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Yusoff AF, Mohd Sharani ZZ, Kee CC, Md Iderus NH, Md Zamri ASS, Nagalingam T, Mohamad Bashaabidin MS, Wan Ibadullah WAH, Ghazali SM, Yusof AY, Ching YM, Mohamed Nor N, Kamarudin B, Ahmad N, Arip M. Seroprevalence of diphtheria toxoid IgG antibodies in the Malaysian population. BMC Infect Dis 2021; 21:581. [PMID: 34134646 PMCID: PMC8207650 DOI: 10.1186/s12879-021-06285-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Despite high childhood immunization coverage, sporadic cases of diphtheria have been reported in Malaysia in recent years. This study aims to evaluate the seroprevalence of diphtheria among the Malaysian population. Methods A total of 3317 respondents age 2 years old to 60 years old were recruited in this study from August to November 2017. Enzyme-linked immunosorbent assay (ELISA) was used to measure the level of IgG antibody against the toxoid of C. diphtheriae in the blood samples of respondents. We classified respondent antibody levels based on WHO definition, as protective (≥0.1 IU/mL) and susceptible (< 0.1 IU/mL) to C. diphtheriae infection. Results Among the 3317 respondents, 57% were susceptible (38.1% of children and 65.4% of adults) and 43% (61.9% of children and 34.6% of adults) had protective antibody levels against diphtheria. The mean antibody level peaked among individuals aged 1–2 years old (0.59 IU/mL) and 6–7 years old (0.64 IU/mL) but generally decreased with age, falling below 0.1 IU/mL at around 4–6 years old and after age 20 years old. There was a significant association between age [Children: χ2 = 43.22(df = 2),p < 0.001)], gender [Adults: χ2 = 5.58(df = 1),p = 0.018] and ethnicity [Adults: χ2 = 21.49(df = 5),p = 0.001] with diphtheria toxoid IgG antibody level. Conclusions About 57% of the Malaysian population have inadequate immunity against diphtheria infection. This is apparently due to waning immunity following childhood vaccination without repeated booster vaccination in adults. Children at age 5–6 years old are particularly vulnerable to diphtheria infection. The booster vaccination dose normally given at 7 years should be given earlier, and an additional booster dose is recommended for high-risk adults.
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Affiliation(s)
- Ahmad Faudzi Yusoff
- SEAMEO TROPMED Malaysia, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Zatil Zahidah Mohd Sharani
- Biomedical Epidemiology Unit, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Chee Cheong Kee
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Nuur Hafizah Md Iderus
- Biomedical Epidemiology Unit, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Ahmed Syahmi Syafiq Md Zamri
- Biomedical Epidemiology Unit, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Tharmarajah Nagalingam
- Infection Control Unit, Kuala Lumpur Hospital, Ministry of Health Malaysia, Jalan Pahang, 50588, Kuala Lumpur, Malaysia
| | - Mohd Safrin Mohamad Bashaabidin
- Biomedical Epidemiology Unit, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Wan Abdul Hannan Wan Ibadullah
- Biomedical Epidemiology Unit, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Sumarni Mohd Ghazali
- Biomedical Epidemiology Unit, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Ainur Yusniza Yusof
- Allergy and Immunology Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Yee Ming Ching
- Allergy and Immunology Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Nurhanani Mohamed Nor
- Allergy and Immunology Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Balqis Kamarudin
- Allergy and Immunology Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Norazah Ahmad
- Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Masita Arip
- Allergy and Immunology Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
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