Diphtheria is a reemerging vaccine-preventable infection of public health concern. Pooled estimates of serum IgG anti-diphtheria antibody levels can assist in estimating the susceptible population. The objective was to estimate pooled estimate of protective IgG anti-diphtheria antibodies in population globally. We searched three databases until May 2023. We included studies reporting serum anti-diphtheria antibody titre > 0.1 IU/ml as seroprotection. NHLBI checklist was used for quality assessment. Heterogeneity was explored and resolved by statistical methods. 1720 articles were retrieved out of which 51 articles were included. The pooled seropositivity rate against diphtheria was 57%. After removal of two influential outlier studies, pooled seropositivity became 51%. The meta-regression results for age depicted that seroprevalence significantly decreased with increasing age. Subgroup analysis done on basis of geographical distribution significantly reduced heterogeneity and revealed that the Western Pacific region and African regions had lower seroprotectivity compared to other regions. Subgrouping done based on year of sample collection revealed seroprotection was lower (55.63%) between 1986 and 2005 which increased to 67.11% between 2006 and 2015 and again dropped to 45.75% between 2016 and 2023. We concluded that after 2015, the disease has reemerged globally, with seroprotection level below 50% (45.75%) and overall only half of the population being seroprotected against diphtheria. So, there is a need for reinforcement of immunity against diphtheria (supplementary vaccination) after screening for antibody titre. PROSPERO registration number CRD42023458131.

Amit Kumar Mital

Priyanka Choudhary

Bijaya K. Padhi

Muhammad Aaqib Shamim

Aravind Gandhi P

Mayuri Raul

None Sruthi

Prakasini Satapathy

Pathogens and Global Health

PATHOGENS AND GLOBAL HEALTH 是一本传染病和公共卫生期刊，专注于将分子、免疫学、基因组学和流行病学知识转化为应对全球健康威胁的控制措施。该杂志发表原创的创新研究论文、评论文章并就具有国际意义的健康主题采访政策制定者和意见领袖。它为控制和根除传染病的新创新解决方案提供科学、伦理和政治讨论的论坛，特别强调影响世界最贫困地区的疾病。

Pathogens and Global Health is a journal focused on infectious diseases and public health, dedicated to translating research findings in molecular biology, immunology, genomics, and epidemiology into effective control measures against global health threats. The journal publishes original innovative research papers and review articles, and conducts interviews with policymakers and opinion leaders on health topics of international significance. It provides a forum for scientific, ethical, and political discussions on new innovative solutions for controlling and eradicating infectious diseases, with a particular emphasis on diseases affecting the world's poorest regions.

《Pathogens and Global Health》是一本专注于传染病和公共卫生的期刊，致力于将分子生物学、免疫学、基因组学和流行病学的研究成果转化为应对全球健康威胁的有效控制措施。该期刊发表原创的创新研究论文和评论文章，并对具有国际意义的健康主题进行政策制定者和意见领袖的采访。它为控制和根除传染病提供了一个科学、伦理和政治讨论的论坛，特别强调影响世界最贫困地区的疾病。

Category	Quartile
医学	4
医学, 热带医学	3
医学, 寄生虫学	4
医学, 公共卫生、环境卫生与职业卫生	4

Mapping anti-diphtheria toxin antibody: a systematic review and meta-analysis with multi-level meta-regression

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Journal Info

Category	Quartile
TROPICAL MEDICINE	1