1
|
Le HT, Do TH, Dao TA, Hoang TT, Nguyen BT, Le TL, Nguyen DL, Yoshida LM, Le XH, Le HQ, Ton TT, Ha MJ. Seroprevalence of anti-diphtheria toxoid antibody and implications for vaccination policy in Vietnam's South-central coast: a cross-sectional study. BMC Infect Dis 2024; 24:813. [PMID: 39134980 PMCID: PMC11318120 DOI: 10.1186/s12879-024-09688-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Diphtheria is a re-emerging infectious disease and public health concern worldwide and in Vietnam with increasing cases in recent years. This study aimed to assess the anti-diphtheria toxoid antibodies status in Khanh Hoa Province and identify factors contributing to the vaccination policy in the south-central coast of Vietnam. METHODS This was a cross-sectional study to evaluate the seroprevalence of anti-diphtheria toxoid antibodies among 1,195 participants, aged 5 - 40 years in Khanh Hoa Province, Vietnam. Immunoglobulin G antibody levels against diphtheria were detected using a commercial anti-diphtheria toxoid enzyme-linked immunosorbent assay (SERION ELISA classic Diphtheria Immunoglobulin G) and were categorized following the World Health Organization guidelines. RESULTS The mean anti-diphtheria toxoid antibody levels were 0.07 IU/ml (95% Confidence Interval: 0.07-0.08). Anti-diphtheria toxoid antibody levels were found to be associated with age and history of diphtheria vaccination. The 5-15 years age group had the highest levels (0.09 IU/ml), while the older age group had the lowest antibody level (p < 0.001). Individuals who received three doses (adjusted Odds ratio: 2.34, 95%CI: 1.35 - 4.07) or 4+ doses (adjusted Odds ratio: 2.45, 95%CI: 1.29 - 4.64) had a higher antibody level compared to those who received only one dose regardless of age. CONCLUSION It is crucial to promote routine vaccination coverage to over 95% for children under one year of age with three primary doses of the diphtheria-containing vaccine, including additional doses at 18 months and 7 years of age. Booster doses should be promoted and administered to adolescents and adults every 10 years.
Collapse
Affiliation(s)
- Hoang Thieu Le
- Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - Thai Hung Do
- Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - The Anh Dao
- Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | | | | | - Thuy Lien Le
- Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | | | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Xuan Huy Le
- Pasteur Institute in Nha Trang, Nha Trang, Khanh Hoa, Vietnam
| | - Hong Quan Le
- Khanh Hoa Province Health Department, Nha Trang, Khanh Hoa, Vietnam
| | - That Toan Ton
- Nha Trang Center for Disease Control, Nha Trang, Khanh Hoa, Vietnam
| | - Min Jin Ha
- Department of Health Informatics and Biostatistic, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Thwaites CL, Thanh TT, Ny NTH, Nguyet LA, Nhat NTD, Thuy CT, Thanh NTL, Dung NT, Campbell J, Thai PQ, Tan LV, Choisy M, Boni MF. Seroprotection against tetanus in southern Vietnam. Vaccine 2023; 41:2208-2213. [PMID: 36849339 PMCID: PMC10580288 DOI: 10.1016/j.vaccine.2023.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/17/2023] [Accepted: 02/10/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Ongoing tetanus cases and sporadic outbreaks of vaccine-preventable diseases associated with routine vaccination programmes remain problems in many low and middle-income countries, including Vietnam. With no human-to-human transmission or natural immunity, tetanus antibody levels indicate both individual risk of tetanus and gaps in vaccination programmes. METHODS To investigate gaps in immunity to tetanus in Vietnam, a country with a historically high level of tetanus vaccination coverage, tetanus antibodies were measure by ELISA from samples selected from a long-term serum bank, established for the purposes of general-population seroepidemiological investigations in southern Vietnam. Samples were selected from 10 provinces, focussing on age-groups targeted by national vaccination programmes for infants and pregnant women (Expanded Programme on Immunization, EPI, and Maternal and Neonatal Tetanus, MNT). RESULTS Antibodies were measured from a total of 3864 samples. Highest tetanus antibody concentrations occurred in children under 4 years old, over 90 % of whom had protective levels. Approximately 70 % of children aged 7-12 years had protective antibody concentrations although there was variation among provinces. For infants and children, there were no significant differences in tetanus protection between males and females, but for adults aged 20-35 years, in five of the ten provinces surveyed, protection against tetanus was higher in females (p < 0.05) who are eligible for booster doses under the MNT programme. In seven of ten provinces, antibody concentrations were inversely related to age (p < 0.01) and protection of older individuals was generally low. CONCLUSION Widespread immunity to tetanus toxoid is seen in infants and young children consistent with the high coverage rates reported for diptheria tetanus toxoid and pertussis (DTP) in Vietnam. However, the lower antibody concentrations seen in older children and men suggest reduced immunity to tetanus in populations not targeted by EPI and MNT programmes.
