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Leveraging serology to titrate immunisation programme functionality for diphtheria in Madagascar.

Solohery L Razafimahatratra^1,2, Arthur Menezes³, Amy Wesolowski⁴

¹Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.

Epidemiology and Infection

|March 1, 2022

Summary

Diphtheria vaccination coverage in Madagascar is difficult to assess. Serological data suggests potential gaps in protection, particularly for pertussis, indicating low vaccine efficacy or high natural diphtheria infection rates.

Keywords:

Diphtheria Madagascar pertussis serology

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Area of Science:

Epidemiology
Immunology
Public Health

Background:

Diphtheria epidemiology is poorly understood in Madagascar.
Diphtheria vaccination coverage is a key health system indicator but difficult to measure accurately.
Serological data offers an alternative but faces challenges in distinguishing natural vs. vaccine-induced immunity.

Purpose of the Study:

To estimate diphtheria vaccine coverage in Madagascar using serological data.
To refine coverage estimates by incorporating pertussis serology.
To investigate potential reasons for discrepancies in serological profiles.

Main Methods:

Measured diphtheria antibody titres in children aged 6-11 months (n=185) and 8-15 years (n=362).
Analyzed diphtheria antibody titres alongside previously measured pertussis antibody titres.
Assessed seronegativity rates and variations across age groups and districts.

Main Results:

Diphtheria seronegativity was 18.9% in 6-11 month olds and 11.3% in 8-15 year olds.
Significant variations in seronegativity were observed between age groups and districts.
Elevated diphtheria seropositivity without pertussis seropositivity was noted in younger children.

Conclusions:

Serological data reveals potential challenges in achieving effective diphtheria and pertussis immunisation in Madagascar.
Low pertussis component efficacy or high rates of natural diphtheria infection may contribute to observed serological patterns.
Further investigation into DTP vaccine effectiveness and diphtheria epidemiology is warranted.