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Integrated Serological Surveillance and Cross-Pathogen Associations for Infectious Diseases in Zambezia Province, Mozambique Using Multiplex Bead Assays
Background: Multiplex immunoassays allow simultaneous measurement of antibodies to multiple antigens, potentially saving time and resources. They also open opportunities to examine cross-pathogen vulnerabilities in populations. We incorporated a multiplexed serosurvey for vaccine preventable diseases (VPDs), malaria, neglected tropical diseases (NTDs), and enteric pathogens into a Countrywide Mortality Surveillance for Action (COMSA) in Zambezia Province, Mozambique.
Methods: From December 2020 to March 2021, 30 sampling clusters were visited, and dried blood spots were collected from 1,292 individuals aged 6 months to 49 years. Specimens were tested for IgG antibodies to 35 antigens from 18 pathogens using a multiplex bead assay. Weighted seroprevalence estimates by age, sex, and cluster as well as age-seroprevalence curves were produced. The odds of seropositivity by cluster were compared using Bayesian logistic random effects models and individual level associations were identified using multiple logistic regression.
Findings: Seroprevalence ranged widely from 0% (Plasmodium vivax) to 90% (Cryptosporidium parvum) and tended to increase with age and vary by cluster. Rural clusters had higher odds of seropositivity for most NTDs, Plasmodium falciparum, and enteric pathogens but lower odds of seropositivity to SARS-CoV-2 and VPDs compared to urban clusters. Some clusters had particularly high seroprevalence to multiple infectious diseases. At the individual level, seropositivity was most strongly associated with seropositivity to antigens in the same disease category.
Interpretation: Heterogeneities in seroprevalence identified across pathogens, age, sex, and space can inform subnational risk assessments. Understanding the co-endemicity of diseases allows for integrated strategies to target interventions to vulnerable communities.
Funding: This work was funded by the Bill and Melinda Gates Foundation (grant #125027).
Declaration of Interest: Authors have no conflicts of interest to declare.
Ethical Approval: The study protocol was approved by the National Bioethics Committee for Health of Mozambique and the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Written informed consent for each participant, parental permission for children younger than 18 years of age, and written assent for children 12–17 years of age was obtained.
Keywords: multi-pathogen serosurveillance, multiplex bead immunoassay, infectious disease surveillance, serological surveillance, low- and middle-income countries
Carcelen, Andrea and Monjane, Celso and Bérubé, Sophie and Takahashi, Saki and Sultane, Thebora and Chelene, Imelda and Cooley, Gretchen and Goodhew, E. Brook and Patterson, Catriona and Tetteh, Kevin and Mutambe, Manuel and Higdon, Melissa M. and Mwinnyaa, George and Nhapure, Gilberto and Duce, Pedro and Martin, Diana and Drakeley, Chris and Moss, William J. and Macicame, Ivalda, Integrated Serological Surveillance and Cross-Pathogen Associations for Infectious Diseases in Zambezia Province, Mozambique Using Multiplex Bead Assays. Available at SSRN: https://ssrn.com/abstract=4972812 or http://dx.doi.org/10.2139/ssrn.4972812
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