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. 2022 Nov 30;18(6):2099700.
doi: 10.1080/21645515.2022.2099700. Epub 2022 Jul 21.

Waning rate of immunity and duration of protective immunity against diphtheria toxoid as a function of age and number of doses: Systematic review and quantitative data analysis

Noriko Kitamura  1   2   3 , Khawater Bahkali  1   4 , Elvis D Chem  1 , Billy J Quilty  1 , Tansy Edwards  1   2 , Michiko Toizumi  2   3 , Lay-Myint Yoshida  2   3   5
Affiliations

Waning rate of immunity and duration of protective immunity against diphtheria toxoid as a function of age and number of doses: Systematic review and quantitative data analysis

Noriko Kitamura et al. Hum Vaccin Immunother. .

Abstract

Although the burden of diphtheria has declined greatly since the introduction of vaccines, sporadic outbreaks continue to be reported. WHO recommends booster doses after a primary series, but questions remain about the optimal interval between these doses. We conducted a systematic review and quantitative data analysis to quantify the duration of protective immunity after different numbers of doses. Fifteen cross-sectional seroprevalence studies provided data on geometric mean concentration (GMC). Single-year age-stratified GMCs were analyzed using a mixed-effect linear regression model with a random intercept incorporating the between-country variability. GMC was estimated to decline to 0.1 IU/ml in 2.5 years (95% CI: 0.9-4.0), 10.3 years (95% CI: 7.1-13.6), and 25.1 years (95% CI: 7.6-42.6) after receiving three, four and five doses, respectively. The results drawn from cross-sectional data collected in countries with different epidemiologies, vaccines, and schedules had several limitations. However, these analyses contribute to the discussion of optimal timing between booster doses of diphtheria toxoid-containing vaccine.

Keywords: Antibody; DTP; diphtheria; immunity; systematic review; vaccination.

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Conflict of interest statement

The authors report there are no conflict of interest.

Figures

Figure 1.
Figure 1.
A hypothesized schematic image of the data and analysis and measurement of waning rate of immunity and duration of protective immunity.
Figure 2.
Figure 2.
Results of literature search and flow diagram.
Figure 3.
Figure 3.
Seroprevalence and DTP3 coverage by age and year of birth in data included in the analyses.
Figure 4.
Figure 4.
Declining trend of GMC over time after different numbers of DTP doses were given in 15 countries: Czech Republic, Denmark, Finland, France, Hungary, Ireland, Israel, Italy, Latvia, Luxembourg, Norway, Russia, Slovakia, Sweden, and the United Kingdom.
See this image and copyright information in PMC

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