Measles, Mumps, and Rubella Seroprevalence Among HIV Negative Women of Childbearing Age at High Risk for HIV in Zambia Open Access

Abstract

Background: It is estimated that 2 to 3 million deaths every year are currently averted by immunization and an estimated 1.5 million additional deaths could be avoided if global vaccination coverage continues to increase (1). Measles, mumps, and rubella are vaccine-preventable diseases that can be effectively controlled by immunization. Unfortunately, Zambia’s current immunization schedule only contains measles and the country has relatively low coverage of the vaccine.

 

Methods: This study aims to evaluate the immune response to measles, mumps, and rubella in a population of women who are HIV-negative but are at high risk for HIV-infection in Lusaka and Ndola, Zambia. Additionally, rubella antibody titers will be evaluated at time points pre- and post-vaccination. A predictive model was created to determine which covariates impacted the odds of being measles IgG negative. Paired t-tests were performed to evaluate the difference between pre- and post-vaccine mean titers for rubella.

 

Results: Of the three viruses, our population had the highest negativity for measles IgG. Our analysis showed no statistical significance of any covariates in the predictive model evaluating the odds of being measles IgG negative. The mean rubella titer pre- vs. post-vaccine were statistically significantly different.

 

Conclusions: Overall, these results identify gaps in MMR coverage in Zambia. Even though this study had no statistically significant predictors of sero-negativity for measles, multiple studies have shown that covariates such as age and BMI are typically predictors of sero-status. The mean increase in pre- vs post-vaccine rubella titers indicates that boosters are important for maintaining immunity.

Table of Contents

Table of Contents

 

Chapter I: Literature Review ......................................................................................... 1

Chapter II: Manuscript .................................................................................. 8

Introduction ..................................................................................................... 10

Methods ..................................................................................... 14

Study Population ......................................................................................... 14

Study Design ............................................................................................ 16

Variable Specification .............................................................................. 17

Statistical Analyses .................................................................................... 20

Results .............................................................................................. 22

Participant Pre- and Post-Vaccination Results ............................................................ 22

Baseline Seroprevalence ........................................................................................... 22

Participant Characteristics at Enrollment .................................................................. 23

Predictors of Sero-Negativity for Measles Antibody ........................................................ 23

Evaluate Pre- and Post-Vaccination Titer for Rubella ....................................................... 24

Pre- and Post-vaccine Seroprevalence of IgG to Measles, Mumps, and Rubella ............... 25

Discussion ................................................................................................... 27

Strengths and Limitations .......................................................................................... 29

Conclusions ............................................................................................................. 30

References ...................................................................................................... 32

Tables and Figures ............................................................................................. 34

Table 1 ............................................................................................................... 34

Table 2 ..................................................................................................................... 34

Table 3 ........................................................................................................................... 35

Table 4 ............................................................................................................................ 36

Table 5 ........................................................................................................................... 37

Table 6 ............................................................................................................. 38

Table 7 ..................................................................................................................... 38

Figure 1 .................................................................................................................. 39

Figure 2 .................................................................................................................... 39

Figure 3 ............................................................................................................... 40

Figure 4 .............................................................................................................. 41

Appendices ............................................................................................................ 42

Appendix A: Zambian Immunization Schedule ............................................................. 42

Appendix B: Group A and B Schedule of Procedur....................................................... 43

Appendix C ............................................................................................................ 44

Chapter III: Summary, Public Health Implications, Possible Future Directions ..................45

Summary .............................................................................................................. 45

Public Health Implications ....................................................................................... 46

Future Directions ................................................................................................... 46

References ............................................................................................................ 48

 

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Biology, Virology
Keyword	Measles Rubella Vaccines MMR Mumps Zambia
Committee Chair / Thesis Advisor	Susan, Allen, Emory University
Committee Members	Tichacek, Amanda, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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