Seroprevalence of Measles, Rubella, Tetanus, and Diphtheria Antibodies among Children in Haiti, 2017

Abstract

In Haiti, measles, rubella, and maternal and neonatal tetanus have been eliminated, but a diphtheria outbreak is ongoing as of 2019. We conducted a nationally representative, household-based, two-stage cluster survey among children aged 5-7 years in 2017 to assess progress toward maintenance of control and elimination of selected vaccine-preventable diseases (VPDs). We stratified Haiti into West region (West department, including the capital city) and non-West region (all other departments). We obtained vaccination history and dried blood spots, and measured antibody concentrations to VPDs on a multiplex bead assay. Among 1,146 children, national seropositivity was 83% (95% CI: 80-86%) for tetanus, 83% (95% CI: 81-85%) for diphtheria, 87% (95% CI: 85-89%) for measles, and 84% (95% CI: 81-87%) for rubella. None of the children had long-term immunity to tetanus or diphtheria (IgG concentration ³ 1 international unit/mL). Seropositivity in the West region was lower than that in the non-West region. Vaccination coverage was 68% (95% CI: 61-74%) for ³ 3 doses of tetanus-and diphtheria-containing vaccine (DTP3), 84% (95% CI: 80-87%) for one dose of measles-rubella vaccine (MR1), and 20% (95% CI: 16-24%) for MR2. The seroprevalence of measles, rubella, and diphtheria antibodies is lower than population immunity levels needed to prevent disease transmission, particularly in the West region; reintroduction of these diseases could lead to an outbreak. To maintain VPD control and elimination, Haiti should achieve DTP3 and MR2 coverage ³ 95%, and include tetanus and diphtheria booster doses in the routine immunization schedule.

The epidemiology of diphtheria in Haiti, December 2014–June 2021: A spatial modeling analysis

“…The sharp increase in incidence in the early stages of the outbreak indicates that a large proportion of the population in Haiti was susceptible to diphtheria. This is consistent with the results of Minta et al [39], who found no evidence of long-term protection against the infection (IgG�1 IU/mL) among a nationally representative sample of 1,146 children aged 5-7 years in Haiti in 2017. There are a few probable explanations for the decrease in incidence after 2018.…”

“…This is consistent with the results of Minta et al . [ 39 ], who found no evidence of long-term protection against the infection (IgG≥1 IU/mL) among a nationally representative sample of 1,146 children aged 5–7 years in Haiti in 2017. There are a few probable explanations for the decrease in incidence after 2018.…”

“…There are a few probable explanations for the decrease in incidence after 2018. That year, the MSPP conducted a mass vaccination campaign that saw more than two million children aged 1–14 years receiving at least one dose of a diphtheria vaccine [ 39 , 40 ]. It is reasonable to assume that the campaign contributed to reducing the size of susceptible individuals, ultimately driving down the incidence of the disease.…”

Evaluating the effect of measles and rubella mass vaccination campaigns on seroprevalence in India: a before-and-after cross-sectional household serosurvey in four districts, 2018–2020

“…In the past, several studies documented the effect of SIAs using residual serum samples or by doing only post-SIA serosurveys. 12 , 13 , 14 , 15 , 16 , 17 , 18 By contrast, we did community-based serosurveys, both before and after the MR-SIA, and each time used the same methods to estimate seroprevalence and document the effect of the MR-SIAs, thus reducing bias in our estimates.…”

Tetanus and Diphtheria Seroprotection among Children Younger Than 15 Years in Nigeria, 2018: Who Are the Unprotected Children?

“…In settings with weak surveillance or unreliable vaccination coverage, serological surveillance can potentially play an important role for appropriately directing interventions to improve population immunity [ 2 , 3 ]. Serological surveys are increasingly being used to guide immunization policy and strategy from support of vaccine introduction, evidence generation for optimizing timing of booster doses, to the verification of disease elimination [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. In the case of tetanus, serological surveys can also assess routine vaccination coverage as tetanus infection does not lead to development of protective antibodies [ 14 ].…”