Serosurveillance is an important component of any comprehensive surveillance system for vaccine preventable diseases. It is the gold standard for measuring immunity in a population, thereby complementing traditional disease surveillance methods.
Serosurveillance programs are conducted at varying frequencies in a number of overseas countries. In the United States, serosurveillance for vaccine preventable diseases has occurred on an ad hoc basis as a component of the National Health and Nutrition Examination Survey (NHANES). NHANES uses a cluster sampling methodology to assess the health and nutrition of Americans by interview and physical examination. The Health Protection Agency has a long established annual serosurveillance program in England and Wales, using a convenience sampling method similar to that described below for the Australian serosurveillance program. The European Sero-Epidemiology Network (ESEN) was established in 1996 to coordinate and harmonise serological surveillance for vaccine preventable diseases in European countries.
The Australian national serosurvey program, conducted by NCIRS, is a valuable resource for estimating vaccine coverage by population immunity, for immunisation program evaluation and to contribute to disease modelling. The program is conducted in collaboration with the Centre for Infectious Diseases & Microbiology Laboratory Services (CIDMLS), at Pathology West – ICPMR, Westmead. Laboratory liaison and collection of sera is managed by CIDMLS and antibody testing occurs at CIDMLS. This includes development and refinement of specific assays required for the serosurvey and not available in Australia. We have collaborated with ESEN on several programs to standardise serological assays for international comparison.
Serosurveys are conducted at approximately 5-yearly intervals, by collecting a bank of 7,000–10,000 sera from diagnostic laboratories throughout Australia that receive samples from hospitalised and ambulant persons. The sera collected are residual from specimens submitted for testing that would otherwise have been discarded. Ethics approval is obtained for each serosurvey. The convenience sampling method used in these surveys can introduce biases that are difficult to control in analysis. However, a comparative study using data from the first serosurvey and a cluster sampling method showed equivalent results for vaccine preventable diseases such as measles and hepatitis B.
In Australia, the first national serosurveys were conducted using sera collected in 1996–1998 and 1999, i.e. either side of the national Measles Control Campaign. Immunity to the following antigens was tested: measles, mumps, rubella, varicella, hepatitis A, hepatitis B, hepatitis C, diphtheria, tetanus, polio and pertussis.
The second serosurvey was conducted using sera collected in 2002 and immunity to the following antigens was tested: measles, rubella, varicella, hepatitis B, pertussis, meningococcal C, cytomegalovirus and Helicobacter pylori.
The third serosurvey was conducted using sera collected in 2007 and immunity to the following antigens was tested: measles, mumps, rubella, varicella, pertussis, meningococcal C, diphtheria, tetanus and hepatitis B.
In addition to routine national serosurveys, NCIRS also conducted an ad hoc serosurvey using sera collected in 2005, to measure immunity to human papillomavirus (HPV) before the introduction of the national immunisation program.
Diphtheria and tetanus
Immunity to diphtheria and tetanus in Australia: a national serosurvey
Gidding HF, Backhouse JL, Burgess MA, et al. Medical Journal of Australia 2005;183:301-4.
Hepatitis A and B
Hepatitis A epidemiology in Australia: national seroprevalence and notifications
Amin J, Gilbert GL, Escott RG, et al. Medical Journal of Australia 2001;174:338-41.
Estimates of chronic hepatitis B virus infection in Australia, 2000
O'Sullivan BG, Gidding HF, Law M, et al. Australian and New Zealand Journal of Public Health 2004;28:212-6.
Estimates of chronic hepatitis B virus infection in the Northern Territory
Wood N, Backhouse J, Gidding HF, et al. Communicable Diseases Intelligence 2005;29:289-90.
The impact of a new universal infant and school-based adolescent hepatitis B vaccination program in Australia
Gidding HF, Warlow M, MacIntyre CR, et al. Vaccine 2007;25:8637-41.
Population seroprevalence of human papillomavirus types 6, 11, 16, and 18 in men, women, and children in Australia
Newall AT, Brotherton JM, Quinn HE, et al. Clinical Infectious Diseases 2008;46:1647-55.
Impact of the Australian Measles Control Campaign on immunity to measles and rubella
Gilbert GL, Escott RG, Gidding HF, et al. Epidemiology and Infection 2001;127:297-303.
The Australian Measles Control Campaign, 1998
Turnbull FM, Burgess MA, McIntyre PB, et al. Bulletin of the World Health Organization 2001;79:882-8.