Collapse
Affiliation(s)
- C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Global Health and Tropical Medicine, University of Oxford, UK
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Nguyen Thi Han Ny
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | | | - Cao Thu Thuy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | | | | | - James Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Global Health and Tropical Medicine, University of Oxford, UK.
| | - Pham Quang Thai
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam; School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Marc Choisy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Global Health and Tropical Medicine, University of Oxford, UK
| | - Maciej F Boni
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Global Health and Tropical Medicine, University of Oxford, UK; Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA 16802, United States
| |
Collapse
|
3
|
Kitamura N, Hoan TT, Do HM, Dao TA, Le LT, Le TTT, Doan TTT, Chau TN, Dinh HT, Iwaki M, Senoh M, Efstraciou A, Ho NM, Pham DM, Dang DA, Toizumi M, Fine P, Do HT, Yoshida LM. Seroepidemiology and Carriage of Diphtheria in Epidemic-Prone Area and Implications for Vaccination Policy, Vietnam. Emerg Infect Dis 2023; 29:70-80. [PMID: 36573549 PMCID: PMC9796191 DOI: 10.3201/eid2901.220975] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In 2019, a community-based, cross-sectional carriage survey and a seroprevalence survey of 1,216 persons 1-55 years of age were conducted in rural Vietnam to investigate the mechanism of diphtheria outbreaks. Seroprevalence was further compared with that of an urban area that had no cases reported for the past decade. Carriage prevalence was 1.4%. The highest prevalence, 4.5%, was observed for children 1-5 years of age. Twenty-seven asymptomatic Coerynebacterium diphtheriae carriers were identified; 9 carriers had tox gene-bearing strains, and 3 had nontoxigenic tox gene-bearing strains. Child malnutrition was associated with low levels of diphtheria toxoid IgG, which might have subsequently increased child carriage prevalence. Different immunity patterns in the 2 populations suggested that the low immunity among children caused by low vaccination coverage increased transmission, resulting in symptomatic infections at school-going age, when vaccine-induced immunity waned most. A school-entry booster dose and improved infant vaccination coverage are recommended to control transmissions.
Collapse
|
4
|
Kitamura N, Bahkali K, Chem ED, Quilty BJ, Edwards T, Toizumi M, Yoshida LM. Waning rate of immunity and duration of protective immunity against diphtheria toxoid as a function of age and number of doses: Systematic review and quantitative data analysis. Hum Vaccin Immunother 2022; 18:2099700. [PMID: 35862651 DOI: 10.1080/21645515.2022.2099700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although the burden of diphtheria has declined greatly since the introduction of vaccines, sporadic outbreaks continue to be reported. WHO recommends booster doses after a primary series, but questions remain about the optimal interval between these doses. We conducted a systematic review and quantitative data analysis to quantify the duration of protective immunity after different numbers of doses. Fifteen cross-sectional seroprevalence studies provided data on geometric mean concentration (GMC). Single-year age-stratified GMCs were analyzed using a mixed-effect linear regression model with a random intercept incorporating the between-country variability. GMC was estimated to decline to 0.1 IU/ml in 2.5 years (95% CI: 0.9-4.0), 10.3 years (95% CI: 7.1-13.6), and 25.1 years (95% CI: 7.6-42.6) after receiving three, four and five doses, respectively. The results drawn from cross-sectional data collected in countries with different epidemiologies, vaccines, and schedules had several limitations. However, these analyses contribute to the discussion of optimal timing between booster doses of diphtheria toxoid-containing vaccine.
