title: Tetanus Immunity among Women Aged 15 to 39 Years in Cambodia: a National Population-Based Serosurvey, 2012.
abstract: To monitor progress toward maternal and neonatal tetanus elimination (MNTE) in Cambodia, we conducted a nationwide serosurvey of tetanus immunity in 2012. Multistage cluster sampling was used to select 2,154 women aged 15 to 39 years. Tetanus toxoid antibodies in serum samples were measured by gold-standard double-antigen enzyme-linked immunosorbent assay (DAE) and a novel multiplex bead assay (MBA). Antibody concentrations of ≥0.01 IU/ml by DAE or the equivalent for MBA were considered seroprotective. Estimated tetanus seroprotection was 88% (95% confidence interval [CI], 86 to 89%); 64% (95% CI, 61 to 67%) of women had antibody levels of ≥1.0 IU/ml. Seroprotection was significantly lower (P < 0.001) among women aged 15 to 19 years (63%) and 20 to 24 years (87%) than among those aged ≥25 years (96%), among nulliparous women than among parous women (71 versus 97%), and among those living in the western region than among those living in other regions (82 versus 89%). The MBA showed high sensitivity (99% [95% CI, 98 to 99%]) and specificity (92% [95% CI, 88 to 95%]) compared with DAE. Findings were compatible with MNTE in Cambodia (≥80% protection). Tetanus immunity gaps should be addressed through strengthened routine immunization and targeted vaccination campaigns. Incorporating tetanus testing in national serosurveys using MBAs, which can measure immunity to multiple pathogens simultaneously, may be beneficial for monitoring MNTE.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA hscobie@cdc.gov.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Scobie
authors.affiliation: University of Health Sciences, Phnom Penh, Cambodia.
authors.forename: Bunsoth
authors.initials: B
authors.lastname: Mao
authors.affiliation: National Institute of Public Health, Phnom Penh, Cambodia.
authors.forename: Sokhal
authors.initials: S
authors.lastname: Buth
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.affiliation: Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sørensen
authors.affiliation: National Institute of Public Health, Phnom Penh, Cambodia.
authors.forename: Chheng
authors.initials: C
authors.lastname: Kannarath
authors.affiliation: Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: M Harley
authors.initials: MH
authors.lastname: Jenks
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Delynn M
authors.initials: DM
authors.lastname: Moss
authors.affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Priest
authors.affiliation: National Immunization Program, Ministry of Health, Phnom Penh, Cambodia.
authors.forename: Sann Chan
authors.initials: SC
authors.lastname: Soeung
authors.affiliation: Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Deming
authors.affiliation: Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Lammie
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gregory
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D000992:Antitoxins / Q000097:blood*; D002160:Cambodia; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods; D013742:Tetanus / Q000276:immunology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000992:Antitoxins