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Habib MA, Soofi SB, Hussain I, Ahmed I, Hussain Z, Tahir R, Anwar S, Cousens S, Bhutta ZA. Does IPV Boost Intestinal Immunity among Children under Five Years of Age? An Experience from Pakistan. Vaccines (Basel) 2023; 11:1444. [PMID: 37766121 PMCID: PMC10534550 DOI: 10.3390/vaccines11091444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The oral poliovirus vaccine (OPV) has been the mainstay of polio eradication, especially in low-income countries, and its use has eliminated wild poliovirus type 2. However, the inactivated poliovirus vaccine (IPV) is safer than OPV, as IPV protects against paralytic poliomyelitis without producing adverse reactions. The present study compared mucosal and humoral responses to poliovirus vaccines administered to previously OPV-immunized children to assess the immunity gap in children in areas of high poliovirus transmission. A cluster-randomized trial was implemented in three high-risk districts of Pakistan-Karachi, Kashmore, and Bajaur-from June 2013 to May 2014. This trial was community-oriented and included three arms, focusing on healthy children below five years of age. The study involved the randomization of 387 clusters, of which 360 were included in the final analysis. The control arm (A) received the routine polio program bivalent poliovirus vaccine (bOPV). The second arm (B) received additional interventions, including health camps providing routine vaccinations and preventive maternal and child health services. In addition to the interventions in arm B, the third arm (C) was also provided with IPV. Blood and stool samples were gathered from children to evaluate humoral and intestinal immunity. The highest levels of poliovirus type 1 serum antibodies were observed in Group C (IPV + OPV). The titers for poliovirus type 2 (P2) and poliovirus type 3 (P3) were noticeably higher in those who had received a routine OPV dose than in those who had not across all study groups and visits. Providing an IPV booster after at least two OPV doses could potentially fill immunity gaps in regions where OPV does not show high efficacy. However, IPV only marginally enhances humoral immunity and fails to offer intestinal immunity, which is critical to stop the infection and spread of live poliovirus in populations that have not been exposed before.
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Affiliation(s)
- Muhammad Atif Habib
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan (S.B.S.)
| | - Sajid Bashir Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan (S.B.S.)
- Department of Pediatrics & Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Imtiaz Hussain
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan (S.B.S.)
| | - Imran Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan (S.B.S.)
| | - Zamir Hussain
- Trust for Vaccines and Immunization, Karachi 74400, Pakistan
| | - Rehman Tahir
- Trust for Vaccines and Immunization, Karachi 74400, Pakistan
| | - Saeed Anwar
- Prime Institute of Public Health, Peshawar 25160, Pakistan
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan (S.B.S.)
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Habib A, Nausheen S, Nooruddin S, Javed T, Samejo T, Hussain A, Namdev S, Amirali S, Umer M, Sheikh L, Hussain I, Ariff S, Soofi S. Effect of bovine lactoferrin on seroconversion following polio vaccine administration in children: protocol for a double-blinded randomised controlled trial. BMJ Open 2022; 12:e050849. [PMID: 35613782 PMCID: PMC9125737 DOI: 10.1136/bmjopen-2021-050849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The oral polio vaccine (OPV) has substantial results in eliminating wild poliovirus and the vaccine of choice in polio eradication. However, the mucosal immunity induced by the OPV is still uncertain. Literature has shown that bovine lactoferrin (BLF) is a safe and useful protein found in cow's milk with extraordinary antimicrobial, antiviral, antiinflammatory and immune-modulatory functions that help children's gut to fight against micro-organisms like poliovirus. However, limited data exist regarding the effect of BLF on polio vaccine immune response. The primary objective is to evaluate the effect of BLF in enhancing mucosal and humoral immunity in children following the administration of oral and inactivated polio vaccines. METHODS AND ANALYSIS This is a two-arm double-blinded randomised controlled trial comparing 462 neonates (231 in both groups) receiving either BLF or placebo with breast milk. The intervention is administered from day 1 till 6 weeks of age to a full-term healthy singleton newborn born at the Aga Khan University Hospitals, Karachi, Pakistan. The primary outcome is the seroconversion, 1 month after the receipt of two doses of OPV (at 10 weeks). For descriptive statistical analysis, Stata will be used, the frequency with percentages will be reported to describe baseline characteristics of the participants. A χ2 test will be used to compare categorical variables and a simple t test to compare continuous variables. The proportion of seroconversion and shedding will be compared using χ2 test or Fisher's exact test. ETHICS AND DISSEMINATION The Ethics approval has been granted by the Ethics Review Committee (ERC) of Aga Khan University for the proposed trial (ID: 2019-1955-5013). Furthermore, the National Bioethics Committee (NBC) of Pakistan has also approved the study for human subject research (ID: 4-87/NBC-443/19/669). Study findings will be disseminated through presentations at scientific conferences and educational practice workshops and will be published in an international peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER NCT04432935; ClinicalTrials.gov.
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Affiliation(s)
- Atif Habib
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sidrah Nausheen
- Department of Obstetrics & Gynecology, Aga Khan University, Karachi, Sindh, Pakistan
| | - Shanila Nooruddin
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Tooba Javed
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Tariq Samejo
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Amjad Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Suneeta Namdev
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sehrish Amirali
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Lumaan Sheikh
- Department of Obstetrics & Gynecology, Aga Khan University, Karachi, Sindh, Pakistan
| | - Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shabina Ariff
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sajid Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Paediatric & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
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Gonçalves JIB, Borges TJ, de Souza APD. Microbiota and the Response to Vaccines Against Respiratory Virus. Front Immunol 2022; 13:889945. [PMID: 35603203 PMCID: PMC9122122 DOI: 10.3389/fimmu.2022.889945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
This mini review describes the role of gut and lung microbiota during respiratory viral infection and discusses the implication of the microbiota composition on the immune responses generated by the vaccines designed to protect against these pathogens. This is a growing field and recent evidence supports that the composition and function of the microbiota can modulate the immune response of vaccination against respiratory viruses such as influenza and SARS-CoV-2. Recent studies have highlighted that molecules derived from the microbiome can have systemic effects, acting in distant organs. These molecules are recognized by the immune cells from the host and can trigger or modulate different responses, interfering with vaccination protection. Modulating the microbiota composition has been suggested as an approach to achieving more efficient protective immune responses. Studies in humans have reported associations between a better vaccine response and specific bacterial taxa. These associations vary among different vaccine strategies and are likely to be context-dependent. The use of prebiotics and probiotics in conjunction with vaccination demonstrated that bacterial components could act as adjuvants. Future microbiota-based interventions may potentially improve and optimize the responses of respiratory virus vaccines.
