Issues and considerations in the use of serologic biomarkers for classifying vaccination history in household surveys

MacNeil, Adam; Lee, Chungwon; Dietz, Vance

doi:10.1016/j.vaccine.2014.07.005

Cited by 23 publications

(24 citation statements)

References 46 publications

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“…No regional differences in immunity were noted in the polio, measles, and rubella serosurveys in Cambodia (27). Determination of true population immunity by serosurvey is helpful in light of the challenges of collecting accurate vaccination histories (14,35). Six tetanus doses are required for lifelong immunity when vaccination is begun in infancy, but childhood vaccination records are rarely available for data abstraction in surveys of adult women (28).…”

Section: Discussionmentioning

confidence: 99%

“…1) (13). Serosurveys could be used to monitor progress toward the achievement and maintenance of MNTE given challenges of reliably assessing TT coverage through vaccination history (14). For in vitro assays of tetanus seroprotection, gold standards are the DAE (double-antigen enzyme-linked immunosorbent assay [ELISA]) and toxin binding inhibition (ToBI) tests, which are not commercially available (15)(16)(17)(18)(19).…”

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confidence: 99%

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Tetanus Immunity among Women Aged 15 to 39 Years in Cambodia: a National Population-Based Serosurvey, 2012

Scobie

Mao

Sokhal

et al. 2016

Clin Vaccine Immunol

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gTo monitor progress toward maternal and neonatal tetanus elimination (MNTE) in Cambodia, we conducted a nationwide serosurvey of tetanus immunity in 2012. Multistage cluster sampling was used to select 2,154 women aged 15 to 39 years. Tetanus toxoid antibodies in serum samples were measured by gold-standard double-antigen enzyme-linked immunosorbent assay (DAE) and a novel multiplex bead assay (MBA). Antibody concentrations of >0.01 IU/ml by DAE or the equivalent for MBA were considered seroprotective. Estimated tetanus seroprotection was 88% (95% confidence interval [CI], 86 to 89%); 64% (95% CI, 61 to 67%) of women had antibody levels of >1.0 IU/ml. Seroprotection was significantly lower (P < 0.001) among women aged 15 to 19 years (63%) and 20 to 24 years (87%) than among those aged >25 years (96%), among nulliparous women than among parous women (71 versus 97%), and among those living in the western region than among those living in other regions (82 versus 89%). The MBA showed high sensitivity (99% [95% CI, 98 to 99%]) and specificity (92% [95% CI, 88 to 95%]) compared with DAE. Findings were compatible with MNTE in Cambodia (>80% protection). Tetanus immunity gaps should be addressed through strengthened routine immunization and targeted vaccination campaigns. Incorporating tetanus testing in national serosurveys using MBAs, which can measure immunity to multiple pathogens simultaneously, may be beneficial for monitoring MNTE.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Tetanus Immunity among Women Aged 15 to 39 Years in Cambodia: a National Population-Based Serosurvey, 2012

Scobie

Mao

Sokhal

et al. 2016

Clin Vaccine Immunol

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show abstract

“…They can help to elucidate reasons for outbreaks and evaluate the impact of vaccination campaigns on population immunity. There is also great interest in using serological data to infer routine vaccination coverage .…”

Section: Uses Of Seroepidemiological Data For Vaccination Programme Dmentioning

confidence: 99%

“…There is therefore interest in using seroprevalence as an indicator of coverage of infant or adult vaccination. To infer vaccination coverage from seroprevalence data, either there must be no natural infection occurring in the area or antibody induced by vaccine should be distinguishable from that following infection; there should be known vaccine immunogenicity under a wide range of programme conditions, antibody should have known duration after primary vaccination and the appropriate age group should be studied, and antibody levels should correlate with the number of doses of vaccine received and be identified precisely and accurately by a field‐friendly assay .…”

Section: Estimation Of Routine Vaccination Coveragementioning

confidence: 99%

Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low‐ and middle‐income countries

Cutts

Hanson

2016

Tropical Med Int Health

115

135

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SummarySeroepidemiology, the use of data on the prevalence of bio-markers of infection or vaccination, is a potentially powerful tool to understand the epidemiology of infection before vaccination and to monitor the effectiveness of vaccination programmes. Global and national burden of disease estimates for hepatitis B and rubella are based almost exclusively on serological data. Seroepidemiology has helped in the design of measles, poliomyelitis and rubella elimination programmes, by informing estimates of the required population immunity thresholds for elimination. It contributes to monitoring of these programmes by identifying population immunity gaps and evaluating the effectiveness of vaccination campaigns. Seroepidemiological data have also helped to identify contributing factors to resurgences of diphtheria, Haemophilus Influenzae type B and pertussis. When there is no confounding by antibodies induced by natural infection (as is the case for tetanus and hepatitis B vaccines), seroprevalence data provide a composite picture of vaccination coverage and effectiveness, although they cannot reliably indicate the number of doses of vaccine received. Despite these potential uses, technological, time and cost constraints have limited the widespread application of this tool in low-income countries. The use of venous blood samples makes it difficult to obtain high participation rates in surveys, but the performance of assays based on less invasive samples such as dried blood spots or oral fluid has varied greatly. Waning antibody levels after vaccination may mean that seroprevalence underestimates immunity. This, together with variation in assay sensitivity and specificity and the common need to take account of antibody induced by natural infection, means that relatively sophisticated statistical analysis of data is required. Nonetheless, advances in assays on minimally invasive samples may enhance the feasibility of including serology in large survey programmes in low-income countries. In this paper, we review the potential uses of seroepidemiology to improve vaccination policymaking and programme monitoring and discuss what is needed to broaden the use of this tool in low-and middle-income countries.

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“…Prior efforts to study epidemic survivors retrospectively have primarily been confined to serologic surveys. Positive serology can identify individuals who have been exposed to a particular pathogen, and antibody titers can be used to assess adaptive immunity, but these are not highly precise measures of the host response (MacNeil et al, 2014). Serotypic crossreactivity between structurally similar epitopes conserved among or within viral taxa can make it difficult to distinguish specific pathogen strains or species, and antibody titers can vary dramatically between individuals and decrease over time.…”

Section: Tracking Viruses With Host Response Datamentioning

confidence: 99%

Genomic Signatures of Emerging Viruses: A New Era of Systems Epidemiology

Rasmussen

Katze

2016

Cell Host & Microbe

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Compared to classical epidemiologic methods, genomics can be used to precisely monitor virus evolution and transmission in real time across large, diverse populations. Integration of pathogen genomics with data about host genetics and global transcriptional responses to infection allows for comprehensive studies of population-level responses to infection and provides novel methods for predicting clinical outcomes. As genomic technologies become more accessible, these methods will redefine how emerging viruses are studied and outbreaks are contained. Here we review the existing and emerging genomic technologies that are enabling systems epidemiology and systems virology and making it possible to respond rapidly to emerging viruses such as Zika.

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Issues and considerations in the use of serologic biomarkers for classifying vaccination history in household surveys

Cited by 23 publications

References 46 publications

Tetanus Immunity among Women Aged 15 to 39 Years in Cambodia: a National Population-Based Serosurvey, 2012

Tetanus Immunity among Women Aged 15 to 39 Years in Cambodia: a National Population-Based Serosurvey, 2012

Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low‐ and middle‐income countries

Genomic Signatures of Emerging Viruses: A New Era of Systems Epidemiology

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