·01 IU/mL as non-immune (and hence susceptible to diphtheria), and those with levels in the range of 0·01 to less than 0·1 IU/mL as partially immune. We calculated the weighted proportion of children who were immune, partially immune, and non-immune, with 95% CIs, for each geographical region by age group, sex, and area of residence (urban vs rural). FINDINGS 29·7% (95% CI 26·3-33·4) of 8309 children aged 5-17 years were immune to diphtheria, 10·5% (8·6-12·8) were non-immune, and 59·8% (56·3-63·1) were partially immune. The proportion of children aged 5-17 years who were non-immune to diphtheria ranged from 6·0% (4·2-8·3) in the south to 16·8% (11·2-24·4) in the northeast. Overall, 9·9% (7·7-12·5) of children residing in rural areas and 13·1% (10·2-16·6) residing in urban areas were non-immune to diphtheria. A higher proportion of girls than boys were non-immune to diphtheria in the northern (17·7% [12·6-24·2] vs 7·1% [4·1-11·9]; p=0·0007) and northeastern regions (20·0% [12·9-29·8] vs 12·9% [8·6-19·0]; p=0·0035). INTERPRETATION The findings of our serosurvey indicate that a substantial proportion of children aged 5-17 years were non-immune or partially immune to diphtheria. Transmission of diphtheria is likely to continue in India until the immunity gap is bridged through adequate coverage of primary and booster doses of diphtheria vaccine. FUNDING Indian Council of Medical Research.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India.
| | - Pattabi Kamaraj
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India
| | | | - Siraj Ahmed Khan
- ICMR Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip V Barde
- ICMR National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | | | - Subarna Roy
- ICMR National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - C P Girish Kumar
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India
| | - Ramasamy Sabarinathan
- Indian Council of Medical Research (ICMR) National Institute of Epidemiology, Chennai, India
| | | | | | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Provash Sadhukhan
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | | | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- ICMR National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR Desert Medicine Research Centre, Jodhpur, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases Division, ICMR, New Delhi, India
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Zasada AA, Rastawicki W, Śmietańska K, Rokosz N, Jagielski M. Comparison of seven commercial enzyme-linked immunosorbent assays for the detection of anti-diphtheria toxin antibodies. Eur J Clin Microbiol Infect Dis 2013; 32:891-7. [PMID: 23354678 DOI: 10.1007/s10096-013-1823-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/09/2013] [Indexed: 11/24/2022]
Abstract
Determination of immune status of patients to diphtheria toxin is based mainly on the results of commercially available ELISA kits. The aim of the present study was to compare the results obtained by ELISAs from seven different manufacturers: Mikrogen, Immunolab, Sekisui Virotech, NovaTec, Virion\Serion, IBL International and Euroimmun. All assays were performed according to the manufacturers' instructions. The concentrations of the anti-diphtheria toxin antibodies in 72 serum samples were calculated on the basis of curves constructed from standards supplied by manufacturers and the new reference material-International Standard for Diphtheria Antitoxin (10/262). The repeatability and reproducibility of all the ELISA kits tested were good. Number of sera with concentrations of the anti-diphtheria toxin antibodies below the WHO-recommended level of protection (0.1 IU/ml) were dependent on the ELISA used: Mikrogen, 20/72 samples (27.7%); Immunolab, 11/72 samples (15.3%); Sekisui Virotech, 0/72 samples (0%); NovaTec 18/72 samples (25.0%); Serion 12/72 samples (16.7%); IBL International, 7/72 samples (9.7 %); and Euroimmun, 17/72 samples (23.6%). However, the results obtained in particular ELISAs, with the exception of Sekisui Virotech, were much more consistent when the concentrations of the anti-diphtheria toxin antibodies in 72 sera measured by using curves constructed from the International Standard 10/262. The data obtained clearly demonstrated that manufacturer-dependent differences between anti-diphtheria IgG ELISA kits exist. The differences in recommendations accepted by the individual manufacturers together with differences shown in our studies in sensitivity greatly affect the clinical interpretation of results.
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Affiliation(s)
- A A Zasada
- Department of Bacteriology, National Institute of Public Health-National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.
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