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Integrated Serological Surveillance and Cross-Pathogen Associations for Infectious Diseases in Zambezia Province, Mozambique Using Multiplex Bead Assays

22 Pages Posted: 2 Oct 2024

See all articles by Andrea Carcelen

Andrea Carcelen

Johns Hopkins University

Celso Monjane

Instituto Nacional de Saude

Sophie Bérubé

University of Florida

Saki Takahashi

Johns Hopkins University

Thebora Sultane

Instituto Nacional de Saude

Imelda Chelene

Instituto Nacional de Saude

Gretchen Cooley

Government of the United States of America - CDC Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch

E. Brook Goodhew

affiliation not provided to SSRN

Catriona Patterson

London School of Hygiene & Tropical Medicine - Department of Infection Biology

Kevin Tetteh

London School of Hygiene & Tropical Medicine - Department of Infection Biology

Manuel Mutambe

Instituto Nacional de Saude

Melissa M. Higdon

Johns Hopkins University - Department of International Health, International Vaccine Access Center

George Mwinnyaa

Johns Hopkins University

Gilberto Nhapure

Instituto Nacional de Estadística (INE)

Pedro Duce

Instituto Nacional de Estadística (INE)

Diana Martin

Government of the United States of America - Centers for Disease Control and Prevention (CDC)

Chris Drakeley

London School of Hygiene & Tropical Medicine - Faculty of Infectious and Tropical Diseases

William J. Moss

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Ivalda Macicame

Government of Mozambique

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Abstract

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

Suggested Citation

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

Andrea Carcelen (Contact Author)

Johns Hopkins University ( email )

Celso Monjane

Instituto Nacional de Saude ( email )

Avenida Eduardo Mondlane, No. 1008
Maputo
Mozambique

Sophie Bérubé

University of Florida ( email )

PO Box 117165, 201 Stuzin Hall
Gainesville, FL 32610-0496
United States

Saki Takahashi

Johns Hopkins University ( email )

Thebora Sultane

Instituto Nacional de Saude ( email )

Avenida Eduardo Mondlane, No. 1008
Maputo
Mozambique

Imelda Chelene

Instituto Nacional de Saude ( email )

Avenida Eduardo Mondlane, No. 1008
Maputo
Mozambique

Gretchen Cooley

Government of the United States of America - CDC Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch ( email )

United States

E. Brook Goodhew

affiliation not provided to SSRN ( email )

No Address Available

Catriona Patterson

London School of Hygiene & Tropical Medicine - Department of Infection Biology ( email )

London
United Kingdom

Kevin Tetteh

London School of Hygiene & Tropical Medicine - Department of Infection Biology ( email )

London
United Kingdom

Manuel Mutambe

Instituto Nacional de Saude ( email )

Avenida Eduardo Mondlane, No. 1008
Maputo
Mozambique

Melissa M. Higdon

Johns Hopkins University - Department of International Health, International Vaccine Access Center ( email )

United States

George Mwinnyaa

Johns Hopkins University ( email )

Gilberto Nhapure

Instituto Nacional de Estadística (INE) ( email )

Pedro Duce

Instituto Nacional de Estadística (INE) ( email )

Diana Martin

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

Anchorage, AK 99508
United States

Chris Drakeley

London School of Hygiene & Tropical Medicine - Faculty of Infectious and Tropical Diseases ( email )

Keppel St.
Bloomsbury, London, WC1E 7HT
United Kingdom

William J. Moss

Johns Hopkins University - Department of International Health, International Vaccine Access Center

Ivalda Macicame

Government of Mozambique ( email )

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