Deming Michael S, Roungou Jean-Baptiste, Kristiansen Max, Heron Iver, Yango Alphonse, Guenengafo Alexis, Ndamobissi Robert
International Child Survival and Emerging Infections Program Support Activity, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724 USA.
Bull World Health Organ. 2002;80(9):696-703.
A Multiple-Indicator Cluster Survey (MICS) was conducted at mid-decade in more than 60 developing countries to measure progress towards the year 2000 World Summit for Children goals. These goals included the protection of at least 90% of children against neonatal tetanus through the immunization of their mothers, as measured by tetanus toxoid (TT) coverage. In the Central African Republic (CAR), serological testing was added to the MICS to understand better the relationship between survey estimates of TT coverage and the prevalence of serological protection.
In the CAR MICS, mothers of children younger than one year of age gave verbal histories of the TT vaccinations they had received, using the MICS TT questionnaire. A subsample of mothers was tested for tetanus antitoxin, using a double-antigen enzyme-linked immunoadsorbent assay (ELISA). Seropositivity was defined as a titre of > or =0.01 IU/ml, and TT coverage was defined as the proportion of mothers protected at delivery, according to their history of TT vaccinations.
Among the 222 mothers in the subsample, weighted TT coverage was 74.4% (95% Confidence Interval (CI); 67.0% - 81.7%) and tetanus antitoxin seroprevalence was 88.7% (95% CI; 83.2% - 94.2%). The weighted median antitoxin titre was 0.35 IU/ml.
Tetanus toxoid coverage in the CAR was lower than the prevalence of serological protection against neonatal tetanus. If this relationship holds for other countries, TT coverage estimates from the MICS may underestimate the extent to which the year 2000 goal for protecting children against neonatal tetanus was reached. We also showed that a high level of serological protection had been achieved in a country facing major public health challenges and resource constraints.
在十年中期，60多个发展中国家开展了多指标类集调查（MICS），以衡量在实现2000年世界儿童问题首脑会议目标方面取得的进展。这些目标包括通过母亲接种破伤风类毒素（TT），使至少90%的儿童免受新生儿破伤风感染，以TT接种覆盖率衡量。在中非共和国（CAR），MICS增加了血清学检测，以更好地了解TT接种覆盖率的调查估计值与血清学保护患病率之间的关系。
在中非共和国MICS中，一岁以下儿童的母亲使用MICS TT问卷，口头讲述她们接受TT疫苗接种的情况。使用双抗原酶联免疫吸附测定（ELISA）对母亲的一个子样本进行破伤风抗毒素检测。血清阳性定义为滴度≥0.01 IU/ml，TT接种覆盖率定义为根据母亲的TT疫苗接种史，分娩时得到保护的母亲比例。
在子样本的222名母亲中，加权TT接种覆盖率为74.4%（95%置信区间（CI）；67.0% - 81.7%），破伤风抗毒素血清阳性率为88.7%（95% CI；83.2% - 94.2%）。加权抗毒素滴度中位数为0.35 IU/ml。
中非共和国的破伤风类毒素接种覆盖率低于针对新生儿破伤风的血清学保护患病率。如果其他国家也存在这种关系，那么MICS的TT接种覆盖率估计值可能低估了实现2000年保护儿童免受新生儿破伤风感染目标的程度。我们还表明，在一个面临重大公共卫生挑战和资源限制的国家，已经实现了高水平的血清学保护。