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Affiliation(s)
- João I. B. Gonçalves
- Laboratory of Clinical and Experimental Immunology, Health and Life Science School - Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Thiago J. Borges
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ana Paula Duarte de Souza
- Laboratory of Clinical and Experimental Immunology, Health and Life Science School - Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Badran Abu Zher L, Weil M, Kassem E, Elias N, Levine MM, Muhsen K. Relationship Between Helicobacter pylori IgG Seroprevalence and the Immune Response to Poliovirus Vaccine Among School-Age Children From a Population With Near-Universal Immunity Level. Front Med (Lausanne) 2022; 8:797719. [PMID: 35127752 PMCID: PMC8810818 DOI: 10.3389/fmed.2021.797719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives To examine the association between Helicobacter pylori seroprevalence and serum pepsinogens (PGs) as markers of gastric inflammation), with high neutralizing antibody titers to poliovirus type 1 and 3 vaccine strains among children age 3–4 years, subsequent to sub-clinical infection acquired during a wild-type poliovirus type 1 outbreak in Israel. Methods A serosurvey was conducted among 336 children aged 5–17 years who were vaccinated with both inactivated polio vaccine and oral polio vaccines. H. pylori serum IgG antibodies and PG concentrations were measured using ELISA. Neutralizing antibodies to poliovirus vaccine strains were measured and children with a titer ≥1:8 were considered immune. High-level immunity was defined as having a serum NA titer >1:2048. Propensity score inverse weighting was used to account for confounders. Results Neutralizing antibodies titers ≥1:8 to poliovirus type 1 and 3 vaccine strains were found in 99.4 and 98.2% of the children, respectively. An inverse association was found between H. pylori seropositivity accompanied by PGI:PGII ratio ≤6.5 (marker of gastric inflammation) and high-level immunity to poliovirus type 1: OR 0.39 (95% CI 0.68–0.91), p = 0.027. The association between H. pylori seropositivity of CagA virulent phenotype and polio high immunity was not significant. The association between H. pylori seropositivity and high neutralizing antibodies to type 3 poliovirus was of low magnitude and not significant. Conclusions H. pylori seroprevalence accompanied by evidence of gastric inflammation was inversely correlated with high titers of neutralizing antibodies to poliovirus in children from a population with near universal polio immunity.
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Affiliation(s)
- Layaly Badran Abu Zher
- Sackler Faculty of Medicine, Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University Ramat Aviv, Tel Aviv, Israel
| | - Merav Weil
- Central Virology Laboratory, Ministry of Health, Tel Hashomer, Israel
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nael Elias
- Saint Vincent de Paul-French Hospital, Nazareth, Israel
| | - Myron M. Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Khitam Muhsen
- Sackler Faculty of Medicine, Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University Ramat Aviv, Tel Aviv, Israel
- *Correspondence: Khitam Muhsen
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Connor RI, Brickley EB, Wieland-Alter WF, Ackerman ME, Weiner JA, Modlin JF, Bandyopadhyay AS, Wright PF. Mucosal immunity to poliovirus. Mucosal Immunol 2022; 15:1-9. [PMID: 34239028 PMCID: PMC8732262 DOI: 10.1038/s41385-021-00428-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 02/04/2023]
Abstract
A cornerstone of the global initiative to eradicate polio is the widespread use of live and inactivated poliovirus vaccines in extensive public health campaigns designed to prevent the development of paralytic disease and interrupt transmission of the virus. Central to these efforts is the goal of inducing mucosal immunity able to limit virus replication in the intestine. Recent clinical trials have evaluated new combined regimens of poliovirus vaccines, and demonstrated clear differences in their ability to restrict virus shedding in stool after oral challenge with live virus. Analyses of mucosal immunity accompanying these trials support a critical role for enteric neutralizing IgA in limiting the magnitude and duration of virus shedding. This review summarizes key findings in vaccine-induced intestinal immunity to poliovirus in infants, older children, and adults. The impact of immunization on development and maintenance of protective immunity to poliovirus and the implications for global eradication are discussed.
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Affiliation(s)
- Ruth I Connor
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Margaret E Ackerman
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Joshua A Weiner
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | | | - Peter F Wright
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Isanaka S, Garba S, Plikaytis B, Malone McNeal M, Guindo O, Langendorf C, Adehossi E, Ciglenecki I, Grais RF. Immunogenicity of an oral rotavirus vaccine administered with prenatal nutritional support in Niger: A cluster randomized clinical trial. PLoS Med 2021; 18:e1003720. [PMID: 34375336 PMCID: PMC8354620 DOI: 10.1371/journal.pmed.1003720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nutritional status may play a role in infant immune development. To identify potential boosters of immunogenicity in low-income countries where oral vaccine efficacy is low, we tested the effect of prenatal nutritional supplementation on immune response to 3 doses of a live oral rotavirus vaccine. METHODS AND FINDINGS We nested a cluster randomized trial within a double-blind, placebo-controlled randomized efficacy trial to assess the effect of 3 prenatal nutritional supplements (lipid-based nutrient supplement [LNS], multiple micronutrient supplement [MMS], or iron-folic acid [IFA]) on infant immune response (n = 53 villages and 1,525 infants with valid serology results: 794 in the vaccine group and 731 in the placebo group). From September 2015 to February 2017, participating women received prenatal nutrient supplement during pregnancy. Eligible infants were then randomized to receive 3 doses of an oral rotavirus vaccine or placebo at 6-8 weeks of age (mean age: 6.3 weeks, 50% female). Infant sera (pre-Dose 1 and 28 days post-Dose 3) were analyzed for anti-rotavirus immunoglobulin A (IgA) using enzyme-linked immunosorbent assay (ELISA). The primary immunogenicity end point, seroconversion defined as ≥3-fold increase in IgA, was compared in vaccinated infants among the 3 supplement groups and between vaccine/placebo groups using mixed model analysis of variance procedures. Seroconversion did not differ by supplementation group (41.1% (94/229) with LNS vs. 39.1% (102/261) with multiple micronutrients (MMN) vs. 38.8% (118/304) with IFA, p = 0.91). Overall, 39.6% (n = 314/794) of infants who received vaccine seroconverted, compared to 29.0% (n = 212/731) of infants who received placebo (relative risk [RR]: 1.36; 95% confidence interval [CI]: 1.18, 1.57, p < 0.001). This study was conducted in a high rotavirus transmission setting. Study limitations include the absence of an immune correlate of protection for rotavirus vaccines, with the implications of using serum anti-rotavirus IgA for the assessment of immunogenicity and efficacy in low-income countries unclear. CONCLUSIONS This study showed no effect of the type of prenatal nutrient supplementation on immune response in this setting. Immune response varied depending on previous exposure to rotavirus, suggesting that alternative delivery modalities and schedules may be considered to improve vaccine performance in high transmission settings. TRIAL REGISTRATION ClinicalTrials.gov NCT02145000.
