Volume 99, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Age-specific population immunity to many vaccine-preventable diseases can be measured using serological surveys. However, stand-alone serological surveys are infrequently conducted in low- and middle-income countries because of costs, operational challenges, and potential high refusal rates for blood collection. Nesting a serosurvey within a household cluster survey may overcome some of these challenges. We share lessons learned from nesting a serosurvey within a measles and rubella vaccination post-campaign coverage evaluation survey (PCES). In 15 of the 26 PCES clusters in Southern Province, Zambia, we collected dried blood spots from 581 participants aged 9 months and older. Household participation rates for the main PCES were higher in the serosurvey clusters (86%) than PCES-only clusters (71%), suggesting that a serosurvey can be successfully integrated without adversely affecting PCES participation. Among households that participated in the PCES, 80% also participated in the serosurvey and 86% of individuals available in the household provided a blood sample for the serosurvey. Substantial planning and coordination, additional staff training, and community mobilization were critical to the success of the serosurvey. Most challenges stemmed from using different data collecting tools and teams for the serosurvey and PCES. A more efficient design would be to fully integrate the serosurvey by adding blood collection and additional questions to the PCES.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Cutts FT, Hanson M, 2013. Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low‐and middle‐income countries. Trop Med Int Health 21: 10861098.
    [Google Scholar]
  2. MacNeil A, Lee CW, Dietz V, 2014. Issues and considerations in the use of serologic biomarkers for classifying vaccination history in household surveys. Vaccine 32: 48934900.
    [Google Scholar]
  3. Nguipdop-Djomo P, Thomas S, Fine P, 2013. Correlates of Vaccine-Induced Protection: Methods and Implications. Available at: http://researchonline.lshtm.ac.uk/2728969/. Accessed August 5, 2018.
  4. Travassos MA et al., 2015. Strategies for coordination of a serosurvey in parallel with an immunization coverage survey. Am J Trop Med Hyg 93: 416424.
    [Google Scholar]
  5. Cutts FT, Izurieta HS, Rhoda DA, 2013. Measuring coverage in MNCH: design, implementation, and interpretation challenges associated with tracking vaccination coverage using household surveys. PLoS Med 10: 1001404.
    [Google Scholar]
  6. Boerma JT, Holt E, Black R, 2001. Measurement of biomarkers in surveys in developing countries: opportunities and problems. Popul Dev Rev 27: 303314.
    [Google Scholar]
  7. Lim SS, Stein DB, Charrow A, Murray CJ, 2008. Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage. Lancet 372: 20312046.
    [Google Scholar]
  8. Metcalf CJE, Farrar J, Cutts FT, Basta NE, Graham AL, Lessler J, Ferguson NM, Burke DS, Grenfell BT, 2016. Use of serological surveys to generate key insights into the changing global landscape of infectious disease. Lancet 388: 728.
    [Google Scholar]
  9. Cutts FT, Claquin P, Danovaro-Holliday MC, Rhoda DA, 2016. Monitoring vaccination coverage: defining the role of surveys. Vaccine 34: 41034109.
    [Google Scholar]
  10. Kaiser R, Shibeshi ME, Chakauya JM, Dzeka E, Masresha BG, Daniel F, Shivute N, 2015. Surveys of measles vaccination coverage in eastern and southern Africa: a review of quality and methods used. Bull World Health Organ 93: 314319.
    [Google Scholar]
  11. WHO, 2018. Vaccination Coverage Cluster Surveys: Reference Manual. Available at: http://www.who.int/immunization/documents/who_ivb_18.09/en/. Accessed August 6, 2018.
  12. Ministry of Health Zambia, 2017. Zambia Population-Based HIV Impact Assessment (ZAMPHIA). Available at: http://phia.icap.columbia.edu/wp-content/uploads/2016/09/ZAMBIA-Factsheet.FIN_.pdf. Accessed August 6, 2018.
  13. Borrow R, Tang Y, Yakubu A, Kulkarni PS, LaForce FM, 2015. MenAfriVac as an antitetanus vaccine. Clin Infect Dis 61 (Suppl 5): S570S577.
    [Google Scholar]
  14. Central Statistical Office Zambia, Ministry of Health Zambia, ICF International, 2014. Zambia Demographic and Health Survey 2013–14. Available at: https://dhsprogram.com/pubs/pdf/FR304/FR304.pdf. Accessed August 6, 2018.
  15. Helfand R, Keyserling HL, Williams I, Murray A, Mei J, Moscatiello C, Icenogle J, Bellini WJ, 2001. Comparative detection of measles and rubella IgM and IgG derived from filter paper blood and serum samples. J Med Virol 65: 751757.
    [Google Scholar]

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  • Received : 14 Apr 2018
  • Accepted : 08 Aug 2018
  • Published online : 01 Oct 2018
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