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Serosurveillance for monitoring immunization coverage in DHS July 24, 2015 Bernard Barrère

Exploring serosurveillance methodologies in Madagascar and DR Congo to monitor immunization coverage. Includes sample overview, methodology, testing coverage, and example results from DHS reports.

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Serosurveillance for monitoring immunization coverage in DHS July 24, 2015 Bernard Barrère

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  1. Serosurveillance for monitoring immunization coverage in DHS July 24, 2015 Bernard Barrère

  2. Madagascar DHS 2003-04: Overview • SAMPLE and BIOMARKERS • National sample of 8,400 households • In all households: anthropometric measurements and hemoglobin testing among women age 15-49 and children < 5 • In 1/3 households: syphilis testing among all women age 15-49 and men age 15-59 • In 1/3 households: testing for immunity to tetanus among women and children <5, and immunity (or exposure) to measles among children <5 • Measles/Tetanus testing was entirely part of the DHS • Blood samples were collected by the DHS teams • Testing in the labs was done according to a protocol developed with and approved by DHS • Results were analyzed in collaboration with the labs and reported in the Madagascar DHS report

  3. Madagascar DHS 2003-04: Methodology Capillary blood from finger prick was collected on filter paper (DBS) • One DBS was sent to the Pasteur Institute in Antananarivo for measles testing • One DBS was sent to the Baxter Health Care Lab (MD, USA) for tetanus testing COVERAGE FOR TETANUS/MEASLES TESTING Blood samples were collected and tested for: • 91% of 2,817 eligible women • 86% of 1,917 eligible children

  4. Madagascar DHS 2003-04: Example of Results

  5. DR Congo DHS 2013-14: Overview (1) SAMPLE and BIOMARKERS • National sample of 18,171 households. • In all households: anthropometric measurements of women age 15-49 and children < 5 In 1/2 households: • Anemia testing among women age 15-49, men age 15-59, and children age 6-59 months • HIV testing women age 15-49 and men age 15-59 • Malaria testing (RDT and thick smear) among children age 6-59 months • DBS collected from children 6-59 months for PCR test for diagnosis of malaria and for immunity to Tetanus, Rubella, Measles, Mumps, Polio and Varicella.

  6. Immunity testing was not entirely part of the DHS • Blood samples were collected by the DHS teams • DHS developed programs to log-in the DBS and record the test results, and merged the testing data and survey data • But testing in the labs was done independently without any involvement of DHS • Initially basic test results were supposed to be reported in the DRC-DHS report released in September 2014. No result was available at that time. DR Congo DHS 2013-14: Overview (2)

  7. DR Congo DHS 2013-14: Methodology Capillary blood from finger prick was collected on filter paper (DBS) The filter papers were sent to UCLA-DRC laboratory at the National Laboratory for Biomedical Research (INRB) in Kinshasa, were they were logged in and divided in three: • One DBS remained at the UCLA/INRB lab in Kinshasa for Measles, Mumps, Rubella, Varicella, and Tetanus testing • One was sent to CDC Atlanta for polio testing • COVERAGE FOR TESTING AT UCLA/INRB LAB • Blood samples were collected and tested for • 95.4% of 8,420 eligible children age 6-59 months

  8. DR Congo DHS 2013-14: Example of Results

  9. On-going survey As part of the on-going Mozambique HIV/Malaria survey, DBS are collected from children age 6-59 months for Tetanus and Hep B testing

  10. Madagascar DHS 2003-04: Example of Results (3)

  11. Madagascar DHS 2003-04: Example of Results (2)

  12. DR Congo DHS 2013-14: Example of Results (1)

  13. DR Congo DHS 2013-14: Example of Results (3)

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