A mathematical model to measure the impact of the Measles Control Campaign on the potential for measles transmission in Australia
MacIntyre CR, Gay NJ, Gidding HF, Hull BP, Gilbert GL, et al. International Journal of Infectious Diseases 2002;6:277-282.
Measles immunity in young Australian adults
Gidding HF, Gilbert GL. Communicable Diseases Intelligence 2001;25:133-6.
Sustained measles elimination in Australia and priorities for long term maintenance
Gidding HF, Wood J, MacIntyre CR, Kelly H, Lambert SB, et al. Vaccine 2007;25:3574-3580.
Residual susceptibility to measles among young adults in Victoria, Australia following a national targeted measles-mumps-rubella vaccination campaign
Kelly HA, Gidding HF, Karapanagiotidis T, Leydon JA, Riddell MA. BMC Public Health 2007;7:99.
Population-based seroprevalence of Neisseria meningitidis serogroup C capsular antibody before the introduction of conjugate vaccine, in Australia
Backhouse JL, Gidding HF, MacIntyre CR, et al. Vaccine 2007;25:1310-5.
Evaluation of two enzyme immunoassays for detection of immunoglobulin G antibodies to mumps virus
Backhouse JL, Gidding HF, McIntyre PB, Gilbert GL. Clinical and Vaccine Immunology 2006;13:764-767.
Recent increases in mumps incidence in Australia: the "forgotten" age group in the 1998 Australian Measles Control Campaign
Aratchige PE, McIntyre PB, Quinn HE, et al. Medical Journal of Australia 2008;189:434-7.
The seroepidemiology of pertussis in Australia during an epidemic period
Cagney M, MacIntyre CR, McIntyre P, et al. Epidemiology and Infection 2006;134:1208-16.
The utility of seroepidemiology for tracking trends in pertussis infection
Quinn HE, McIntyre PB, Backhouse JL, et al. Epidemiology and Infection 2010;138:426-33.
The seroepidemiology of pertussis in NSW: fluctuating immunity profiles related to changes in vaccination schedules
Quinn HE, Mahajan D, Hueston L, et al. NSW Public Health Bulletin 2011;22:224-9.
Increased population prevalence of low pertussis toxin antibody levels in young children preceding a record pertussis epidemic in Australia
Campbell P, McIntyre P, Quinn H, et al. PLoS One 2012;7:e35874.
National serosurvey of poliovirus immunity in Australia, 1996-99
Gidding HF, Backhouse JL, Gilbert GL, Burgess MA. Australian and New Zealand Journal of Public Health 2005;29:48-52.
Rubella in Australia: can we explain two recent cases of congenital rubella syndrome?
Gidding HF, Young M, Pugh R, et al. Communicable Diseases Intelligence 2003;27:537-40.
Current epidemiology of rubella and congenital rubella syndrome in Australia: progress towards elimination
Song N, Gao Z, Wood JG, et al. Vaccine 2012;30:4073-8.
The seroepidemiology and transmission dynamics of varicella in Australia
Gidding HF, MacIntyre CR, Burgess MA, et al. Epidemiology and Infection 2003;131:1085-9.
Modelling the impact of vaccination on the epidemiology of varicella zoster virus in Australia
Gidding HF, Brisson M, MacIntyre CR, et al. Australian and New Zealand Journal of Public Health 2005;29:544-51.
Varicella seroprevalence and vaccine uptake in preschool children [letter]
Gilbert GL, Gidding HF, Backhouse J, et al. Medical Journal of Australia 2005;182:42.
Modelling the impact of one-dose vs. two-dose vaccination regimens on the epidemiology of varicella zoster virus in Australia
Gao Z, Gidding HF, Wood JG, et al. Epidemiology and Infection 2010;138:457-68.
Evaluation of Australia’s varicella vaccination program for children and adolescents
Ward K, Dey A, Hull B, Quinn HE, Macartney K, Menzies R. Vaccine 2013;31:1413-9.
Other vaccine preventable and infectious disease related articles
National serosurvey of cytomegalovirus in Australia
Seale H, MacIntyre CR, Gidding HF, et al. Clinical and Vaccine Immunology 2006;13:1181-4.
The seroepidemiology of Helicobacter pylori infection in Australia
Moujaber T, MacIntyre CR, Backhouse J, et al. International Journal of Infectious Diseases 2008;12:500-4.