Tetanus
Conditions
Keywords
point-of-care, Lateral Flow Test, Rapid Diagnostic, Immune Diagnostic
Brief summary
This study aims to design, develop and optimise a non-invasive, saliva sample-based point-of-care lateral flow test for use in low and middle income settings that can return a qualitative result on whether an individual has or has not immunity to tetanus within 10-15mins. If successful, this approach would not require blood sampling or laboratory facilities, empower personalised decision making on vaccine needs and support the development of population level data-driven public health policies.
Detailed description
The development of non-invasive point-of-care (POC) diagnostic testing for the detection of protective immunity to tetanus would empower LMICs to identify immunity gaps and individuals who are a priority for vaccination and generate sero-epidemiology models for future public health decision around tetanus control. Given tetanus antigen is included as polyvalent vaccine formulations for infants as part of the WHO EPI schedule for LMICS, the absence of anti-tetanus toxoid antibody might also indicate missed vaccine doses that would have conferred protection to other infectious diseases. This is a cross-sectional, non-interventional, biological sampling study. This study will be conducted at the Center for Family Health Research in Kigali, Rwanda, in collaboration with Rwanda Biomedical Centre, the national health implementation agency for Rwanda, and the University of Birmingham, United Kingdom. WHO/UNICEF estimates DTP3 coverage in Rwanda at 97% following extensive SIA activity after vaccination coverage dropped to 88% in 2021. Rwanda hosts a significant number of refugees (135,000 at the end of April 2024), nearly half of these are children and many are from the Democratic Republic of the Congo where only just over half of children are fully immunised. The overall aim of this study is to assess the real-world performance and the diagnostic clinical accuracy of a novel, saliva-based, point-of-care lateral flow test in determining the immune status to tetanus for individuals in Rwanda. Participants will be recruited from the following groups: * Group A: Healthy children aged 5-10 years (n=250) * Group B: Healthy younger adults aged 18-25 years (n=35) * Group C: Healthy pregnant women (n=30) * Group D: Adults with known immune suppression (see table 1) aged 18-45 years (n=75)
Interventions
DIAGNOSTIC_TESTPoint of care, saliva-based lateral flow test
Measurement of anti-tetanus toxoid antibody concentration in saliva
DIAGNOSTIC_TESTBlood based immunoassay
Measurement of anti-tetanus toxoid antibody concentration in blood
Sponsors
University of Birmingham
Rwanda Biomedical Centre
Center for Family Health Research/Projet San Francisco
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
5 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
* Able and willing to provide informed consent to take part in the study; either directly or from a parent/guardian, where appropriate * \[Group A\] Aged 5-10 years inclusive, and determined as healthy by a member of the study team * \[Group B\] Aged 18-25yrs inclusive, and determined as healthy by a member of the study team * \[Group C\] Currently pregnant at any stage of pregnancy, prior to receipt of a tetanus booster vaccine in pregnancy, and determined as healthy by a member of the study team and safe to provide a blood sample * \[Group D\] Adults aged 18-45 years with one or more of the medical conditions that may affect antibody response to vaccination.
Exclusion criteria
* Participants or parents/guardians unwilling or unable to provide informed consent to take part * Unwilling or unable to comply with study procedures * Have a bleeding disorder deemed significant by study doctor * \[Groups A, B and C only\] Any health condition which, in the opinion of a study physician which could 1. mean blood sampling has the potential for harm and/or 2. affect immune response to a vaccine for example known/suspected impairment of immune function (with the exception of Group D)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The clinical diagnostic performance of the saliva-based lateral flow test in determining immune status as compared to bead-based multiplexed assay on serum. | Day 1 | Immune status according to the saliva-based lateral flow test. Any pigment on the test line will be interpreted as immune. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Serum anti-tetanus toxoid antibody concentration | Day 1 | Serum anti-tetanus toxoid antibody concentration as measured by bead-based multiplex assay. |
| Serum antibody titres to other EPI vaccine antigens | Day 1 | Serum antibody titres to diptheria, haemophilus influenzae, hepatitis B and measles as measured by multiplex assay or enzyme-linked immunosorbent assay. |
| Vaccination history | Day 1 | Vaccination history either by electronic healthcare records, vaccination card or maternal recall. |
| Perspectives of healthcare workers and the public | Day 1 | Perceptions and acceptability of this approach from healthcare workers and members of the public around using a novel salivary point-of-care lateral flow test for tetanus and vaccination decisions. This will be determined by thematic analysis of transcripts from focus groups of 5-15 people who have either been a participant in the study or helped with delivery of the study. |
Countries
Rwanda
Contacts
CONTACTKarishma Gokani
Outcome results
None listed