Multiplex bead assays enable integrated serological surveillance and reveal cross-pathogen vulnerabilities in Zambezia Province, Mozambique.

Multiplex serological assays simultaneously measure antibodies to multiple antigens, furnishing insights into exposure and susceptibility to several pathogens and cross-pathogen vulnerabilities. Our serosurvey tests dried blood spots from 1292 individuals for IgG antibodies to 35 antigens from 18 pathogens using a multiplex bead assay for vaccine preventable diseases, malaria, SARS-CoV-2, neglected tropical diseases, and enteric pathogens in Mozambique. We produce pathogen-specific seroprevalence estimates and age-seroprevalence curves and identify spatial differences in seroprevalence. Rural clusters have higher odds of seropositivity to most NTDs neglected tropical diseases, Plasmodium falciparum malaria, and enteric pathogens, but lower odds of seropositivity to SARS-CoV-2 and vaccine preventable diseases compared to urban clusters. This co-occurrence identifies clusters with high vulnerability to multiple pathogens. We identify a candidate group of antigens that are correlated with high overall vulnerability. Our results demonstrate a role for multiplex serology in integrated disease surveillance to guide control strategies for individual and co-endemic pathogens.