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American Journal of Epidemiology Vol. 123, No. 2: 316-324
Copyright © 1986 by The Johns Hopkins University School of Hygiene and Public Health

research-article

A COMPREHENSIVE INVESTIGATION OF IMMUNITY TO POLIOMYELITIS IN A DEVELOPING COUNTRY

B. D. SCHOUB1,, S. JOHNSON1, J. M. McANERNEY1, H. G. V. KÜSTNER2 and C. A. VAN DER MERWE3

1National Institute for Virology, and Department of Virology, University of the Witwatersrand Johannesburg, South Africa
2Department of Health and Welfare Civitas, Pretoria, South Africa
3Institute for Biostatistics, South African Medical Research Council Pretoria, South Africa

Reprint requests to Prof. B. D. Schoub, National Institute for Virology, Private Bag X4, Sandringham 2131, South Africa

A comprehensive nationwide surveillance program of serologic immunity of two-year-old black children, combined with evaluation of vaccine quality and distribution, was carried out in South Africa during 1983–1984. Sera were randomly collected from urban and rural groups and cluster samples collected from the semi-urban group. The sample represented 0.23% of the total target population. Satisfactory levels of immunity were found in the urban (80%) and semi-urban (71%) groups but a disquietingly low level was found for the rural group (59%). Individual districts in the rural group could be singled out for directed cluster sampling at a later stage. History and documentation of immunization corresponded well to serologic findings and revealed also a fairly substantial level of natural immunization among individuals who, on history, had received no vaccine. Some 95% of random samples of vaccine recalled from the field showed satisfactory levels of potency. An immunity surveillance program such as this is ideally suited and highly cost-effective for developing countries with incomplete immunization to prevent large-scale buildup of immunity deficit. The technique, however, is too insensitive to detect localized community immunity defects.

data collection; developing countries; immunization; neutralization tests; poliomyelitis; random allocation; serology; vaccines


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