Tetanus Immunity Gaps in Children 5–14 Years and Men ≥ 15 Years of Age Revealed by Integrated Disease Serosurveillance in Kenya, Tanzania, and Mozambique

Heather M. Scobie Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Minal Patel Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Diana Martin Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Harran Mkocha Kongwa Trachoma Project, Kongwa, Tanzania.

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Sammy M. Njenga Eastern and Southern Africa Centre of International of Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.

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Maurice R. Odiere Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.

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Sonia Pelletreau Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Jeffrey W. Priest Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Ricardo Thompson Instituto Nacional de Saúde, Maputo, Mozambique.

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Kimberly Y. Won Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Patrick J. Lammie Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Recent tetanus cases associated with male circumcision in Eastern and Southern Africa (ESA) prompted an examination of tetanus immunity by age and sex using multiplex serologic data from community surveys in three ESA countries during 2012–2013. Tetanus seroprotection was lower among children 5–14 years versus 1–4 years of age in Kenya (66% versus 90%) and Tanzania (66% versus 89%), but not in Mozambique (91% versus 88%), where children receive two booster doses in school. Among males ≥ 15 years of age, tetanus seroprotection was lower than females in Kenya (45% versus 96%), Tanzania (28% versus 94%), and Mozambique (64% versus 90%). Tetanus immunity from infant vaccination doses wanes over time, and only women of reproductive age routinely receive booster doses. To prevent immunity gaps in older children, adolescents, and adult men, a life-course vaccination strategy is needed to provide the three recommended tetanus booster doses.

Author Notes

* Address correspondence to Heather M. Scobie, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E98, Atlanta, GA 30333. E-mail: hscobie@cdc.gov

Financial support: This work was supported by a grant from the Bill & Melinda Gates Foundation (OPP 1022543).

Authors' addresses: Heather M. Scobie and Minal Patel, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: vih8@cdc.gov and hgo9@cdc.gov. Diana Martin, Jeffrey W. Priest, Kimberly Y. Won, and Patrick J. Lammie, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: hzx3@cdc.gov, jip8@cdc.gov, kfw7@cdc.gov, and pjl1@cdc.gov. Harran Mkocha, Kongwa Trachoma Project, Kongwa, Tanzania, E-mail: hmkocha@yahoo.com. Sammy M. Njenga, Eastern and Southern Africa Centre of International of Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya, E-mail: snjenga@kemri.org. Maurice R. Odiere, Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya, E-mail: modiere@kemricdc.org. Sonia Pelletreau, Children's Investment Fund Foundation, London, United Kingdom, E-mail: spelletreau@ciff.org. Ricardo Thompson, Instituto Nacional de Saúde, Maputo, Mozambique, E-mail: rthompsonmz@gmail.com.

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