Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America.
School of Medicine, Kinshasa University, Kinshasa, Democratic Republic of the Congo.
PLoS One. 2022 May 19;17(5):e0268703. doi: 10.1371/journal.pone.0268703. eCollection 2022.
Tetanus is a potentially fatal disease that is preventable through vaccination. While the Democratic Republic of the Congo (DRC) has continued to improve implementing routine vaccination activities throughout the country, they have struggled to maintain high childhood vaccine coverage. This study aims to examine the seroprevalence of tetanus in children 6 to 59 months to identify areas for intervention and improvement of vaccination coverage.
In collaboration with the 2013-2014 Demographic and Health Survey, we assessed the seroprevalence of tetanus antibodies among children in the DRC. Dried blood spot samples collected from children 6-59 months of age were processed using a prototype DYNEX Multiplier® chemiluminescent automated immunoassay instrument with a multiplex measles, mumps, rubella, varicella and tetanus assay. Multivariable logistic regression was used to determine factors associated with tetanus vaccination and seroprotection.
Overall, 36.1% of children 6-59 months of age reported receiving at least 1 dose of tetanus vaccine while 28.7% reported receiving 3 doses; tetanus seroprotection was 40%. Increasing age in children was associated with decreased tetanus seroprotection, but increased number tetanus vaccinations received. Factors related to increased tetanus seroprotection included number of children in the household, wealth index of the family, urban residence compared to rural, level of maternal education, and province and geography.
Our findings in this nationally representative sample indicate that serology biomarkers may help identify children who are not fully immunized to tetanus more accurately than reported vaccination. While children may be captured for routine immunization activities, as children age, decreasing seroprevalence may indicate additional need to bolster routine vaccination activities and documentation of vaccination in school aged children. Additionally, the study highlights gaps in rural residential areas and vaccination coverage based on maternal education, indicating that policies targeting maternal education and awareness could improve the coverage and seroprevalence of tetanus antibodies in the DRC.
破伤风是一种潜在致命的疾病，可以通过接种疫苗来预防。尽管刚果民主共和国（DRC）在全国范围内不断改进常规疫苗接种活动，但他们一直难以维持高的儿童疫苗接种覆盖率。本研究旨在检查 6 至 59 个月儿童的破伤风血清阳性率，以确定干预和提高疫苗接种覆盖率的领域。
我们与 2013-2014 年人口与健康调查合作，评估了刚果民主共和国儿童破伤风抗体的血清阳性率。从 6-59 个月大的儿童采集的干血斑样本使用 Dynex Multiplier®化学发光自动免疫分析仪器进行处理，该仪器采用麻疹、腮腺炎、风疹、水痘和破伤风联合检测。多变量逻辑回归用于确定与破伤风疫苗接种和血清保护相关的因素。
总体而言，36.1%的 6-59 个月龄儿童报告至少接种了 1 剂破伤风疫苗，28.7%的儿童报告接种了 3 剂；破伤风血清保护率为 40%。儿童年龄的增加与破伤风血清保护率的降低有关，但与接种破伤风疫苗的次数增加有关。与破伤风血清保护率增加相关的因素包括家庭中儿童的数量、家庭的财富指数、与农村相比的城市居住、母亲的教育程度以及省份和地理位置。
我们在全国代表性样本中的发现表明，血清学生物标志物可能有助于比报告的疫苗接种更准确地识别未完全接种破伤风疫苗的儿童。虽然儿童可能会因常规免疫活动而被捕获，但随着儿童年龄的增长，血清阳性率的下降可能表明需要加强常规免疫活动，并在学龄儿童中记录疫苗接种情况。此外，该研究强调了农村居住地区和基于母亲教育的疫苗接种覆盖率差距，表明针对母亲教育和意识的政策可以提高刚果民主共和国破伤风抗体的覆盖率和血清阳性率。
