Seroprevalence and determinants of immunity to diphtheria for children living in two districts of contrasting incidence during an outbreak in East Java, Indonesia

Gareth J. Hughes, Amy F.W. Mikhail, Dominicus Husada, Eveline Irawan, George Kafatos, Samantha Bracebridge, Richard Pebody, Androulla Efstratiou*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)

Abstract

Background: In 2012, an ongoing outbreak of diphtheria in Indonesia was focused in the province of East Java. There was a need to assess vaccine coverage and immunity gaps in children. Methods: We conducted a cross-sectional seroprevalence and vaccine coverage survey of children 1-15 years of age in 2 districts of East Java: one of high incidence (on the island of Madura) and one of low incidence (on the mainland). From each district, we sampled 150 children (10 children per year of age). Sera and throat swabs were taken to determine immunity and carriage status. Immunity was defined as ≥0.1 international unit/mL of antibody to diphtheria toxin. Results: A total of 297 children were selected to participate in the study. Coverage of three doses of combined vaccine for diphtheria, tetanus and pertussis was significantly lower (P < 0.001) in the high incidence district compared with the low [57%, 95% confidence interval (CI): 36-78 vs. 97%, 95% CI: 93-100]. Despite this higher vaccine coverage, seroprevalence of immunity was lower in the low incidence district compared with the high (71%, 95% CI: 63-80 vs. 83%, 95% CI: 76-90). Immunity in the high incidence district was associated with increased age, increased prevalence of toxigenic Corynebacterium diphtheriae carriers and with receipt of multiple (and likely more recent) boosters. Conclusions: Significant variation exists in vaccine coverage and seroprevalence of immunity to diphtheria in East Java. Immunity in high incidence districts is likely because of natural immunity acquired through exposure to toxigenic C. diphtheriae. Booster vaccines are essential for achieving protective levels of immunity.

Original languageEnglish
Pages (from-to)1152-1156
Number of pages5
JournalPediatric Infectious Disease Journal
Volume34
Issue number11
DOIs
Publication statusPublished - 2015

Bibliographical note

Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • Corynebacterium diphtheriae
  • Diphtheria
  • Indonesia
  • Serology
  • Seroprevalence

Fingerprint

Dive into the research topics of 'Seroprevalence and determinants of immunity to diphtheria for children living in two districts of contrasting incidence during an outbreak in East Java, Indonesia'. Together they form a unique fingerprint.

Cite this