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Affiliation(s)
- Sheila Isanaka
- Department of Research, Epicentre, Paris, France
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | | | - Brian Plikaytis
- BioStat Consulting, LLC, Worthington, Ohio, United States of America
| | - Monica Malone McNeal
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | | | | | | | - Iza Ciglenecki
- Médecins Sans Frontières—Operational Center Geneva, Geneva, Switzerland
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Impact of Microbiota: A Paradigm for Evolving Herd Immunity against Viral Diseases. Viruses 2020; 12:v12101150. [PMID: 33050511 PMCID: PMC7599628 DOI: 10.3390/v12101150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022] Open
Abstract
Herd immunity is the most critical and essential prophylactic intervention that delivers protection against infectious diseases at both the individual and community level. This process of natural vaccination is immensely pertinent to the current context of a pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection around the globe. The conventional idea of herd immunity is based on efficient transmission of pathogens and developing natural immunity within a population. This is entirely encouraging while fighting against any disease in pandemic circumstances. A spatial community is occupied by people having variable resistance capacity against a pathogen. Protection efficacy against once very common diseases like smallpox, poliovirus or measles has been possible only because of either natural vaccination through contagious infections or expanded immunization programs among communities. This has led to achieving herd immunity in some cohorts. The microbiome plays an essential role in developing the body’s immune cells for the emerging competent vaccination process, ensuring herd immunity. Frequency of interaction among microbiota, metabolic nutrients and individual immunity preserve the degree of vaccine effectiveness against several pathogens. Microbiome symbiosis regulates pathogen transmissibility and the success of vaccination among different age groups. Imbalance of nutrients perturbs microbiota and abrogates immunity. Thus, a particular population can become vulnerable to the infection. Intestinal dysbiosis leads to environmental enteropathy (EE). As a consequence, the generation of herd immunity can either be delayed or not start in a particular cohort. Moreover, disparities of the protective response of many vaccines in developing countries outside of developed countries are due to inconsistencies of healthy microbiota among the individuals. We suggested that pan-India poliovirus vaccination program, capable of inducing herd immunity among communities for the last 30 years, may also influence the inception of natural course of heterologous immunity against SARS-CoV-2 infection. Nonetheless, this anamnestic recall is somewhat counterintuitive, as antibody generation against original antigens of SARS-CoV-2 will be subdued due to original antigenic sin.
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Parashar UD, Tate JE. The control of diarrhea, the case of a rotavirus vaccine. SALUD PUBLICA DE MEXICO 2019; 62:1-5. [PMID: 31869556 DOI: 10.21149/9943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
[No disponible]
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Affiliation(s)
- Umesh D Parashar
- Viral Gastroenteritis Branch, Division of Viral Diseases, Centers for Disease Control and Prevention. Atlanta GA, USA
| | - Jacqueline E Tate
- Viral Gastroenteritis Branch, Division of Viral Diseases, Centers for Disease Control and Prevention. Atlanta GA, USA
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Hart PH, Norval M. Are there differences in immune responses following delivery of vaccines through acutely or chronically sun-exposed compared with sun-unexposed skin? Immunology 2019; 159:133-141. [PMID: 31593303 DOI: 10.1111/imm.13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
The majority of human vaccines are administered above the deltoid muscle of the arm, a site that is chronically sun-exposed in many people. It is known that exposure of the skin to the UV wavelengths in sunlight stimulates systemic immunosuppression, an outcome that is associated with reduced immunity to microbial infections in animal models. Here we consider whether immunization of humans through a UV-irradiated skin site will lead to a less effective immune response compared with immunization through an unexposed site. Studies showing that the efficacy of vaccination can be reduced when surrogates of increased levels of sun exposure, such as latitude of residence and season of the year, are considered. Results from a limited number of intervention experiments in humans demonstrate a similar pattern. To provide an explanation for these findings, changes in the number and functional potential of immune cells in chronically sun-exposed compared with unexposed skin are outlined. UV radiation-induced changes to skin cells are also relevant when considering skin sites for administration of immune-tolerizing peptides. The review provides the basis for further research into the effects of acute and chronic UV radiation exposure on skin cells in the context of vaccination.
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Affiliation(s)
- Prue H Hart
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Mary Norval
- University of Edinburgh Medical School, Edinburgh, Scotland
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10
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Polio endgame: Lessons for the global rotavirus vaccination program. Vaccine 2019; 37:3040-3049. [DOI: 10.1016/j.vaccine.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 12/19/2022]
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Pan WK, Seidman JC, Ali A, Hoest C, Mason C, Mondal D, Knobler SL, Bessong P. Oral polio vaccine response in the MAL-ED birth cohort study: Considerations for polio eradication strategies. Vaccine 2018; 37:352-365. [PMID: 30442479 PMCID: PMC6325791 DOI: 10.1016/j.vaccine.2018.05.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/28/2022]
Abstract
Background Immunization programs have leveraged decades of research to maximize oral polio vaccine (OPV) response. Moving toward global poliovirus eradication, the WHO recommended phased OPV-to-IPV replacement on schedules in 2012. Using the MAL-ED prospective birth cohort data, we evaluated the influence of early life exposures impacting OPV immunization by measuring OPV response for serotypes 1 and 3. Methods Polio neutralizing antibody assays were conducted at 7 and 15 months of age for serotypes 1 and 3. Analyses were conducted on children receiving ≥3 OPV doses (n = 1449). History of vaccination, feeding patterns, physical growth, home environment, diarrhea, enteropathogen detection, and gut inflammation were examined as risk factors for non-response [Log2(titer) < 3] and Log2(titer) by serotype using multivariate regression. Findings Serotype 1 seroconversion was significantly higher than serotype 3 (96.6% vs. 89.6%, 15 months). Model results indicate serotypes 1 and 3 failure was minimized following four and six OPV doses, respectively; however, enteropathogen detection and poor socioeconomic conditions attenuated response in both serotypes. At three months of age, bacterial detection in stool reduced serotype 1 and 3 Log2 titers by 0.34 (95% CI 0.14–0.54) and 0.53 (95% CI 0.29–0.77), respectively, and increased odds of serotype 3 failure by 3.0 (95% CI 1.6–5.8). Our socioeconomic index, consisting of Water, Assets, Maternal education, and Income (WAMI), was associated with a 0.79 (95% CI 0.15–1.43) and 1.23 (95% CI 0.34–2.12) higher serotype 1 and 3 Log2 titer, respectively, and a 0.04 (95% CI 0.002–0.40) lower odds of serotype 3 failure. Introduction of solids, transferrin receptor, and underweight were differentially associated with serotype response. Other factors, including diarrheal frequency and breastfeeding practices, were not associated with OPV response. Interpretation Under real-world conditions, improved vaccination coverage and socio-environmental conditions, and reducing early life bacterial exposures are key to improving OPV response and should inform polio eradication strategies.
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Affiliation(s)
- William K Pan
- Duke Global Health Institute, Duke University, Trent Hall, 310 Trent Drive, Durham, NC 27710, USA.
