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Clin Infect Dis. 2019 Feb 19. pii: ciz143. doi: 10.1093/cid/ciz143. [Epub ahead of print]

Seroprotection at different levels of the health care system after routine vaccination with DTPw-HepB-Hib in Lao PDR.

Author information

1
Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR.
2
Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg.
3
Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR.
4
Luxembourg Development Cooperation Agency, Vientiane, Lao PDR.
5
Children Hospital, Phonetong-Chommany Rd, Vientiane, Lao PDR.
6
Expanded Programme on Immunisation, Samsenthai Rd, Vientiane, Lao PDR.
7
Laboratoire national de santé, 1, rue Louis Rech, Dudelange, Grand-Duchy of Luxembourg.

Abstract

BACKGROUND:

Lao PDR continues to sustain a considerable burden of vaccine preventable diseases because of incomplete vaccine coverage and weak vaccine responses. We have assessed seroconversion after routine vaccination with DTPw-HepB-Hib to capture weaknesses of vaccine management at the different levels of the health care system.

METHODS:

1151 children (8-28 months) with three documented doses of the pentavalent vaccine delivered at Central hospitals in Vientiane and the Provincial hospital, 3 district hospitals and 10 health centers in Bolikhamxay province were enrolled. Socio-demographic information was collected with a standardized questionnaire. Serum samples were analysed for antibodies against each of the vaccine components and bivariate and multivariable analyses were performed to identify risk factors for low vaccine responses.

RESULTS:

Seroprotection rates at the provincial, district and health center level were as high as in Central hospitals but seroprotection rates in areas covered by remote health centers (>60 min from district hospital) were significantly lower. Protective levels also rapidly decreased with age at sampling. Seroprotection rates in Bolikhamxay against the different components reached 70%-77% and were up to 20% higher than in previous studies in the same region: 18.8% more children received the hepatitis B vaccine birth dose and the HBV infection rate was 4 times lower.

CONCLUSION:

Vaccine immunogenicity has dramatically improved in a central province, likely thanks to training and investment in the cold chain. Nevertheless there remains a need to focus on the "last mile" in remote areas were most children are vaccinated through outreach activities.

KEYWORDS:

Diphtheria; Hepatitis B; Immunogenicity; Tetanus; Vaccination

PMID:
30778522
DOI:
10.1093/cid/ciz143

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