{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T03:14:24Z","timestamp":1764731664582,"version":"3.37.3"},"reference-count":49,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T00:00:00Z","timestamp":1642032000000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["106866\/Z\/15\/Z"],"award-info":[{"award-number":["106866\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2022]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Diphtheria is a potentially devastating disease whose epidemiology remains poorly described in many settings, including Madagascar. Diphtheria vaccination is delivered in combination with pertussis and tetanus antigens and coverage of this vaccine is often used as a core measure of health system functioning. However, coverage is challenging to estimate due to the difficulty in translating numbers of doses delivered into numbers of children effectively immunised. Serology provides an alternative lens onto immunisation, but is complicated by challenges in discriminating between natural and vaccine-derived seropositivity. Here, we leverage known features of the serological profile of diphtheria to bound expectations for vaccine coverage for diphtheria, and further refine these using serology for pertussis. We measured diphtheria antibody titres in 185 children aged 6\u201311 months and 362 children aged 8\u201315 years and analysed them with pertussis antibody titres previously measured for each individual. Levels of diphtheria seronegativity varied among age groups (18.9% of children aged 6\u201311 months old and 11.3% of children aged 8\u201315 years old were seronegative) and also among the districts. We also find surprisingly elevated levels of individuals seropositive to diphtheria but not pertussis in the 6\u201311 month old age group suggesting that vaccination coverage or efficacy of the pertussis component of the DTP vaccine remains low or that natural infection of diphtheria may be playing a significant role in seropositivity in Madagascar.<\/jats:p>","DOI":"10.1017\/s0950268822000097","type":"journal-article","created":{"date-parts":[[2022,1,13]],"date-time":"2022-01-13T10:03:11Z","timestamp":1642068191000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Leveraging serology to titrate immunisation programme functionality for diphtheria in Madagascar"],"prefix":"10.1017","volume":"150","author":[{"given":"Solohery L.","family":"Razafimahatratra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0195-4071","authenticated-orcid":false,"given":"Arthur","family":"Menezes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6320-3575","authenticated-orcid":false,"given":"Amy","family":"Wesolowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lala","family":"Rafetrarivony","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Cauchemez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richter","family":"Razafindratsimandresy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aina","family":"Harimanana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania","family":"Crucitti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Marc","family":"Collard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. J. E.","family":"Metcalf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2022,1,13]]},"reference":[{"key":"S0950268822000097_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.06.050"},{"key":"S0950268822000097_ref42","doi-asserted-by":"publisher","DOI":"10.1101\/2021.06.09.21257809"},{"key":"S0950268822000097_ref44","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268812000210"},{"key":"S0950268822000097_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-35761-6.00019-5"},{"key":"S0950268822000097_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz808"},{"key":"S0950268822000097_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-1759(00)00273-8"},{"key":"S0950268822000097_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmaa064"},{"key":"S0950268822000097_ref29","doi-asserted-by":"publisher","DOI":"10.1586\/14760584.2014.944167"},{"key":"S0950268822000097_ref3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246301"},{"key":"S0950268822000097_ref30","unstructured":"30 World Health Organization (2015) Whole-Cell Pertussis Vaccines Summary of evidence relevant to schedules. Available at https:\/\/www.who.int\/immunization\/sage\/meetings\/2015\/april\/2_wP_summary_WG_23Mar2015_submitted.pdf?ua= (Accessed 31 August 2021)."},{"key":"S0950268822000097_ref45","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa066092"},{"key":"S0950268822000097_ref14","unstructured":"14 World Health Organization (2009) Immunological basis for immunization: module 2: diphtheria \u2013 update 2009. World Health Organization."},{"key":"S0950268822000097_ref48","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01313"},{"key":"S0950268822000097_ref11","unstructured":"11 Ministry of Health and Ministry of Health and Family Planning- Vaccination Department. Complete Multi-Year Plan Expanded Immunization Program 2010\u20132014."