| | - Jessica C Seidman
- Fogarty International Center/National Institutes of Health, Bethesda, MD, USA
| | - Asad Ali
- Aga Khan University, Karachi, Pakistan
| | - Christel Hoest
- Fogarty International Center/National Institutes of Health, Bethesda, MD, USA
| | - Carl Mason
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Stacey L Knobler
- Fogarty International Center/National Institutes of Health, Bethesda, MD, USA
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Abhimanyu, Coussens AK. The role of UV radiation and vitamin D in the seasonality and outcomes of infectious disease. Photochem Photobiol Sci 2018; 16:314-338. [PMID: 28078341 DOI: 10.1039/c6pp00355a] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The seasonality of infectious disease outbreaks suggests that environmental conditions have a significant effect on disease risk. One of the major environmental factors that can affect this is solar radiation, primarily acting through ultraviolet radiation (UVR), and its subsequent control of vitamin D production. Here we show how UVR and vitamin D, which are modified by latitude and season, can affect host and pathogen fitness and relate them to the outcomes of bacterial, viral and vector-borne infections. We conducted a thorough comparison of the molecular and cellular mechanisms of action of UVR and vitamin D on pathogen fitness and host immunity and related these to the effects observed in animal models and clinical trials to understand their independent and complementary effects on infectious disease outcome. UVR and vitamin D share common pathways of innate immune activation primarily via antimicrobial peptide production, and adaptive immune suppression. Whilst UVR can induce vitamin D-independent effects in the skin, such as the generation of photoproducts activating interferon signaling, vitamin D has a larger systemic effect due to its autocrine and paracrine modulation of cellular responses in a range of tissues. However, the seasonal patterns in infectious disease prevalence are not solely driven by variation in UVR and vitamin D levels across latitudes. Vector-borne pathogens show a strong seasonality of infection correlated to climatic conditions favoring their replication. Conversely, pathogens, such as influenza A virus, Mycobacterium tuberculosis and human immunodeficiency virus type 1, have strong evidence to support their interaction with vitamin D. Thus, UVR has both vitamin D-dependent and independent effects on infectious diseases; these effects vary depending on the pathogen of interest and the effects can be complementary or antagonistic.
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Affiliation(s)
- Abhimanyu
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa.
| | - Anna K Coussens
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa. and Division of Medical Microbiology, Department of Pathology, University of Cape Town, Anzio Rd, Observatory, 7925, Western Cape, South Africa
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Kityo C, Makamdop KN, Rothenberger M, Chipman JG, Hoskuldsson T, Beilman GJ, Grzywacz B, Mugyenyi P, Ssali F, Akondy RS, Anderson J, Schmidt TE, Reimann T, Callisto SP, Schoephoerster J, Schuster J, Muloma P, Ssengendo P, Moysi E, Petrovas C, Lanciotti R, Zhang L, Arévalo MT, Rodriguez B, Ross TM, Trautmann L, Sekaly RP, Lederman MM, Koup RA, Ahmed R, Reilly C, Douek DC, Schacker TW. Lymphoid tissue fibrosis is associated with impaired vaccine responses. J Clin Invest 2018; 128:2763-2773. [PMID: 29781814 DOI: 10.1172/jci97377] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/10/2018] [Indexed: 11/17/2022] Open
Abstract
Vaccine responses vary by geographic location. We have previously described how HIV-associated inflammation leads to fibrosis of secondary lymph nodes (LNs) and T cell depletion. We hypothesized that other infections may cause LN inflammation and fibrosis, in a process similar to that seen in HIV infection, which may lead to T cell depletion and affect vaccine responses. We studied LNs of individuals from Kampala, Uganda, before and after yellow fever vaccination (YFV) and found fibrosis in LNs that was similar to that seen in HIV infection. We found blunted antibody responses to YFV that correlated to the amount of LN fibrosis and loss of T cells, including T follicular helper cells. These data suggest that LN fibrosis is not limited to HIV infection and may be associated with impaired immunologic responses to vaccines. This may have an impact on vaccine development, especially for infectious diseases prevalent in the developing world.
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Affiliation(s)
- Cissy Kityo
- Joint Clinical Research Center, Kampala, Uganda
| | - Krystelle Nganou Makamdop
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | - Rama S Akondy
- Emory Vaccine Center, and Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA
| | - Jodi Anderson
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | | | - Eirini Moysi
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Constantinos Petrovas
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Lin Zhang
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria T Arévalo
- Center for Vaccines and Immunology and Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | | | - Ted M Ross
- Center for Vaccines and Immunology and Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Lydie Trautmann
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | | | - Richard A Koup
- Immunology Laboratory, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rafi Ahmed
- Emory Vaccine Center, and Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA
| | - Cavan Reilly
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Obanewa O, Newell ML. Maternal nutritional status during pregnancy and infant immune response to routine childhood vaccinations. Future Virol 2017; 12:525-536. [PMID: 29225661 PMCID: PMC5716389 DOI: 10.2217/fvl-2017-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/08/2017] [Indexed: 01/08/2023]
Abstract
To systematically review the association between maternal nutritional status in pregnancy and infant immune response to childhood vaccines. We reviewed literature on maternal nutrition during pregnancy, fetal immune system and vaccines and possible relationships. Thereafter, we undertook a systematic review of the literature of maternal nutritional status and infant vaccine response, extracted relevant information, assessed quality of the nine papers identified and present findings in a narrative format. From limited evidence of average quality, intrauterine nutrition deficiency could lead to functional deficit in the infant's immune function; child vaccine response may thus be negatively affected by maternal malnutrition. Response to childhood vaccination may be associated with fetal and early life environment; evaluation of programs should take this into account.
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Affiliation(s)
- Olayinka Obanewa
- Human Development & Health, Global Health Research Institute, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Marie-Louise Newell
- Human Development & Health, Global Health Research Institute, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Patel M, Cochi S. Addressing the Challenges and Opportunities of the Polio Endgame: Lessons for the Future. J Infect Dis 2017; 216:S1-S8. [PMID: 28838196 PMCID: PMC5853839 DOI: 10.1093/infdis/jix117] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 01/09/2023] Open
Abstract
The Global Commission for the Certification of the Eradication of Poliomyelitis certified the eradication of type 2 poliovirus in September 2015, making type 2 poliovirus the first human pathogen to be eradicated since smallpox. The eradication of type 2 poliovirus, the absence of detection of type 3 poliovirus worldwide since November 2012, and cornering type 1 poliovirus to only a few geographic areas of 3 countries has enabled implementation of the endgame of polio eradication which calls for a phased withdrawal of oral polio vaccine beginning with the type 2 component, introduction of inactivated poliovirus vaccine, strengthening of routine immunization in countries with extensive polio resources, and initiating activities to transition polio resources, program experience, and lessons learned to other global health initiatives. This supplement focuses on efforts by global partners to successfully launch polio endgame activities to permanently secure and sustain the enormous gains of polio eradication forever.
