Measles and rubella serosurvey identifies rubella immunity gap in young adults of childbearing age in Zambia: The added value of nesting a serological survey within a post-campaign coverage evaluation survey

Kyla Hayford, Simon Mutembo, Andrea Carcelen, Hellen K. Matakala, Passwell Munachoonga, Amy Winter, Jane W. Wanyiri, Kelly Searle, Francis D. Mwansa, Angels Mwiche, Caroline Phiri, Chris Book, Philip E. Thuma, William J. Moss

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Serological surveys can potentially complement vaccine coverage surveys, such as post-vaccination campaign coverage evaluation surveys (PCES), by providing direct information on population immunity within and outside the target age range of the mass vaccination campaign. We estimate age-specific population immunity to measles and rubella viruses in Southern Province, Zambia, and assess the value of adding serological data to vaccination coverage estimates by nesting a serological survey within a PCES. Methods: Dried blood spots (DBS) from fingerprick blood were collected from all individuals ages nine months or older in households participating in the PCES and tested for measles and rubella virus-specific immunoglobulin G (IgG) by enzyme immunoassay (Siemens Enzygnost, Marburg, Germany). Results: Overall seroprevalence was 95.5% (95% CI: 92.8, 97.2) for measles virus-specific IgG and 97.7% (95% CI: 96.0, 98.7) for rubella virus-specific IgG. Rubella seroprevalence was 98.4% (95% CI: 95.9, 99.4) among children eligible for the MR vaccination campaign, significantly higher than the reported measles-rubella (MR) vaccination campaign coverage of 89.8% (p = 0.003), and higher than the 91.3% rubella seroprevalence for adolescents and adults 16–30 years of age (p = 0.049). Conclusion: Seroprevalence to measles and rubella viruses in children younger than 16 years of age was significantly higher than expected from vaccination coverage estimates, likely reflecting exposure to wild-type viruses and underreporting of vaccination. The serosurvey revealed rubella immunity gaps among women 16–30 years of age, precisely the age group in which protection from rubella is most important to prevent congenital rubella syndrome. Nesting serological surveys within existing surveys can leverage resources and infrastructure while providing complementary information important to immunization programs.

Original languageEnglish (US)
Pages (from-to)2387-2393
Number of pages7
Issue number17
StatePublished - Apr 17 2019

Bibliographical note

Funding Information:
We thank the Government of Zambia, Dr. Penelope Kalesha Masumbo and World Health Organization in Zambia, and Professor Seter Siziya for their support in the design and implementation of the nested serosurvey within the post-campaign coverage evaluation (PCES). We thank the post-PCES survey team, the serosurvey team and the families who volunteered to participate in the study. The study was funded by the Bill & Melinda Gates Foundation. The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers? bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. * The authors marked with an asterisk received financial support from a grant from the Bill & Melinda Gates Foundation to conduct this study. Kyla Hayford* Simon Mutembo* Andrea Carcelen* Hellen K. Matakala Passwell Munachoonga Amy Winter* Jane W. Wanyiri Kelly Searle* Francis D. Mwansa Angels Mwiche Caroline Phiri. Chris Book. Philip E. Thuma William J. Moss*

Publisher Copyright:
© 2019 The Author(s)


  • Dried blood spots
  • IgG antibody
  • Immunization coverage
  • Measles
  • Rubella
  • Serological survey
  • Serology
  • Surveillance
  • Vaccination


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