},{"key":"S0950268822000097_ref37","doi-asserted-by":"publisher","DOI":"10.1016\/0264-410X(87)90009-0"},{"key":"S0950268822000097_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2013.09.022"},{"key":"S0950268822000097_ref49","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.58989.sa2"},{"key":"S0950268822000097_ref33","first-page":"427","article-title":"Safety and immunogenicity of Haemophilus influenzae type B vaccine given in combination with DTwP at 6, 10 and 14 weeks of age","volume":"39","author":"Cherian","year":"2002","journal-title":"Indian Pediatrics"},{"key":"S0950268822000097_ref13","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12737"},{"key":"S0950268822000097_ref5","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1288-7"},{"key":"S0950268822000097_ref38","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001110"},{"key":"S0950268822000097_ref22","doi-asserted-by":"publisher","DOI":"10.3109\/00365548609032332"},{"key":"S0950268822000097_ref24","doi-asserted-by":"publisher","DOI":"10.1080\/00365540500262658"},{"key":"S0950268822000097_ref25","unstructured":"25 Efstratiou, A , Maple, CPA , World Health Organization and Regional Office for Europe (1994) Laboratory diagnosis of diphtheria\/by Androulla Efstratiou and P. A. Christopher Maple. Copenhagen: WHO Regional Office for Europe. Report No.: ICP\/EPI 038(C)."},{"key":"S0950268822000097_ref26","unstructured":"26 World Health Organization (2017) Review of evidence on vaccine effectiveness and immunogenicity to assess the duration of protection \u2a7e10 years after the last booster dose."},{"key":"S0950268822000097_ref39","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-018-1337-y"},{"key":"S0950268822000097_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(49)90047-1"},{"key":"S0950268822000097_ref40","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-010-1104-y"},{"key":"S0950268822000097_ref19","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268820002800"},{"key":"S0950268822000097_ref34","unstructured":"34 Centers for Disease Control and Prevention (2021) About Diphtheria, Tetanus, and Pertussis Vaccination. Available at https:\/\/www.cdc.gov\/vaccines\/vpd\/dtap-tdap-td\/hcp\/about-vaccine.html (Accessed 16 September 2021)."},{"key":"S0950268822000097_ref28","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.08.053819"},{"key":"S0950268822000097_ref1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2510.190271"},{"key":"S0950268822000097_ref6","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268817000851"},{"key":"S0950268822000097_ref46","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2014.0141"},{"key":"S0950268822000097_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30226-0"},{"key":"S0950268822000097_ref21","doi-asserted-by":"crossref","first-page":"325","DOI":"10.4049\/jimmunol.54.4.325","article-title":"Circulating antitoxin at the onset of diphtheria in 425 patients","volume":"54","author":"Ipsen","year":"1946","journal-title":"Journal of Immunology"},{"key":"S0950268822000097_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)90705-X"},{"key":"S0950268822000097_ref47","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00084-18"},{"key":"S0950268822000097_ref8","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268810001895"},{"key":"S0950268822000097_ref32","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/157.4.731"},{"key":"S0950268822000097_ref15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pbio.2006601"},{"key":"S0950268822000097_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2018.e00563"},{"key":"S0950268822000097_ref23","doi-asserted-by":"publisher","DOI":"10.1128\/CVI.00026-06"},{"key":"S0950268822000097_ref9","doi-asserted-by":"publisher","DOI":"10.3201\/eid2307.170262"},{"key":"S0950268822000097_ref12","unstructured":"12 World Health Organization (2017) The immunological basis for immunization series: module 4: pertussis. World Health Organization."},{"key":"S0950268822000097_ref7","first-page":"1","article-title":"A case of respiratory toxigenic diphtheria: contact tracing results and considerations following a 30-year disease-free interval, Catalonia, Spain, 2015","volume":"23","author":"Jan\u00e9","year":"2018","journal-title":"Euro surveillance: bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin"},{"key":"S0950268822000097_ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-013-1823-y"},{"key":"S0950268822000097_ref36","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw051"},{"key":"S0950268822000097_ref41","doi-asserted-by":"publisher","DOI":"10.1093\/femspd\/ftv050"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268822000097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,22]],"date-time":"2023-01-22T20:49:50Z","timestamp":1674420590000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268822000097\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022]]},"references-count":49,"alternative-id":["S0950268822000097"],"URL":"https:\/\/doi.org\/10.1017\/s0950268822000097","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"type":"print","value":"0950-2688"},{"type":"electronic","value":"1469-4409"}],"subject":[],"published":{"date-parts":[[2022]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2022. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e39"}}