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Affiliation(s)
- Manish Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Cochi
- Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Molodecky NA, Blake IM, O’Reilly KM, Wadood MZ, Safdar RM, Wesolowski A, Buckee CO, Bandyopadhyay AS, Okayasu H, Grassly NC. Risk factors and short-term projections for serotype-1 poliomyelitis incidence in Pakistan: A spatiotemporal analysis. PLoS Med 2017; 14:e1002323. [PMID: 28604777 PMCID: PMC5467805 DOI: 10.1371/journal.pmed.1002323] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/12/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pakistan currently provides a substantial challenge to global polio eradication, having contributed to 73% of reported poliomyelitis in 2015 and 54% in 2016. A better understanding of the risk factors and movement patterns that contribute to poliovirus transmission across Pakistan would support evidence-based planning for mass vaccination campaigns. METHODS AND FINDINGS We fit mixed-effects logistic regression models to routine surveillance data recording the presence of poliomyelitis associated with wild-type 1 poliovirus in districts of Pakistan over 6-month intervals between 2010 to 2016. To accurately capture the force of infection (FOI) between districts, we compared 6 models of population movement (adjacency, gravity, radiation, radiation based on population density, radiation based on travel times, and mobile-phone based). We used the best-fitting model (based on the Akaike Information Criterion [AIC]) to produce 6-month forecasts of poliomyelitis incidence. The odds of observing poliomyelitis decreased with improved routine or supplementary (campaign) immunisation coverage (multivariable odds ratio [OR] = 0.75, 95% confidence interval [CI] 0.67-0.84; and OR = 0.75, 95% CI 0.66-0.85, respectively, for each 10% increase in coverage) and increased with a higher rate of reporting non-polio acute flaccid paralysis (AFP) (OR = 1.13, 95% CI 1.02-1.26 for a 1-unit increase in non-polio AFP per 100,000 persons aged <15 years). Estimated movement of poliovirus-infected individuals was associated with the incidence of poliomyelitis, with the radiation model of movement providing the best fit to the data. Six-month forecasts of poliomyelitis incidence by district for 2013-2016 showed good predictive ability (area under the curve range: 0.76-0.98). However, although the best-fitting movement model (radiation) was a significant determinant of poliomyelitis incidence, it did not improve the predictive ability of the multivariable model. Overall, in Pakistan the risk of polio cases was predicted to reduce between July-December 2016 and January-June 2017. The accuracy of the model may be limited by the small number of AFP cases in some districts. CONCLUSIONS Spatiotemporal variation in immunization performance and population movement patterns are important determinants of historical poliomyelitis incidence in Pakistan; however, movement dynamics were less influential in predicting future cases, at a time when the polio map is shrinking. Results from the regression models we present are being used to help plan vaccination campaigns and transit vaccination strategies in Pakistan.
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Affiliation(s)
- Natalie A. Molodecky
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Isobel M. Blake
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Kathleen M. O’Reilly
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | | | - Rana M. Safdar
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Amy Wesolowski
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
| | - Caroline O. Buckee
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | | | - Nicholas C. Grassly
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
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17
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Kim YG. Microbiota Influences Vaccine and Mucosal Adjuvant Efficacy. Immune Netw 2017; 17:20-24. [PMID: 28261017 PMCID: PMC5334119 DOI: 10.4110/in.2017.17.1.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/28/2017] [Accepted: 02/10/2017] [Indexed: 12/19/2022] Open
Abstract
A symbiotic relationship between humans and the microbiota is critical for the maintenance of our health, including development of the immune system, enhancement of the epithelial barrier, and acquisition of nutrients. Recent research has shown that the microbiota impacts immune cell development and differentiation. These findings suggest that the microbiota may also influence adjuvant and vaccine efficacy. Indeed, several factors such as malnutrition and poor sanitation, which affect gut microbiota composition, impair the efficacy of vaccines. Although there is little evidence that microbiota alters vaccine efficacy, further understanding of human immune system-microbiota interactions may lead to the effective development of adjuvants and vaccines for the treatment of diseases.
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Affiliation(s)
- Yun-Gi Kim
- Division of Biochemistry, Faculty of Pharmacy, Keio University, Tokyo 105-8512, Japan
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18
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Wright CY, Albers PN, Mathee A, Kunene Z, D'Este C, Swaminathan A, Lucas RM. Sun protection to improve vaccine effectiveness in children in a high ambient ultraviolet radiation and rural environment: an intervention study. BMC Public Health 2017; 17:37. [PMID: 28061843 PMCID: PMC5217337 DOI: 10.1186/s12889-016-3966-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination is a mainstay of preventive healthcare, reducing the incidence of serious childhood infections. Ecological studies have demonstrated an inverse association between markers of high ambient ultraviolet (UV) radiation exposure (e.g., sunny season, low latitude of residence) and reduction in the vaccination-associated immune response. Higher sun exposure on the day prior to and spanning the day of vaccination has been associated with a reduced antigen-specific immune response independent of skin pigmentation. The South African Department of Health's Expanded Programme on Immunisation provides free vaccinations in government primary health care clinics. In some areas, these clinics may have only a small waiting room and patients wait outside in full sun conditions. In rural areas, patients may walk several kilometres to and from the clinic. We hypothesised that providing sun protection advice and equipment to mothers of children (from 18 months) who were waiting to be vaccinated would result in a more robust immune response for those vaccinated. METHODS We conducted an intervention study among 100 children receiving the booster measles vaccination. We randomised clinics to receive (or not) sun protection advice and equipment. At each clinic we recorded basic demographic data on the child and mother/carer participants, their sun exposure patterns, and the acceptability and uptake of the provided sun protection. At 3-4 weeks post-vaccination, we measured measles IgG levels in all children. DISCUSSION This is the first intervention study to assess the effect of sun protection measures on vaccine effectiveness in a rural, real-world setting. The novel design and rural setting of the study can contribute much needed evidence to better understand sun exposure and protection, as well as factors determining vaccine effectiveness in rural Africa, and inform the design of immunisation programmes. (TRN PACTCR201611001881114, 24 November 2016, retrospective registration).
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Affiliation(s)
- Caradee Y Wright
- Environment and Health Research Unit, South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa. .,Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa.
| | - Patricia N Albers
- Environment and Health Research Unit, South African Medical Research Council, 1 Soutpansberg Road, Pretoria, 0001, South Africa
| | - Angela Mathee
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, South Africa.,University of Johannesburg, Johannesburg, South Africa
| | - Zamantimande Kunene
- Environment and Health Research Unit, South African Medical Research Council, Johannesburg, South Africa
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | | | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
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19
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Ngabo F, Tate JE, Gatera M, Rugambwa C, Donnen P, Lepage P, Mwenda JM, Binagwaho A, Parashar UD. Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis. LANCET GLOBAL HEALTH 2016; 4:e129-36. [PMID: 26823214 DOI: 10.1016/s2214-109x(15)00270-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/22/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings. METHODS We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals. FINDINGS Compared with the 2009-11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17-29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48-49%, and admissions specific to rotavirus captured by active surveillance fell by 61-70%. The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group. INTERPRETATION The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings. FUNDING Gavi, the Vaccine Alliance and the Government of Rwanda.
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Affiliation(s)
- Fidele Ngabo
- Université Libre de Bruxelles, Ecole de Santé Publique, Centre de Recherche Politiques et Systèmes de Santé-Santé Internationale, Brussels, Belgium.
