Multi-pathogen serosurveillance reveals correlated vaccination performance, waning tetanus immunity, and diphtheria boosting in Zambian children

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Publication Details

Journal
Vaccine
Published
2026-09-17
DOI
https://doi.org/10.1016/j.vaccine.2026.129160
Primary Topic
Diphtheria, Corynebacterium, and Tetanus
Type
article
Field-Weighted Citation Impact
0.00

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article

Multi-pathogen serosurveillance reveals correlated vaccination performance, waning tetanus immunity, and diphtheria boosting in Zambian children

Gershom Chongwe, Innocent C. Bwalya, Evans Betha, Saki Takahashi et al.
Vaccine
Diphtheria, Corynebacterium, and Tetanus
article

Multi-pathogen serosurveillance reveals correlated vaccination performance, waning tetanus immunity, and diphtheria boosting in Zambian children

Gershom Chongwe, Innocent C. Bwalya, Evans Betha, Saki Takahashi, Alyssa N. Sbarra, Simon Mutembo, Lombe Kampamba, Shaun Truelove, Amy Wesolowski, Christine Prosperi, Elizabeth Kabeta, William J. Moss, Andrea Carcelen, Amy K. Winter
article en

Abstract

BACKGROUND: Vaccination coverage estimates and case-based surveillance have limitations in evaluating immunization programs. Serosurveillance offers a complementary approach by directly measuring population immunity. We assessed whether serologic analyses across multiple antigens (i.e., measles, diphtheria, tetanus) could provide additional insights into vaccination program performance. METHODS: We conducted a matched case-control study among children aged 2- to 10-years-old (n = 1286) in Zambia using specimens from the 2016 ZAMPHIA survey. Using previously generated data on measles serostatus, measles seronegative children (i.e., "cases") were matched to measles seropositive children (i.e., "controls") on sex, age, HIV infection status, and province. Samples were tested for tetanus and diphtheria antitoxin IgG antibodies using commercial enzyme immunoassays. We estimated the odds of tetanus and diphtheria seropositivity by measles serostatus using conditional logistic regression and examined age-specific antibody dynamics. RESULTS: Measles seronegative children had 1.7-fold increased odds (95% credible interval [CrI]: 1.3-2.1) of being tetanus seronegative compared to measles seropositive children. Diphtheria serostatus had no significant association with measles serostatus (odds ratio: 1.3; 95% CrI: 0.9-1.7). Tetanus seroprevalence declined monotonically with age. However, diphtheria seroprevalence initially declined through 5 years of age, then increased again beginning at 6 years of age despite the lack of vaccine booster doses given after the primary series in infancy, potentially from asymptomatic or subclinical infections. CONCLUSIONS: Serologic analyses revealed measles serostatus was positively associated with tetanus serostatus (where seropositivity arises only via vaccination and not infection), suggesting children who are measles seronegative are more likely to have missed DTP vaccination. We additionally found that measles serostatus was not associated with diphtheria serostatus, suggesting that antibody responses to diphtheria continue to boost beyond infancy when DTP vaccination is given. Our findings support consideration of DTP booster doses in Zambia to address waning tetanus immunity and further investigation of potential diphtheria carriage and transmission.

VaccineVol. 92
Johns Hopkins University (US), University of Georgia (US), Northrise University (ZM)
Bill and Melinda Gates Foundation, National Institutes of Health
Zero hunger
Openalex Percentile: Top 13%
Diphtheria, Corynebacterium, and Tetanus
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