Collapse
Affiliation(s)
- Noriko Kitamura
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Khawater Bahkali
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health Intelligence, Public Health Authority, Riyadh, Saudi Arabia
| | - Elvis D Chem
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Billy J Quilty
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tansy Edwards
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
5
|
Nguyen Thi Nguyen T, Parry CM, Campbell JI, Vinh PV, Kneen R, Baker S. Endemic erythromycin resistant Corynebacterium diphtheriae in Vietnam in the 1990s. Microb Genom 2022; 8:mgen000861. [PMID: 36259695 PMCID: PMC9676054 DOI: 10.1099/mgen.0.000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Diphtheria is a potentially fatal respiratory disease caused by toxigenic forms of the Gram-positive bacterium Corynebacterium diphtheriae. Despite the availability of treatments (antitoxin and antimicrobials) and effective vaccines, the disease still occurs sporadically in low-income countries and in higher income where use of diphtheria vaccine is inconsistent. Diphtheria was highly endemic in Vietnam in the 1990s; here, we aimed to provide some historical context to the circulation of erythromycin resistant organisms in Vietnam during this period. After recovering 54 C. diphtheriae isolated from clinical cases of diphtheria in Ho Chi Minh City between 1992 and 1998 we conducted whole genome sequencing and analysis. Our data outlined substantial genetic diversity among the isolates, illustrated by seven distinct Sequence Types (STs), but punctuated by the sustained circulation of ST67 and ST209. With the exception of one isolate, all sequences contained the tox gene, which was classically located on a corynebacteriophage. All erythromycin resistant isolates, accounting for 13 % of organisms in this study, harboured a novel 18 kb erm(X)-carrying plasmid, which exhibited limited sequence homology to previously described resistance plasmids in C. diphtheriae. Our study provides historic context for the circulation of antimicrobial resistant C. diphtheriae in Vietnam; these data provide a framework for the current trajectory in global antimicrobial resistance trends.
Collapse
Affiliation(s)
- To Nguyen Thi Nguyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Microbiology, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Parry
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK
- Alder Hey Children’s Hospital, NHS Foundation Trust, Liverpool, UK
| | - James I. Campbell
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phat Voong Vinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Rachel Kneen
- Alder Hey Children’s Hospital, NHS Foundation Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Stephen Baker
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| |
Collapse
|
6
|
Rosana Y, Lusiana DIG, Yasmon A. Genetic characterization of diphtheria tox B to evaluate vaccine efficacy in Indonesia. IRANIAN JOURNAL OF MICROBIOLOGY 2022; 14:606-610. [PMID: 36721501 PMCID: PMC9867633 DOI: 10.18502/ijm.v14i4.10248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background and Objectives Blocking the attachment of diphtheria toxins to host cells through the intact receptor binding site (tox B) was the initial mechanism of action of the diphtheria vaccine. Diphtheria outbreaks in populations with good vaccination coverage can be caused by mutations or changes in the genetic structure of the tox B protein. The aim of this study was to characterize the Tox B protein produced by Corynebacterium diphtheriae isolated from 2018 to 2019 in patients in Jakarta who had already received the diphtheria vaccine. Materials and Methods Of the 89 throat swab specimens of patients with a clinical diagnosis of diphtheria, 10 were positive for diphtheria and toxin. PCR was used to amplify the tox B DNA fragment in the 10 positive isolates. DNA sequencing was conducted with overlapping primers and the DNA sequences were analysed by using SeqScape V2.7. Results Of the 10 isolates, nine isolate showed a DNA mutation (G30A), but the mutation did not change the amino acid encoding arginin (silent mutation). Our findings indicate that the efficacy of the diphtheria vaccine used in Indonesia has not decreased because of mutations in the tox B genes not change the amino acid. Conclusion Overall, there are no amino acid changes in the tox B protein, indicating that the outbreaks are not affected by mutation in tox B. Another possible mechanism - overexpression of the toxin - is likely responsible for causing diphtheria in patients who have a complete history of immunization in Indonesia.