| | | | | | - Celse Rugambwa
- World Health Organization, Rwanda Office, Kigali, Rwanda
| | - Philippe Donnen
- Université Libre de Bruxelles, Ecole de Santé Publique, Centre de Recherche Politiques et Systèmes de Santé-Santé Internationale, Brussels, Belgium
| | - Philippe Lepage
- Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Jason M Mwenda
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - Agnes Binagwaho
- Ministry of Health, Kigali, Rwanda; Harvard Medical School, Boston, MA, USA; Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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McCarthy KA, Chabot-Couture G, Shuaib F. A spatial model of Wild Poliovirus Type 1 in Kano State, Nigeria: calibration and assessment of elimination probability. BMC Infect Dis 2016; 16:521. [PMID: 27681708 PMCID: PMC5041410 DOI: 10.1186/s12879-016-1817-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 09/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the launch of the Global Polio Eradication Initiative, all but three countries (Nigeria, Pakistan, and Afghanistan) have apparently interrupted all wild poliovirus (WPV) transmission, and only one of three wild serotypes has been reported globally since 2012. Countrywide supplemental immunization campaigns in Nigeria produced dramatic reduction in WPV Type 1 paralysis cases since 2010 compared to the 2000's, and WPV1 has not been observed in Nigeria since July 24, 2014. This article presents the development and calibration of a spatial metapopulation model of wild poliovirus Type 1 transmission in Kano State, Nigeria, which was the location of the most recent WPV1 case and 5 out of 6 of the reported WPV1 paralytic cases in Nigeria in 2014. METHODS The model is calibrated to data on the case counts and age at onset of paralysis from 2003-2009. The features of the data drive model development from a simple susceptible-exposed-infective-recovered (SEIR) model to a spatial metapopulation model featuring seasonal forcing and age-dependent transmission. The calibrated parameter space is then resampled, projected forward, and compared to more recent case counts to estimate the probability that Type 1 poliovirus has been eliminated in Kano state. RESULTS The model indicates a 91 % probability that Type 1 poliovirus has been eliminated from Kano state as of October 2015. This probability rises to >99 % if no WPV1 paralysis cases are detected for another year. The other states in Nigeria have experienced even longer case-free periods (the only other state with a WPV1 case was Yobe, on April 19, 2014), and Nigeria is the last remaining country in Africa to experience endemic WPV1 transmission, so these results can be interpreted as an upper bound on the probability that WPV1 transmission is currently interrupted continent-wide. CONCLUSIONS While the results indicate optimism that WPV1 transmission has been interrupted in Kano state, the model also assumes that frequent SIAs with high coverage continue to take place in Kano state through the end of the certification period. We conclude that though WPV1 appears to be on the brink of continent-wide elimination (WHO officially removed Nigeria from the list of polio-endemic countries on September 25, 2015), it is important for the polio program to maintain vigilance in surveillance and vaccination activities to prevent WPV1 resurgence through the WHO's 3-year eradication certification period.
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Affiliation(s)
- Kevin A. McCarthy
- Intellectual Ventures Laboratory, 3150 139th Ave SE, Bellevue, WA 98005 USA
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21
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Effect of booster doses of poliovirus vaccine in previously vaccinated children, Clinical Trial Results 2013. Vaccine 2016; 34:3803-9. [PMID: 27269054 DOI: 10.1016/j.vaccine.2016.05.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/12/2016] [Accepted: 05/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Considering the current polio situation Pakistan needs vaccine combinations to reach maximum population level immunity. The trial assessed whether inactivated poliovirus vaccine (IPV) can be used to rapidly boost immunity among children in Pakistan. METHODS A five-arm randomized clinical trial was conducted among children (6-24months, 5-6years and 10-11years). Children were randomized in four intervention arms as per the vaccines they received (bOPV, IPV, bOPV+vitamin A, and bOPV+IPV) and a control arm which did not receive any vaccine. Baseline seroprevalence of poliovirus antibodies and serological immune response 28days after intervention were assessed. RESULTS The baseline seroprevalence was high for all serotypes and the three age groups [PV1: 97%, 100%, 96%, PV2: 86%, 100%, 99%, PV3: 83%, 95%, 87% for the three age groups respectively]. There was significantly higher rate of immune response observed in the study arms which included IPV (95-99%) compared with bOPV only arms (11-43%), [p<0.001]; Vitamin A was not associated with improved immune response. Immune response rates in the IPV only arm and IPV+bOPV arm were similar [p>0.5]. CONCLUSION IPV has shown the ability to efficiently close existing immunity gaps in a vulnerable population of children in rural Pakistan.
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22
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Taniuchi M, Platts-Mills JA, Begum S, Uddin MJ, Sobuz SU, Liu J, Kirkpatrick BD, Colgate ER, Carmolli MP, Dickson DM, Nayak U, Haque R, Petri WA, Houpt ER. Impact of enterovirus and other enteric pathogens on oral polio and rotavirus vaccine performance in Bangladeshi infants. Vaccine 2016; 34:3068-3075. [PMID: 27154394 PMCID: PMC4912219 DOI: 10.1016/j.vaccine.2016.04.080] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Oral polio vaccine (OPV) and rotavirus vaccine (RV) exhibit poorer performance in low-income settings compared to high-income settings. Prior studies have suggested an inhibitory effect of concurrent non-polio enterovirus (NPEV) infection, but the impact of other enteric infections has not been comprehensively evaluated. METHODS In urban Bangladesh, we tested stools for a broad range of enteric viruses, bacteria, parasites, and fungi by quantitative PCR from infants at weeks 6 and 10 of life, coincident with the first OPV and RV administration respectively, and examined the association between enteropathogen quantity and subsequent OPV serum neutralizing titers, serum rotavirus IgA, and rotavirus diarrhea. RESULTS Campylobacter and enterovirus (EV) quantity at the time of administration of the first dose of OPV was associated with lower OPV1-2 serum neutralizing titers, while enterovirus quantity was also associated with diminished rotavirus IgA (-0.08 change in log titer per tenfold increase in quantity; P=0.037), failure to seroconvert (OR 0.78, 95% CI: 0.64-0.96; P=0.022), and breakthrough rotavirus diarrhea (OR 1.34, 95% CI: 1.05-1.71; P=0.020) after adjusting for potential confounders. These associations were not observed for Sabin strain poliovirus quantity. CONCLUSION In this broad survey of enteropathogens and oral vaccine performance we find a particular association between EV carriage, particularly NPEV, and OPV immunogenicity and RV protection. Strategies to reduce EV infections may improve oral vaccine responses. ClinicalTrials.gov Identifier: NCT01375647.
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Affiliation(s)
- Mami Taniuchi
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville 22908, USA.
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville 22908, USA
| | - Sharmin Begum
- Center for Vaccine Science and Parasitology Lab, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1212, Bangladesh
| | - Md Jashim Uddin
- Center for Vaccine Science and Parasitology Lab, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1212, Bangladesh
| | - Shihab U Sobuz
- Center for Vaccine Science and Parasitology Lab, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1212, Bangladesh
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville 22908, USA
| | - Beth D Kirkpatrick
- Vaccine Testing Center and Unit of Infectious Diseases, Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - E Ross Colgate
- Vaccine Testing Center and Unit of Infectious Diseases, Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Marya P Carmolli
- Vaccine Testing Center and Unit of Infectious Diseases, Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Dorothy M Dickson
- Vaccine Testing Center and Unit of Infectious Diseases, Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Uma Nayak
- Center for Public Health Genomics, University of Virginia, Charlottesville 22908, USA
| | - Rashidul Haque
- Center for Vaccine Science and Parasitology Lab, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1212, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville 22908, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville 22908, USA
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23
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Cardemil CV, Estivariz C, Shrestha L, Sherchand JB, Sharma A, Gary HE, Oberste MS, Weldon WC, Bowen MD, Vinjé J, Schluter WW, Anand A, Mach O, Chu SY. The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal. Vaccine 2016; 34:2519-26. [PMID: 27085172 PMCID: PMC10552718 DOI: 10.1016/j.vaccine.2016.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/26/2016] [Accepted: 03/13/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND A globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1+3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown. METHODS Infants aged 6 weeks to 11 months, who had received <3 doses of OPV and had mild-moderate diarrhea or no diarrhea, were recruited at five health facilities in Nepal. Neutralizing antibody titers to poliovirus types 1 and 3 were measured before and 28 days after bOPV administration. The effect of diarrhea and other factors on seroconversion or boosting in antibody titers to poliovirus was assessed by multivariable analysis. RESULTS Infants with diarrhea, versus those without diarrhea, had reduced response for poliovirus types 1 (56% [87/156] vs 66% [109/164]) and 3 (34% [70/209] vs 52% [122/236]). After adjusting for other factors, infants with diarrhea had significantly reduced response for type 3 (odds ratio [OR]=0.44, 95% CI 0.29-0.68), as did infants with >5 loose stools per day (OR=0.36, 95% CI 0.21-0.62). CONCLUSIONS Diarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease. CLINICAL TRIAL REGISTRY This study is registered at clinicaltrials.gov as NCT01559636.
