Peer-reviewed article
Assessing vaccination coverage and antibody levels for measles, pertussis, and tetanus in Boende, DR Congo: Implications for maternal and child health.
Maha Salloum, Leen Vandermosten, Tafadzwa Maseko, Solange Milolo, Ynke Lariviere et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study measured antibody levels for measles, pertussis, and tetanus in children aged 12-23 months and postpartum women in Boende Health Zone, Democratic Republic of Congo. Protective antibody levels were very low in children: 18% for tetanus, 5% for pertussis, and 18-30% for measles depending on the cut-off used. The findings suggest major gaps in vaccination coverage or vaccine effectiveness in this remote region, with some clusters showing zero children with protective antibodies for any of the three diseases.
Key points
- Among children aged 12-23 months, only 18% had protective tetanus antibodies, 5% had protective pertussis antibodies, and 18-30% had protective measles antibodies
- In five clusters, no children had detectable antibodies above protective thresholds for any of the three pathogens
- Among postpartum women, 73% had protective tetanus antibodies, 0% had protective pertussis antibodies, and 55-81% had measles seropositivity
- Reported vaccination rates and serological findings were discrepant, suggesting recall bias, vaccine potency concerns, or record accuracy problems
- The authors recommend including pertussis vaccination in the national maternal immunization program and integrating serology into routine vaccination coverage surveys
Limitations
The study does not assess reasons for low antibody levels or distinguish between lack of vaccination, vaccine failure, or antibody waning. The use of two measles cut-offs reflects lack of standardization and makes definitive conclusions about measles immunity uncertain.
Abstract
INTRODUCTION: Despite vaccines' global success, vaccine-preventable diseases/infections remain a major cause of child mortality. The DRC, and particularly Tshuapa province, faces persistent challenges in improving coverage. Most vaccination coverage studies in the region rely on vaccination cards and caregiver recall, which can be prone to inaccuracies. METHODS: We conducted a 30 × 7 cluster survey with a serology component in Boende Health Zone, Tshuapa. Tshuapa. Antibodies against measles, pertussis, and tetanus were measured using ELISA on dried blood spots from postpartum women and children aged 12-23 months. Two measles cut-offs (150 and 275 IU/L) were applied due to lack of standardization. RESULTS: The study enrolled 205 children and 208 women. Among women, 73 % had tetanus antibody levels above the protective threshold, 0 % had antibodies against pertussis above the predetermined cut-off, and measles seropositivity was 55 % at the more stringent cut-off (275 IU/L) and 81 % at a more relaxed one (150 IU/L). In children, 18 % had tetanus antibodies above the protective threshold and 5 % had antibodies above the pertussis cut-off point. and 18 % and 30 % for measles (strict and relaxed, respectively). In five clusters, no children had antibodies above the cut-off points for any of the three pathogens. CONCLUSION: These findings highlight the potential need to include pertussis vaccination in the national maternal immunization program and advocate for integrating serology into vaccination coverage surveys to provide more accurate assessments. The disparity between reported vaccination rates and serological data could be due to one or a combination of recall bias, desirability bias, test variability, antibody waning, and possible concerns about vaccine potency and record accuracy in remote areas in the Boende Health Zone. This stresses the urgent need to improve vaccination coverage and surveillance efforts in Boende Health Zone and the broader Tshuapa province.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Serological assessment of antibody levels against measles, pertussis, and tetanus using ELISA on dried blood spots from children and postpartum women
- Population
- 205 children aged 12-23 months and 208 postpartum women in Boende Health Zone, Tshuapa province, DRC, selected through 30×7 cluster survey
Key finding
Only 18% of children had protective tetanus antibodies compared to 73% of postpartum women
Salloum et al. · PubMed (US National Library of Medicine) · 26 Dec 2025