Collapse
Affiliation(s)
- Yeva Rosana
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia,Corresponding author: Yeva Rosana, Ph.D, Department of Microbiology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Telefax: +62-21-3100810
| | - Diana Intan Gabriella Lusiana
- Department of Microbiology, Master’s Programme in Biomedical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Andi Yasmon
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
7
|
Mai VQ, Boonstoppel L, Vaughan K, Schutte C, Ozaltin A, Hong DT, Khanh NM, Thang HM, Anh TT, Van Minh H. Cost of Delivering Tetanus Toxoid and Tetanus-Diphtheria Vaccination in Vietnam and the Budget Impact of Proposed Changes to the Schedule. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00482. [PMID: 35487560 PMCID: PMC9053159 DOI: 10.9745/ghsp-d-21-00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Vu Quynh Mai
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam.
| | | | | | | | | | - Duong Thi Hong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Hoang Manh Thang
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Tran Tuan Anh
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | | |
Collapse
|
8
|
Whole genome sequence of a non-toxigenic Corynebacterium diphtheriae strain from a hospital in southeastern China. BMC Genom Data 2021; 22:42. [PMID: 34656079 PMCID: PMC8520229 DOI: 10.1186/s12863-021-00998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Sporadic cases of infection with non-toxigenic Corynebacterium diphtheriae (C. diphtheriae) isolates have been reported in regions covered by the Diphtheria-Tetanus-Pertussis vaccine, but no information describing the whole genome of non-toxigenic strains collected in China is available. Therefore, in this work, the complete genome of a non-toxigenic strain of C. diphtheriae from a hospital located in southeastern China was performed. Results This non-toxigenic isolate belonged to the belfanti biotype and possessed a unique ST (assigned as ST799 in pubMLST). ErmX was present in the genome sequence and this isolate owned the resistance to erythromycin and clindamycin. Genes coding for virulence factors involved in adherence, iron-uptake and regulation of diphtheria toxin were also found. Two genes were involved in the interaction between pathogen and host. The phylogenetic analysis revealed that this newly isolated strain was similar to the strain NCTC10838, CMCNS703 and CHUV2995. Conclusion Non-toxigenic C. diphtheriae strain contained virulence factors, thus it is able to cause an infectious disease, aspect that could be clarified by performing the whole genome sequencing analysis. Supplementary Information The online version contains supplementary material available at 10.1186/s12863-021-00998-9.
Collapse
|
9
|
Gao H, Lau EHY, Cowling BJ. Waning immunity after receipt of Pertussis, Diphtheria, Tetanus and Polio-related vaccines: a systematic review and meta-analysis. J Infect Dis 2021; 225:557-566. [PMID: 34543411 DOI: 10.1093/infdis/jiab480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 11/12/2022] Open
Abstract
DTP-containing (pertussis, diphtheria and tetanus) combined with polio vaccines are recommended by WHO as part of routine immunization programs. The decline of immunity after vaccination has been considered as a possible reason for the re-emergence of vaccine-preventable diseases worldwide. In this study, we evaluated the potential duration of protective immunity of pertussis, diphtheria, tetanus and polio through a systematic review and meta-analysis. We examined data on immunological and clinical outcomes. We observed evidence of waning post-vaccination immunity for pertussis and diphtheria, while tetanus and polio vaccines provided sustained protection. Further research on the risk factors of waning immunity after vaccination and the optimal timing of booster doses for pertussis and diphtheria are needed.
Collapse
Affiliation(s)
- Huizhi Gao
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| |
Collapse
|