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Affiliation(s)
- Cristina V Cardemil
- Centers for Disease Control and Prevention, Global Immunization Division, United States.
| | - Concepcion Estivariz
- Centers for Disease Control and Prevention, Global Immunization Division, United States
| | - Laxman Shrestha
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Arun Sharma
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Howard E Gary
- Centers for Disease Control and Prevention, Global Immunization Division, United States
| | - M Steven Oberste
- Centers for Disease Control and Prevention, Division of Viral Diseases, United States
| | - William C Weldon
- Centers for Disease Control and Prevention, Division of Viral Diseases, United States
| | - Michael D Bowen
- Centers for Disease Control and Prevention, Division of Viral Diseases, United States
| | - Jan Vinjé
- Centers for Disease Control and Prevention, Division of Viral Diseases, United States
| | | | - Abhijeet Anand
- Centers for Disease Control and Prevention, Global Immunization Division, United States
| | - Ondrej Mach
- Centers for Disease Control and Prevention, Global Immunization Division, United States
| | - Susan Y Chu
- Centers for Disease Control and Prevention, Global Immunization Division, United States
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24
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Strömbeck A, Lundell AC, Nordström I, Andersson K, Adlerberth I, Wold AE, Rudin A. Delayed adaptive immunity is related to higher MMR vaccine-induced antibody titers in children. Clin Transl Immunology 2016; 5:e75. [PMID: 27195118 PMCID: PMC4855269 DOI: 10.1038/cti.2016.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 01/06/2023] Open
Abstract
There are notable inter-individual variations in vaccine-specific antibody responses in vaccinated children. The aim of our study was to investigate whether early-life environmental factors and adaptive immune maturation prior and close to measles–mumps–rubella (MMR) immunization relate to magnitudes of vaccine-specific antibody titers. In the FARMFLORA birth cohort, including both farming and non-farming families, children were immunized with the MMR vaccine at 18 months of age. MMR vaccine-induced antibody titers were measured in plasma samples obtained at 36 months of age. Infants' blood samples obtained at birth, 3–5 days and at 4 and 18 months of age were analyzed for T- and B-cell numbers, proportions of naive and memory T and B cells, and fractions of putative regulatory T cells. Multivariate factor analyses show that higher anti-MMR antibody titers were associated with a lower degree of adaptive immune maturation, that is, lower proportions of memory T cells and a lower capacity of mononuclear cells to produce cytokines, but with higher proportions of putative regulatory T cells. Further, children born by cesarean section (CS) had significantly higher anti-measles titers than vaginally-born children; and CS was found to be associated with delayed adaptive immunity. Also, girls presented with significantly higher anti-mumps and anti-rubella antibody levels than boys at 36 months of age. These results indicate that delayed adaptive immune maturation before and in close proximity to immunization seems to be advantageous for the ability of children to respond with higher anti-MMR antibody levels after vaccination.
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Affiliation(s)
- Anna Strömbeck
- Department of Rheumatology and Inflammation Research at the Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Anna-Carin Lundell
- Department of Rheumatology and Inflammation Research at the Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Inger Nordström
- Department of Rheumatology and Inflammation Research at the Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Kerstin Andersson
- Department of Rheumatology and Inflammation Research at the Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Ingegerd Adlerberth
- Department of Infectious Diseases at the Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Agnes E Wold
- Department of Infectious Diseases at the Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research at the Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
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25
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Storrs C. As Oral Vaccines Fall Short In Low-Income Countries, Researchers Look For Solutions. Health Aff (Millwood) 2016; 35:317-21. [PMID: 26858386 DOI: 10.1377/hlthaff.2015.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Carina Storrs
- Carina Storrs is an independent journalist in New York City
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26
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Grassly NC, Kang G, Kampmann B. Biological challenges to effective vaccines in the developing world. Philos Trans R Soc Lond B Biol Sci 2016; 370:rstb.2014.0138. [PMID: 25964451 DOI: 10.1098/rstb.2014.0138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The reason for holding a meeting to discuss biological challenges to vaccines is simple: not all vaccines work equally well in all settings. This special issue reviews the performance of vaccines in challenging environments, summarizes current thinking on the reasons why vaccines underperform and considers what approaches are necessary to understand the heterogeneity in responses and to improve vaccine immunogenicity and efficacy.
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Affiliation(s)
- Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, Norfolk Place, London W2 1PG, UK The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Beate Kampmann
- Department of Medicine, Imperial College London, St Mary's Hospital, Norfolk Place, London W2 1PG, UK Vaccinology Theme, MRC Unit, The Gambia, Atlantic Road, Fajara, The Gambia
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27
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Praharaj I, John SM, Bandyopadhyay R, Kang G. Probiotics, antibiotics and the immune responses to vaccines. Philos Trans R Soc Lond B Biol Sci 2016; 370:rstb.2014.0144. [PMID: 25964456 DOI: 10.1098/rstb.2014.0144] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Orally delivered vaccines have been shown to perform poorly in developing countries. There are marked differences in the structure and the luminal environment of the gut in developing countries resulting in changes in immune and barrier function. Recent studies using newly developed technology and analytic methods have made it increasingly clear that the intestinal microbiota activate a multitude of pathways that control innate and adaptive immunity in the gut. Several hypotheses have been proposed for the underperformance of oral vaccines in developing countries, and modulation of the intestinal microbiota is now being tested in human clinical trials. Supplementation with specific strains of probiotics has been shown to have modulatory effects on intestinal and systemic immune responses in animal models and forms the basis for human studies with vaccines. However, most studies published so far that have evaluated the immune response to vaccines in children and adults have been small and results have varied by age, antigen, type of antibody response and probiotic strain. Use of anthelminthic drugs in children has been shown to possibly increase immunogenicity following oral cholera vaccination, lending further support to the rationale for modulation of the immune response to oral vaccination through the intestinal microbiome.
