ArticlePloS one2015
Diphtheria in Lao PDR: Insufficient Coverage or Ineffective Vaccine?
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 53 citations in OpenAlex.
- A systematic review of the agreement of recall, home-based records, facility records, BCG scar, and serology for ascertaining vaccination status in low and middle-income countries.Gates open research · 2019Pooled it
- Understanding vaccination gaps in Peru: a convergent cross-sectional analysis of coverage, parental perceptions, and child mortality data in Sunampe.Frontiers in public health · 2026Article
- Article
- Eleven-Year Report of High Number of Diphtheria Cases in Children in East Java Province, Indonesia.Tropical medicine and infectious disease · 2024Article
- Article
- Reaching the unreached through building trust: a mixed-method study on COVID-19 vaccination in rural Lao PDR.BMJ global health · 2024Article
- The Shifting Epidemiology of Hepatitis A in the World Health Organization Western Pacific Region.Vaccines · 2024Review
- Article
- An Observational Study on Association of Clinical Outcome of Diphtheria Cases with Immunization Status: A Tertiary Care Hospital, Jaipur.Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India · 2022Article
- Endemic erythromycin resistantMicrobial genomics · 2022Article
- The evaluation of anti-diphtheria toxoid antibodies in healthy population in Kon Tum, Vietnam: a population-based study.IJID regions · 2022Article
- Susceptibility to Vaccine-Preventable Diseases in Four Districts of Xaysomboun Province, Lao People's Democratic Republic.Vaccines · 2022Article
- Vaccine temperature management in Lao People's Democratic Republic: A nationwide cross-sectional study.Heliyon · 2021Article
- The effectiveness of the 13-valent pneumococcal conjugate vaccine against hypoxic pneumonia in children in Lao People's Democratic Republic: An observational hospital-based test-negative study.The Lancet regional health. Western Pacific · 2020Article
- Impact of a three-dose diphtheria outbreak response immunization in East Java, Indonesia, 6 months after completion.Human vaccines & immunotherapeutics · 2020Article
- Whole-Genome Sequencing of Corynebacterium diphtheriae Isolates Recovered from an Inner-City Population Demonstrates the Predominance of a Single Molecular Strain.Journal of clinical microbiology · 2020Article
- Phenotypic and Genotypic Correlates of Penicillin Susceptibility in Nontoxigenic Corynebacterium diphtheriae, British Columbia, Canada, 2015-2018.Emerging infectious diseases · 2020Article
- Seroprotection at Different Levels of the Healthcare System After Routine Vaccination With Diphtheria-Tetanus-Pertussis whole cell-Hepatitis B-Haemophilus influenzae Type B in Lao People's Democratic Republic.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Article
- Varicella zoster and fever rash surveillance in Lao People's Democratic Republic.BMC infectious diseases · 2019Article
- Advances in the measurement of coverage for RMNCH and nutrition: from contact to effective coverage.BMJ global health · 2019Review
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDuring late 2012 and early 2013 several outbreaks of diphtheria were notified in the North of the Lao People's Democratic Republic. The aim of this study was to determine whether the re-emergence of this vaccine-preventable disease was due to insufficient vaccination coverage or reduction of vaccine effectiveness within the affected regions.
methodsA serosurvey was conducted in the Huaphan Province on a cluster sampling of 132 children aged 12-59 months. Serum samples, socio-demographic data, nutritional status and vaccination history were collected when available. Anti-diphtheria and anti-tetanus IgG antibody levels were measured by ELISA.
resultsOverall, 63.6% of participants had detectable diphtheria antibodies and 71.2% tetanus antibodies. Factors independently associated with non-vaccination against diphtheria were the distance from the health centre (OR: 6.35 [95% CI: 1.4-28.8], p = 0.01), the Lao Theung ethnicity (OR: 12.2 [95% CI:1,74-85, 4], p = 0.01) and the lack of advice on vaccination given at birth (OR: 9.8 [95% CI: 1.5-63.8], (p = 0.01) while the level of maternal edu-cation was a protective factor (OR: 0.08 [95% CI: 0.008-0.81], p = 0.03). Most respondents claimed financial difficulties as the main reason for non-vaccination. Out of 55 children whose vaccination certificates stated that they were given all 3 doses of diphtheria-containing vaccine, 83.6% had diphtheria antibodies and 92.7% had tetanus antibodies. Furthermore, despite a high prevalence of stunted and underweight children (53% and 25.8%, respectively), the low levels of anti-diphtheria antibodies were not correlated to the nutritional status.
conclusionsOur data highlight a significant deficit in both the vaccination coverage and diphtheria vaccine effectiveness within the Huaphan Province. Technical deficiencies in the methods of storage and distribution of vaccines as well as unreliability of vaccination cards are discussed. Several hypotheses are advanced to explain such a decline in immunity against diphtheria and recommendations are provided to prevent future outbreaks.
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