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. 2023 Mar 15;11(3):663.
doi: 10.3390/vaccines11030663.

Tetanus and Diphtheria Seroprotection among Children Younger Than 15 Years in Nigeria, 2018: Who Are the Unprotected Children?

Rania A Tohme  1 , Heather M Scobie  1 , Oyeladun Okunromade  2 , Temitope Olaleye  3 , Faisal Shuaib  4 , Tunde Jegede  2 , Ridwan Yahaya  2 , Ndodo Nnaemeka  2 , Bola Lawal  2 , Abiodun Egwuenu  2 , Nishanth Parameswaran  5 , Gretchen Cooley  5 , Qian An  1 , Melissa Coughlin  6 , Bassey B Okposen  4 , Ifedayo Adetifa  2 , Omotayo Bolu  1 , Chikwe Ihekweazu  2
Affiliations

Tetanus and Diphtheria Seroprotection among Children Younger Than 15 Years in Nigeria, 2018: Who Are the Unprotected Children?

Rania A Tohme et al. Vaccines (Basel). .

Abstract

Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged <15 years using stored specimens collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, a national cross-sectional household-based survey. We used a validated multiplex bead assay to test for tetanus and diphtheria toxoid-antibodies. In total, 31,456 specimens were tested. Overall, 70.9% and 84.3% of children aged <15 years had at least minimal seroprotection (≥0.01 IU/mL) against tetanus and diphtheria, respectively. Seroprotection was lowest in the north west and north east zones. Factors associated with increased tetanus seroprotection included living in the southern geopolitical zones, urban residence, and higher wealth quintiles (p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus.

Keywords: Nigeria; diphtheria; serology; seroprevalence; tetanus; vaccine preventable diseases.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Tetanus and diphtheria minimal and full seroprotection among children aged <15 years by age group and state, Nigeria, 2018 (a–d).
Figure 2
Figure 2
Tetanus and diphtheria minimal seroprotection (≥0.01 IU/mL) among children aged <15 years by zone and location, Nigeria, 2018 (a,b).
Figure 3
Figure 3
Tetanus and diphtheria at least minimal seroprotection (≥0.01 IU/mL) among children aged <15 years by zone and wealth quintile, Nigeria, 2018 (a,b).
Figure 4
Figure 4
Tetanus and diphtheria seroprotection levels and geometric mean antibody level by age, Nigeria, 2018 (a,b).
Figure 5
Figure 5
Triangulation of tetanus seroprotection and DTP3 vaccination coverage among children aged <15 years, Nigeria, 2018. WUENIC: WHO/UNICEF estimates of national immunization coverage; DTP3: 3 doses of diphtheria-tetanus-pertussis vaccine; DHS: Demographic and Health Survey; MICS: Multiple Indicator Cluster Survey.
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