Integrated Cross-Sectional Multiplex Serosurveillance of IgG Antibody Responses to Parasitic Diseases and Vaccines in Coastal Kenya

Abstract

Accurate and cost-effective identification of areas where co-endemic infections occur would enable public health managers to identify opportunities for implementation of integrated control programs. Dried blood spots collected during cross-sectional lymphatic filariasis surveys in coastal Kenya were used for exploratory integrated detection of IgG antibodies against antigens from several parasitic infections (Wuchereria bancrofti, Schistosoma mansoni, Plasmodium spp., Ascaris lumbricoides, and Strongyloides stercoralis) as well as for detection of responses to immunizing agents used against vaccine-preventable diseases (VPDs) (measles, diphtheria, and tetanus) using a multiplex bead assay (MBA) platform. High heterogeneity was observed in antibody responses by pathogen and antigen across the sentinel sites. Antibody seroprevalence against filarial antigens were generally higher in Ndau Island (P < 0.0001), which also had the highest prevalence of filarial antigenemia compared with other communities. Antibody responses to the Plasmodium species antigens circumsporozoite protein (CSP) and merozoite surface protein-1 (MSP-1) 19 were higher in Kilifi and Kwale counties, with Jaribuni community showing higher overall mean seroprevalence (P < 0.0001). Kimorigo community in Taita-Taveta County was the only area where antibody responses against S. mansoni Sm25 recombinant antigen were detected. Seroprevalence rates to Strongyloides antigen NIE ranged between 3% and 26%, and there was high heterogeneity in immune responses against an Ascaris antigen among the study communities. Differences were observed between communities in terms of seroprevalence to VPDs. Seroprotection to tetanus was generally lower in Kwale County than in other counties. This study has demonstrated that MBA holds promise for rapid integrated monitoring of trends of infections of public health importance in endemic areas.

Plasmodium falciparumand helminth coinfections increase IgE and parasite-specific IgG responses

“…This is consistent with a cumulative exposure over time, which resulted in a clear age bias whereby most of the adults were in the coexposure/coinfection group. A study that detected IgG against some of the helminth antigens measured in this study (NIE, Sm25) and other P. falciparum antigens also observed similar age trends in Kenya (Njenga et al, 2020). Socioeconomic and water and sanitation metrics had the strongest associations with total IgE, with higher SES and improved water and sanitation conditions showing the lowest IgE levels.…”

Fine-scale heterogeneity in Schistosoma mansoni force of infection measured through antibody response

“…The use of widely generalizable modeling approaches to estimate S. mansoni transmission in cross-sectional, serological surveys further supports its inclusion in integrated surveillance platforms, which benefit from shared analysis methods to translate antibody response into measures of transmission ( 14 ). Multiplex antibody testing from a lymphatic filariasis surveillance survey in coastal Kenya recently identified communities with a clear signature of S. mansoni transmission based on SEA seroprevalence ( 34 ), The methods we have used herein, such as model-based geostatistical mapping and force of infection estimation, could further extend analysis outputs of integrated serosurveillance platforms to help inform control programs.…”

“…Nevertheless, serological surveys with multiplex antibody testing across a range of pathogens are becoming more common ( 14 ). Broader testing of specimens for schistosomiasis SEA in surveys conducted by other programs could provide additional information to complement schistosomiasis-specific monitoring activities ( 34 ), which currently rely on single-pathogen microscopy or circulating cathodic antigen tests ( 37 ).…”

Fine-scale heterogeneity in Schistosoma mansoni force of infection measured through antibody response

“…32 The use of widely generalizable modeling approaches to estimate S. mansoni transmission in cross-sectional, serological surveys further support its inclusion in integrated surveillance platforms, which benefit from shared analysis methods to translate antibody response into measures of transmission. 18 Multiplex antibody testing from a lymphatic filariasis surveillance survey in coastal Kenya recently identified villages with a clear signature of S. mansoni transmission based on SEA seroprevalence, 33 The methods we have used herein, such as model-based geostatistical mapping and force of infection estimation, could further extend analysis outputs of integrated serosurveillance platforms to help inform control programs.…”

“…its inclusion in integrated surveillance platforms, which benefit from shared analysis methods to translate antibody response into measures of transmission. Multiplex antibody testing from a lymphatic filariasis surveillance survey in coastal Kenya recently identified villages with a clear signature of S. mansoni transmission based on SEA seroprevalence,33 The methods we have used herein, such as model-based geostatistical mapping and force of infection estimation, could further extend analysis outputs of integrated serosurveillance platforms to help inform control programs.In addition to broader surveillance, serology could directly inform the design and evaluation of schistosomiasis intervention studies. For example, some villages near Lake Victoria have higher forces of transmission and are less responsive to MDA than others.…”