Implementing Serosurveys in India: Experiences, Lessons Learned, and Recommendations

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  • 1 International Vaccine Access Center Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
  • | 2 National Institute of Epidemiology, Epidemiology Chennai, India;
  • | 3 Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India;
  • | 4 Encephalitis Group, ICMR–National Institute of Virology, Pune, Maharashtra, India;
  • | 5 World Health Organization, Southeast Asia Region Office, New Delhi, India;
  • | 6 Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India;
  • | 7 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;
  • | 8 W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

Serological surveillance for vaccine-preventable diseases, such as measles and rubella, can provide direct measures of population immunity across age groups, identify gaps in immunity, and document changes in immunity over time. Rigorously conducted, representative household serosurveys provide high-quality estimates with minimal bias. However, they can be logistically challenging, expensive, and have higher refusal rates than vaccine coverage surveys. This article shares lessons learned through implementing nine measles and rubella household serosurveys in five districts in India—the challenges faced, the potential impact on results, and recommendations to facilitate the conduct of serosurveys. Specific lessons learned arose from challenges related to community mobilization owing to lack of cooperation in certain settings and populations, limitations of outdated census information, nonresponse due to refusal or unavailability during survey enumeration and enrollment, data collection issues, and specimen collection and handling issues. Although some experiences are specific to serosurveys in India, these lessons are generalizable to other household surveys, particularly vaccination coverage and serosurveys conducted in low- and middle-income settings.

Author Notes

Address correspondence to Manoj V. Murhekar, National Institute of Epidemiology, Indian Council of Medical Research, R-127, Tamil Nadu Housing Board, Ayapakkam, Ambattur, Chennai 600 070, India. E-mail: mmurhekar@nieicmr.org.in

Cosenior authors. The order was mutually agreed on accounting for equal roles in multiple manuscripts and final editorial responsibilities.

These authors contributed equally to this work. The order was mutually agreed on accounting for equal roles in multiple manuscripts and final editorial responsibilities.

Financial support: This serosurvey was supported by the Strengthening Immunization Systems through Serosurveillance grant (grant no. 1094816) from The Bill & Melinda Gates Foundation to the International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

IMRVI Study Group: Sanjay L. Chauhan and Ragini N. Kulkarni, Department of Operational Research, Indian Council of Medical Research (ICMR)–National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India, E-mails: slchauhan@hotmail.com and kulkarnir120@gmail.com. Avi Kumar Bansal and Sandeep Sharma, Division of Epidemiology, ICMR-National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India, E-mails: bansalavikumar@gmail.com and drsandeepsharma82@yahoo.in. Arun Kuman Jain, ICMR–National Institute of Pathology, New Delhi, India, E-mail: drakjain@gmail.com. Gagandeep Singh Grover, Directorate of Health Services, Government of Punjab, Parivar Kalyan Bhavan, Sector-34, Chandigarh, India, E-mail: dr.gagangrover@gmail.com. Santanu Kumar Sharma, ICMR–Regional Medical Research Centre, Dibrugarh, India, E-mail: sksharma.rmrcne@gov.in. Biju Soman and Adarsh Varghese, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India, E-mails: bijusoman@sctimst.ac.in and adarsh.loyola@gmail.com. Jaga Jeevan Babu Geddam, Mahesh Kumar Mummadi, and Raja Sriswan, National Institute of Nutrition–ICMR, Hyderabad, India, E-mails: geddambabuj@yahoo.com, mahidoc@yahoo.com, and srishwan@gmail.com. Itta Krishna Chaaithanya, ICMR–National Institute for Research in Reproductive Health and Department of Health Research, Model Rural Health Research Unit Dahanu, Sub District Hospital Compound, Dahanu, Maharashtra, India, E-mail: chaitanyaitta@gmail.com. Neha R. Salvi, Department of Health Research, Model Rural Health Research Unit Dahanu, Sub District Hospital Compound, Dahanu, Maharashtra, India, E-mail: nehasalvi71@gmail.com. Sunil Kumar Mishra and Sanchit Kharwal, Model Rural Health Research Unit, Hoshiarpur, Punjab, India, E-mails: sunilmishraicmr@gmail.com and kharwalsanchit@gmail.com. Nilanju P. Sarma, Model Rural Health Research Unit, Chabua, Assam, India, E-mail: nilanjusarma@gmail.com. Venkata Prasad Upadrasta, Model Rural Health Research Unit, Chandragiri, Chitoor, Andhra Pradesh, India, E-mail: prasaduv@gmail.com.

Authors’ addresses: Alvira Z. Hasan, Christine Prosperi, and Kyla Hayford, Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: ahasan7@jhmi.edu, cprosperi@jhu.edu, and kylahayford@jhu.edu. Muthusamy Santhosh Kumar, Jeromie Wesley Vivian Thangaraj, R. Sabarinathan, Saravana Kumar, Augustine Duraiswamy, Manoj V. Murhekar, and Sudha Rani D, National Institute of Epidemiology, Epidemiology Chennai, India, E-mails: drsanthosmph09@gmail.com, stanjeromie@nieicmr.org.in, sabari193@gmail.com, saravanan.biostat1985@gmail.com, bhagust@gmail.com, mmurhekar@nieicmr.org.in, and sudharani.ph@gmail.com. Ojas Kaduskar, Vaishali Bhatt, Gururaj Rao Deshpande, and Gajanan N Sapkal, Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India, E-mails: ojas.kaduskar@gmail.com, vaishu.bhatt@gmail.com, gndeshpande@gmail.com, and gajanansapkalniv@gmail.com. Padinjaremattathil Thankappan Ullas, Encephalitis Group, ICMR–National Institute of Virology, Pune, Maharashtra, India, E-mail: ullaspt@gmail.com. Lucky Sangal, Southeast Asia Region Office, World Health Organization, New Delhi, India, E-mail: sangallu@who.int. Sanjay M. Mehendale and Nivedita Gupta, Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India, E-mails: sanmadmehendale@gmail.com and drguptanivedita@gmail.com. William J. Moss, International Vaccine Access Center, Departments of Epidemiology, International Health and Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: wmoss1@jhu.edu.

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