{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:12:09Z","timestamp":1788315129228,"version":"build-2803163510"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["1094816"],"award-info":[{"award-number":["1094816"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Post-campaign coverage surveys estimate the proportion of previously unvaccinated children vaccinated during supplementary immunization activities (SIA) but cannot address whether susceptible children seronegative to measles and rubella viruses were vaccinated during the SIA. We conducted a cross-sectional serosurvey nested within the November 2020 measles-rubella SIA in Zambia, systematically sampling children aged 9 months to 5 years at 30 SIA sites in Choma and Ndola Districts. A questionnaire administered to caregivers collected the child\u2019s demographic information and vaccination history. Dried blood spot specimens were collected from child participants and for Immunoglobulin-G antibodies to measles and rubella viruses by enzyme immunoassay. We used the expected vaccination probability by age derived from Demographic and Health Surveys to quantify the value of the immunization campaign, estimating the proportion of children who would not have otherwise received routine MR doses. Among children enrolled with MR vaccination data (N\u2009=\u20092,364), 2,214 (94%) reported at least one routine MR dose before the SIA. We estimate 5.0% [95%CI, 4.2-5.9%] (n\u2009=\u2009118\/2364) of children would not have otherwise received routine MR dose 1 without the SIA and 23.4% [95%CI, 21.7-25.1] (n\u2009=\u2009553\/2364) would not have otherwise received routine MR dose 2. Thus, 1 in 3.5 doses were given to an MR un- or under-vaccinated child who may not have received that dose in the absence of an SIA. Eighty-six percent and 90% of children were measles and rubella seropositive before vaccination during the SIA. Thirty-six percent of children with no prior routine MR dose were measles seropositive, while nine percent of children with two prior routine MR doses were measles seronegative. Although children vaccinated during this SIA were highly likely to have previously received routine vaccinations, the SIA reached a considerable number of susceptible children. Monitoring SIA effectiveness and efficiency through standardized metrics and formats is critical for impactful vaccine delivery strategies.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003209","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:29:13Z","timestamp":1756488553000},"page":"e0003209","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["High measles and rubella vaccine coverage and seroprevalence among Zambian children participating in a measles and rubella supplementary immunization activity"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1942-5319","authenticated-orcid":true,"given":"Christine","family":"Prosperi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0538-0607","authenticated-orcid":true,"given":"Shaun","family":"Truelove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea C.","family":"Carcelen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3303-308X","authenticated-orcid":true,"given":"Gershom","family":"Chongwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis D.","family":"Mwansa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillimon","family":"Ndubani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9423-0816","authenticated-orcid":true,"given":"Edgar","family":"Simulundu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Innocent C.","family":"Bwalya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6301-5148","authenticated-orcid":true,"given":"Mutinta","family":"Hamahuwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Kapungu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3536-2645","authenticated-orcid":true,"given":"Kalumbu H.","family":"Matakala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7301-3521","authenticated-orcid":true,"given":"Gloria","family":"Musukwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mutale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evans","family":"Betha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nchimunya","family":"Chaavwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3058-9946","authenticated-orcid":true,"given":"Lombe","family":"Kampamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Japhet","family":"Matoba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Passwell","family":"Munachoonga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Webster","family":"Mufwambi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0840-0451","authenticated-orcid":true,"given":"Ken","family":"Situtu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1508-4409","authenticated-orcid":true,"given":"Philip E.","family":"Thuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance","family":"Sakala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Princess","family":"Kayeye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2737-7003","authenticated-orcid":true,"given":"Amy K.","family":"Winter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Ferrari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6579-3513","authenticated-orcid":true,"given":"William J.","family":"Moss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5389-5966","authenticated-orcid":true,"given":"Simon","family":"Mutembo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"pgph.0003209.ref001","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.15585\/mmwr.mm7246a3","article-title":"Progress toward measles elimination - worldwide, 2000-2022","volume":"72","author":"AA Minta","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"pgph.0003209.ref002","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.vaccine.2017.10.080","article-title":"Impact of measles supplementary immunization activities on reaching children missed by routine programs","volume":"36","author":"A Portnoy","year":"2018","journal-title":"Vaccine"},{"key":"pgph.0003209.ref003","first-page":"285","article-title":"The epidemiology of measles","volume":"45","author":"CJ Clements","year":"1992","journal-title":"World Health Stat Q"},{"key":"pgph.0003209.ref004","first-page":"469","article-title":"Worldwide measles prevention","volume":"30","author":"WA Orenstein","year":"1994","journal-title":"Isr J Med Sci"},{"key":"pgph.0003209.ref005","article-title":"Effectiveness of measles vaccination and vitamin A treatment","author":"CR