Seroprevalence of IgG antibodies against pertussis toxin in the Chinese population: A systematic review and meta-analysis

Figures & data

Figure 1. Study search and inclusion. The process of literature screening, inclusion, and exclusion followed the PRISMA guidelines.

Table 1. Characteristics of included studies.

ID	First Author (year)	Study region	Province	Investigation year	Population type	Age group（year）	Sample size	ELISA kit	Cut-off value
1	Q Zhang (2011)^Citation26	East China	Shandong	2010	Adults	18 ~ 50	210	Virion/Serion	30 IU/mL
2	C Wang (2011)^Citation27	East China	Shanghai	2008–2009	Children and adolescents	2 ~ 20	1616	Virion/Serion	30 FDA-U/mL*
3	M Liu (2011)^Citation28	South China	Guangdong	2008	Children and adolescents	1 ~ 10	2661	Virion/Serion	20 IU/mL
4	Q Zhang (2012)^Citation29	South China	Guangdong	2010	General population	0 ~ 95	1313	Virion/Serion	30 IU/mL
5	H Huang (2014)^Citation30	North China	Tianjin	2010–2012	General population	0 ~ 76	1825	Virion/Serion	40 IU/ml
6	Y Wu (2014)^Citation31	North China	Hebei	2012–2013	Children and adolescents	3 ~ 18	1032	Virion/Serion	40 IU/ml
7	Y Xu (2014)^Citation32	Central China	Henan	2011	General population	0 ~ 86	1080	Homemade	30 IU/mL
8	C Ju (2014)^Citation33	South China	Guangdong	2011	Children and adolescents	1 ~ 15	256	Virion/Serion	40 IU/ml
9	X Li (2015)^Citation34	North China	Beijing	2012	General population	0 ~ 74	2147	Euroimmun	28 IU/mL
10	H He (2016)^Citation35	East China	Fujian	2014	General population	0 ~ 91	2107	Virion/Serion	30 FDA-U/mL*
11	Z Chen (2016)^Citation12	North China	Beijing	2010	Childbearing Age	20 ~ 39	897	Virion/Serion	40 IU/ml
12	D Nie.(2017)^Citation36	Central China	Hubei	2016	Adults	17 ~ 63	508	Virion/Serion	40 IU/ml
13	X Gong (2017)^Citation37	East China	Zhejiang	2014	General population	0 ~ 60+	357	Virion/Serion	30 FDA-U/mL*
14	N Yao (2018)^Citation38	Southwest China	Chongqing	2015	General population	1 ~ 59	944	Virion/Serion	40 IU/ml
15	Q Meng (2018)^Citation39	North China	Beijing	2017	Pregnant women	21 ~ 39	194	Euroimmun	40 IU/ml
16	D Zhang (2018)^Citation40	Southwest China	Guizhou	2016	General population	0 ~ 50+	615	Virion/Serion	40 IU/ml
17	X Jing (2018)^Citation41	East China	Shanghai	2017	Children and adolescents	0 ~ 18	372	Euroimmun	30 IU/mL
18	Y Zhang (2019)^Citation42	North China	Beijing	2010–2016	General population	3 ~ 69	3058	Virion/Serion	40 IU/ml
19	C Li (2019)^Citation43	North China	Beijing	2017	Pregnant women	30.1 ± 3.7	612	Virion/Serion	40 IU/ml
20	J Wu (2020)^Citation44	East China	Jiangsu	2018	General population	0 ~ 20+	752	Etebio	20 IU/mL
21	Y Li (2020)^Citation45	South China	Guangdong	2017–2018	General population	0 ~ 16	620	Virion/Serion	40 IU/ml
22	T Wang (2020)^Citation46	South China	Guangdong	2018	General population	0 ~ 65	150	Euroimmun	40 IU/ml
23	Y Liu (2020)^Citation47	East China	Shandong	2018	Pregnant women	20 ~ 39	100	Euroimmun	40 IU/ml
24	W Chen (2020)^Citation48	Central China	Hubei	2017	General population	20 ~ 59	73	Homemade	30 IU/mL
25	S Zhan (2020)^Citation49	North China	Beijing	2016	Pregnant women	21 ~ 39	150	Euroimmun	40 IU/ml
26	D Liu (2021)^Citation50	Southwest China	Chongqing	2018–2019	General population	0 ~ 89	666	Virion/Serion	40 IU/ml
27	Z Zhang (2021)^Citation8	North China	Beijing	2017	General population	0 ~ 76	2144	Euroimmun	40 IU/ml
28	X Zhao (2021)^Citation51	East China	Zhejiang	2019	General population	1 ~ 91	1206	Virion/Serion	40 IU/ml
29	T Wang (2021)^Citation52	South China	Guangdong	2019	Pregnant women	20 ~ 35+	495	Euroimmun	20 IU/mL
30	X Luo (2021)^Citation53	East China	Fujian	2019	General population	0 ~ 59	932	Etebio	20 IU/mL
31	S Geng (2021)^Citation54	Central China	Henan	2019	General population	0 ~ 79	504	Homemade	20 IU/mL
32	C Zhang (2022)^Citation55	North China	Shanxi	2017	Adults	18 ~ 59	4307	Virion/Serion	40 IU/ml
33^a	Q Chen (2022)^Citation56	East China	Jiangsu	2018	General population	15 ~ 40+	212	Virion/Serion	40 IU/ml
33^b	Q Chen (2022)^Citation56	East China	Jiangsu	2019	General population	15 ~ 40+	348	Virion/Serion	40 IU/ml
33^c	Q Chen (2022)^Citation56	East China	Jiangsu	2020	General population	15 ~ 40+	217	Virion/Serion	40 IU/ml
33^d	Q Chen (2022)^Citation56	East China	Jiangsu	2021	General population	15 ~ 40+	223	Virion/Serion	40 IU/ml
34^a	Z Chen (2022)^Citation57	North China	Beijing	2018	Childbearing Age	20 ~ 39	503	Virion/Serion	40 IU/ml
34^b	Z Chen (2022)^Citation57	North China	Beijing	2019	Childbearing Age	20 ~ 39	735	Virion/Serion	40 IU/ml
34^c	Z Chen (2022)^Citation57	North China	Beijing	2020	Childbearing Age	20 ~ 39	783	Virion/Serion	40 IU/ml
35	Z Chen (2022)^Citation58	North China	Beijing	2019	Childbearing Age	0, 20 ~ 39	1175	Virion/Serion	40 IU/ml
36	J Chen (2022)^Citation59	East China	Zhejiang	2018	Children and adolescents	0 ~ 18	1486	Euroimmun	30 IU/mL
37	A Wang (2022)^Citation60	South China	Guangdong	2019	General population	0 ~ 41+	1015	Virion/Serion	40 IU/ml
38	M Liu (2022)^Citation61	South China	Guangdong	2018	General population	0 ~ 40+	2719	Virion/Serion	40 IU/ml
39	H He (2022)^Citation62	East China	Zhejiang	2020	General population	0 ~ 59	4459	Homemade	20 IU/mL

