Strengthening Immunization Systems through Serosurveillance (SISS)

The Challenge

Sero-epidemiology is a potentially powerful tool to measure population immunity to vaccine-preventable diseases, identify immunity gaps, and guide immunization activities. However, there is a need to evaluate how to design, implement and evaluate serological surveillance systems and make the best use of the data to guide vaccination programs and policy. The SISS project addresses epidemiological, technical, and operational issues critical to the generation and interpretation of valid and timely serological data to identify immunity gaps and guide routine, supplemental and targeted immunization activities.

Approach

Multiple measles and rubella serosurveys were conducted in India and Zambia to demonstrate the feasibility and utility of serological surveillance to guide immunization programs. In India, measles and rubella serosurveys were conducted before and after mass vaccination campaigns in four districts to document increases in population immunity and remaining immunity gaps. In Zambia, measles and rubella serosurveys leveraged a national biorepository and were nested within post-coverage evaluation surveys, measles and rubella SIAs, and the fever/rash surveillance system. Comparisons between seroprevalence estimates obtained from community-based surveys and residual specimens from health care facilities and laboratories were done in both countries.

Publications

Zambia:

• Carcelen AC, Hayford K, Moss WJ, Book C, Thuma PE, Mwansa FD, Patenaude B. How much does it cost to measure immunity? A costing analysis of a measles and rubella serosurvey in southern Zambia. PLoS One 2020;15:e0240734.
• Carcelen AC, Mutembo S, Matakala KH, Chilumba I, Mulundu G, Monze M, Mwansa FD, Moss WJ, Hayford K. Impact of a Measles and Rubella Vaccination Campaign on Seroprevalence in Southern Province, Zambia. Am J Trop Med Hyg 2021;104:2229-2232.
• Hayford K, Mutembo S, Carcelen A, Matakala HK, Munachoonga P, Winter A, et al. 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. Vaccine. 2019;37:2387-93.
• Mutembo S, Carcelen A, Mwansa FD, Searle K, Wanyiri JW, Book C, et al. Integrating Blood Collection within Household Surveys: Lessons Learned from Nesting a Measles and Rubella Serological Survey within a Post-Campaign Coverage Evaluation Survey in Southern Province, Zambia. Am J Trop Med Hyg. 2018;99:1639-42.
• Carcelen AC, Limaye RJ, Mutembo S, Hamahuwa M, Thuma PE, Moss WJ, Hayford K. Acceptability of serosurveys in southern Zambia: data collector and caregiver perspectives. Discov Soc Sci Health. 2023;3(1):3. doi: 10.1007/s44155-023-00032-6. Epub 2023 Feb 20.
• Carcelen AC, Winter AK, Moss WJ, Chilumba I, Mutale I, Chongwe G, Monze M, Mulundu G, Nkamba H, Mwansa FD, Mulenga L, Rhoda DA, Hayford K, Mutembo S. Leveraging a national biorepository in Zambia to assess measles and rubella immunity gaps across age and space. Sci Rep 2022;12:10217.
• Carcelen AC, Prosperi C, Mutembo S, Chongwe G, Mwansa FD, Ndubani P, Simulundu E, Chilumba I, Musukwa G, Thuma P, Kapungu K, Hamahuwa M, Mutale I, Winter A, Moss WJ, Truelove SA. COVID-19 vaccine hesitancy in Zambia: a glimpse at the possible challenges ahead for COVID-19 vaccination rollout in sub-Saharan Africa. Hum Vaccin Immunother 2022;18:1-6.
• Arambepola R, Yang Y, Hutchinson K, Mwansa FD, Doherty JA, Bwalya F, et al. Using geospatial models to map zero-dose children: factors associated with zero-dose vaccination status before and after a mass measles and rubella vaccination campaign in Southern province, Zambia. BMJ Glob Health. 2021;6.

India

• Murhekar MV, Gupta N, Hasan AZ, Kumar MS, Kumar VS, Prosperi C, et al. Evaluating the effect of measles and rubella mass vaccination campaigns on seroprevalence in India: a before-and-after cross-sectional household serosurvey in four districts, 2018-2020. Lancet Glob Health. 2022;10:e1655-e64.
• Hasan AZ, Kumar MS, Prosperi C, Thangaraj JWV, Sabarinathan R, Saravanakumar V, et al. Implementing Serosurveys in India: Experiences, Lessons Learned, and Recommendations. Am J Trop Med Hyg. 2021;105:1608-17.
• Prosperi C, Thangaraj JWV, Hasan AZ, Kumar MS, Truelove S, Kumar VS, et al. Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20. Vaccine. 2023;41:486-95.
• Salvi N, Itta KC, Lachyan A, Hasan AZ, Prosperi C, Kumar MS, et al. Experiences of sharing results of community based serosurvey with participants in a district of Maharashtra, India. PLoS One. 2022;17:e0271920.
• Prosperi C, Kaduskar O, Bhatt V, Hasan AZ, Vivian Thangaraj JW, Kumar MS, et al. Diagnostic Accuracy of Dried Blood Spots Collected on HemaSpot HF Devices Compared to Venous Blood Specimens To Estimate Measles and Rubella Seroprevalence. mSphere. 2021;6:e0133020.
• Kaduskar O, Bhatt V, Prosperi C, Hayford K, Hasan AZ, Deshpande GR, et al. Optimization and Stability Testing of Four Commercially Available Dried Blood Spot Devices for Estimating Measles and Rubella IgG Antibodies. mSphere. 2021;6:e0049021.

General

• Holroyd TA, Schiaffino F, Chang RH, Wanyiri JW, Saldanha IJ, Gross M, Moss WJ, Hayford K. Diagnostic accuracy of dried blood spots for serology of vaccine-preventable diseases: a systematic review. Expert Rev Vaccines. 2022;21:185-200.