Sudfeld","year":"2010","journal-title":"Int J Epidemiol"},{"issue":"9","key":"pgph.0003209.ref006","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/j.vaccine.2020.11.050","article-title":"Challenges in measuring supplemental immunization activity coverage among measles zero-dose children","volume":"39","author":"FT Cutts","year":"2021","journal-title":"Vaccine"},{"key":"pgph.0003209.ref007","doi-asserted-by":"crossref","first-page":"539325","DOI":"10.3389\/fpubh.2021.539325","article-title":"Measles serosurveys: a solution in search of the right problem","volume":"9","author":"A Ariyarajah","year":"2021","journal-title":"Front Public Health"},{"issue":"3","key":"pgph.0003209.ref008","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/infdis\/jiy137","article-title":"Benefits and challenges in using seroprevalence data to inform models for Measles and Rubella elimination","volume":"218","author":"AK Winter","year":"2018","journal-title":"J Infect Dis"},{"issue":"10","key":"pgph.0003209.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0240734","article-title":"How much does it cost to measure immunity? A costing analysis of a measles and rubella serosurvey in southern Zambia","volume":"15","author":"AC Carcelen","year":"2020","journal-title":"PLoS One"},{"key":"pgph.0003209.ref010","doi-asserted-by":"crossref","first-page":"416","DOI":"10.4269\/ajtmh.15-0198","article-title":"Strategies for coordination of a serosurvey in parallel with an immunization coverage survey","volume":"93","author":"MA Travassos","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0003209.ref011","volume-title":"Considerations for Integrating Health Campaigns: A Synthesis of Findings from Implementation Research Studies in Immunization, Neglected Tropical Diseases, Malaria, and Vitamin A Supplementation","author":"Health Campaign Effectiveness Coalition","year":"2023"},{"key":"pgph.0003209.ref012","volume-title":"Zambia: WHO and UNICEF estimates of national immunization coverage: 2021 revision","author":"UNICEF, WHO","year":"2022"},{"issue":"1","key":"pgph.0003209.ref013","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/heapol\/czs129","article-title":"Child Health Week in Zambia: costs, efficiency, coverage and a reassessment of need","volume":"29","author":"JL Fiedler","year":"2014","journal-title":"Health Policy Plan"},{"issue":"5","key":"pgph.0003209.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000554","article-title":"An evaluation of the early impact of the COVID-19 pandemic on Zambia\u2019s routine immunization program","volume":"3","author":"AK Winter","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"3","key":"pgph.0003209.ref015","doi-asserted-by":"crossref","first-page":"608","DOI":"10.3390\/vaccines11030608","article-title":"Challenges addressing inequalities in measles vaccine coverage in Zambia through a measles-rubella supplementary immunization activity during the COVID-19 pandemic","volume":"11","author":"Y Yang","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"pgph.0003209.ref016","article-title":"Feasibility and acceptability of collecting dried blood spots (DBS) from children after vaccination during Supplementary Immunization Activities to estimate measles and rubella seroprevalence","author":"AC Carcelen","year":"2024","journal-title":"medRxiv"},{"issue":"6","key":"pgph.0003209.ref017","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.02716-20","article-title":"Development of a Measles and Rubella multiplex bead serological assay for assessing population immunity","volume":"59","author":"MM Coughlin","year":"2021","journal-title":"J Clin Microbiol"},{"issue":"10","key":"pgph.0003209.ref018","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1093\/infdis\/jiz380","article-title":"What is the evidence to support a correlate of protection for Measles? A systematic review","volume":"221","author":"S Bolotin","year":"2020","journal-title":"J Infect Dis"},{"key":"pgph.0003209.ref019","volume-title":"Zambia Demographic and Health Survey 2018","author":"Zambia Statistics Agency, Ministry of Health (MOH) Zambia, ICF","year":"2019"},{"key":"pgph.0003209.ref020","volume-title":"Planning and implementing high-quality supplementary immunization activities for injectable vaccines using an example of measles and rubella vaccines: field guide","author":"Organization WH","year":"2016"},{"key":"pgph.0003209.ref021","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.15585\/mmwr.mm6945a6","article-title":"Progress Toward Regional Measles Elimination - Worldwide, 2000-2019","volume":"69","author":"MK Patel","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"6","key":"pgph.0003209.ref022","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.vaccine.2014.12.033","article-title":"How and why researchers use the number needed to vaccinate to inform decision making--a systematic review","volume":"33","author":"A Hashim","year":"2015","journal-title":"Vaccine"},{"issue":"1","key":"pgph.0003209.ref023","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1186\/s12879-017-2890-y","article-title":"The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis","volume":"17","author":"J Forshaw","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pgph.0003209.ref024","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s12879-020-4806-5","article-title":"Epidemiology of acute rubella infection in Zambia during the pre-vaccination period (2005-2016) as a baseline for monitoring rubella epidemiology in the post-rubella vaccine introduction era","volume":"20","author":"ML Mazaba","year":"2020","journal-title":"BMC Infect Dis"},{"issue":"17","key":"pgph.0003209.ref025","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1016\/j.vaccine.2019.02.037","article-title":"Measles and rubella serosurvey identifies rubella immunity gap in young adults of childbearing age in Zambia: The added value of nesting a serological survey within a post-campaign coverage evaluation survey","volume":"37","author":"K Hayford","year":"2019","journal-title":"Vaccine"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003209","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:29:20Z","timestamp":1756488560000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003209"}},"subtitle":[],"editor":[{"given":"Mara Jana","family":"Broadhurst","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":25,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0003209","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]}}}