EILSA = enzyme-linked immunosorbent assay.

Figure 2. Forest plot of overall estimates of seropositivity rate of anti-PT IgG.

Table 2. Subgroup analysis for seropositivity rate of anti-PT IgG.

	No. of data points	Seropositivity rate (95% CI), %	I^2, %	P value*
Overall	44	7.06 (5.50, 9.07)	98.80%
Age group (year)
Younger than 1	16	8.71 (5.04, 15.08)	96.80%	0.022
1–2	28	12.5 (9.31, 16.78)	98.00%
3–4	19	8.15 (5.30, 12.51)	97.70%
5–9	41	8.96 (7.25, 11.08)	93.50%
10–19	47	8.90 (7.46, 10.63)	94.50%
20–39	50	6.36 (5.17, 7.83)	85.60%
40 and older	37	8.96 (7.20, 11.16)	89.60%
Sex
Man	26	7.03 (5.05, 9.77)	98.30%	0.296
Woman	31	5.55 (3.95, 7.61)	97.90%
Study region
North China	14	4.23 (2.68, 6.69)	95.60%	<0.001
Central China	4	7.55 (4.32, 13.18)	85.10%
Eastern China	15	11.89 (8.17, 17.29)	98.20%
South China	8	7.62 (4.54, 12.81)	99.20%
Southwestern China	3	4.22 (3.20, 5.56)	47.80%
Investigation year
~2012	10	8.31 (5.70, 12.10)	99.20%	0.609
2013–2017	13	7.32 (4.37, 12.27)	98.80%
2018~	21	6.30 (4.24, 9.35)	98.50%
EILSA kit
Virion/Serion	29	6.31 (4.55, 8.75)	98.90%	0.030
Euroimmun	9	6.77 (4.10, 11.18)	97.20%
Other	6	12.79 (8.33, 19.63)	98.60%
Cut-off value
20 IU/mL	6	13.64 (7.43, 25.04)	98.50%	<0.001
28 IU/mL	1	12.34 (11.03, 13.82)	/
30 IU/mL	6	10.59 (6.83, 16.43)	97.40%
40 IU/mL	31	5.59 (4.15, 7.54)	98.50%

*p value between subgroups.

CI = confidence interval, EILSA = enzyme-linked immunosorbent assay.

Table 3. The estimated age-specific seropositivity rate of anti-PT IgG in 2012, 2016, and 2020.

Age, years	Seropositivity rate (95% CI), %			Relative Rate of Change (2012–2020),%
	2012	2016	2020
Younger than 1	16.72 (11.12, 24.38)	11.11 (7.36, 16.45)	7.22 (4.62, 11.11)	56.82
1–2	15.27 (10.31, 22.03)	10.09 (6.79, 14.73)	6.53 (4.24, 9.91)	57.24
3–4	12.83 (8.73, 18.46)	8.39 (5.70, 12.20)	5.40 (3.53, 8.17)	57.94
5–9	11.30 (7.62, 16.42)	7.35 (4.94, 10.80)	4.70 (3.04, 7.21)	58.36
10–14	10.80 (7.36, 15.59)	7.01 (4.76, 10.22)	4.48 (2.92, 6.82)	58.50
15–19	11.67 (7.95, 16.81)	7.60 (5.17, 11.05)	4.87 (3.19, 7.38)	58.26
20–24	12.23 (8.33, 17.61)	7.99 (5.44, 11.58)	5.13 (3.37, 7.73)	58.10
25–29	12.61 (8.61, 18.10)	8.24 (5.63, 11.91)	5.30 (3.49, 7.96)	58.00
30–34	13.00 (8.85, 18.69)	8.51 (5.80, 12.33)	5.47 (3.60, 8.23)	57.89
35–39	13.51 (9.18, 19.43)	8.86 (6.02, 12.85)	5.71 (3.75, 8.60)	57.75
40 and older	14.12 (9.63, 20.25)	9.29 (6.32, 13.44)	5.99 (3.94, 9.02)	57.57

CI = confidence interval.

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Data availability statement

All data required to evaluate the conclusions of this study are presented in the paper, Supplementary Materials, or both.