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Affiliation(s)
- Ira Praharaj
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Sushil M John
- Low Cost Effective Care Unit, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Rini Bandyopadhyay
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
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28
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Sutter RW, Bahl S, Deshpande JM, Verma H, Ahmad M, Venugopal P, Rao JV, Agarkhedkar S, Lalwani SK, Kunwar A, Sethi R, Takane M, Mohanty L, Chatterjee A, John TJ, Jafari H, Aylward RB. Immunogenicity of a new routine vaccination schedule for global poliomyelitis prevention: an open-label, randomised controlled trial. Lancet 2015; 386:2413-21. [PMID: 26388534 DOI: 10.1016/s0140-6736(15)00237-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Polio eradication needs a new routine immunisation schedule--three or four doses of bivalent type 1 and type 3 oral poliovirus vaccine (bOPV) and one dose of inactivated poliovirus vaccine (IPV), but no immunogenicity data are available for this schedule. We aimed to assess immunogenicity of this vaccine schedule. METHODS We did an open-label, randomised controlled trial in four centres in India. After informed consent was obtained from a parent or legally acceptable representative, healthy newborn babies were randomly allocated to one of five groups: trivalent OPV (tOPV); tOPV plus IPV; bOPV; bOPV plus IPV; or bOPV plus two doses of IPV (2IPV). The key eligibility criteria were: full-term birth (≥37 weeks of gestation); birthweight ≥2·5 kg; and Apgar score of 9 or more. OPV was administered at birth, 6 weeks, 10 weeks, and 14 weeks; IPV was administered intramuscularly at 14 weeks. The primary study objective was to investigate immunogenicity of the new vaccine schedule, assessed by seroconversion against poliovirus types 1, 2, and 3 between birth and 18 weeks in the per-protocol population (all participants with valid serology results on cord blood and at 18 weeks). Neutralisation assays tested cord blood and sera collected at 14 weeks, 18 weeks, 19 weeks, and 22 weeks by investigators masked to group allocation. This trial was registered with the India Clinical Trials Registry, number CTRI/2013/06/003722. FINDINGS Of 900 newborn babies enrolled between June 13 and Aug 29, 2013, 782 (87%) completed the per-protocol requirements. Between birth and age 18 weeks, seroconversion against poliovirus type 1 in the tOPV group occurred in 162 of 163 (99·4%, 95% CI 96·6-100), in 150 (98·0%, 94·4-99·6) of 153 in the tOPV plus IPV group, in 153 (98·7%, 95·4-99·8) of 155 in the bOPV group, in 155 (99·4%, 96·5-100) of 156 in the bOPV plus IPV group, and in 154 (99·4%, 96·5-100) of 155 in the bOPV plus 2IPV group. Seroconversion against poliovirus type 2 occurred in 157 (96·3%, 92·2-98·6) of 163 in the tOPV group, 153 (100%, 97·6-100·0) of 153 in the tOPV plus IPV group, 29 (18·7%, 12·9-25·7) of 155 in the bOPV group, 107 (68·6%, 60·7-75·8) of 156 in the bOPV plus IPV group, and in 121 (78·1%, 70·7-84·3) of 155 in the bOPV plus 2IPV group. Seroconversion against poliovirus type 3 was achieved in 147 (90·2%, 84·5-94·3) of 163 in the tOPV group, 152 (99·3%, 96·4-100) of 153 in the tOPV plus IPV group, 151 (97·4%, 93·5-99·3) of 155 in the bOPV group, 155 (99·4%, 96·5-100) of 156 in the bOPV plus IPV group, and 153 (98·7%, 95·4-99·8) of 155 in the bOPV plus 2IPV group. Superiority was achieved for vaccine regimens including IPV against poliovirus type 3 compared with those not including IPV (tOPV plus IPV vs tOPV alone, p=0·0008; and bOPV plus IPV vs bOPV alone, p=0·0153). 12 serious adverse events occurred (six in the tOPV group, one in the tOPV plus IPV group, three in the bOPV group, zero in the bOPV plus IPV group, and two in the bOPV plus 2IPV group), none of which was attributed to the trial intervention. INTERPRETATION The new vaccination schedule improves immunogenicity against polioviruses, especially against poliovirus type 3. FUNDING WHO, through a grant from Rotary International (grant number 59735).
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Affiliation(s)
| | - Sunil Bahl
- World Health Organization, India-National Polio Surveillance Project, New Delhi, India; World Health Organization, Regional Office for South East Asia, New Delhi, India
| | | | | | - Mohammad Ahmad
- World Health Organization, India-National Polio Surveillance Project, New Delhi, India
| | - P Venugopal
- Andhra Medical College, Visakhapatnam, India
| | | | | | - Sanjay K Lalwani
- Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Abhishek Kunwar
- World Health Organization, India-National Polio Surveillance Project, New Delhi, India
| | - Raman Sethi
- World Health Organization, India-National Polio Surveillance Project, New Delhi, India
| | | | | | - Arani Chatterjee
- Panacea Biotec Ltd, New Delhi, India; Biological E Ltd, Hyderabad, India
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Rao TS, Arora R, Khera A, Tate JE, Parashar U, Kang G. Insights from global data for use of rotavirus vaccines in India. Vaccine 2015; 32 Suppl 1:A171-8. [PMID: 25091672 DOI: 10.1016/j.vaccine.2014.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rotavirus vaccines are being introduced in several low- and middle-income countries across the world with and without support from the GAVI Alliance. India has the highest disease burden of rotavirus based on morbidity and mortality estimates and several indigenous vaccine manufacturers are developing rotavirus vaccines. One candidate has undergone phase III testing and others have completed evaluation in phase II. Global data on licensed vaccine performance in terms of impact on disease, strain diversity, safety and cost-effectiveness has been reviewed to provide a framework for decision making in India.
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Affiliation(s)
- T S Rao
- Department of Biotechnology, Ministry of Science and Technology, Government of India, CGO Complex, New Delhi, India
| | - Rashmi Arora
- Division of Epidemiology and Communicable Diseases, Indian Council for Medical Research, Ansari Nagar, New Delhi, India
| | - Ajay Khera
- Child Health and Immunization, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, India
| | - Jacqueline E Tate
- Viral Gastroenteritis Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh Parashar
- Viral Gastroenteritis Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India.
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30
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Hoest C, Seidman JC, Pan W, Ambikapathi R, Kang G, Kosek M, Knobler S, Mason CJ, Miller M. Evaluating associations between vaccine response and malnutrition, gut function, and enteric infections in the MAL-ED cohort study: methods and challenges. Clin Infect Dis 2015; 59 Suppl 4:S273-9. [PMID: 25305297 DOI: 10.1093/cid/ciu611] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Most vaccine assessments have occurred in well-nourished populations of higher socioeconomic status. However, vaccines are often used in populations with high incidences of malnutrition and infections, in whom the effectiveness of some vaccines is inferior for unknown reasons. The degree and extent of vaccine underperformance have not been systematically studied for most vaccines across differing epidemiologic settings. This paper outlines the methods used and challenges associated with measuring immunological responses to oral vaccines against poliovirus and rotavirus, and parenteral vaccines against pertussis, tetanus, and measles in an observational study that monitored daily illness, monthly growth, intestinal inflammation and permeability, pathogen burden, dietary intake, and micronutrient status in children in 8 countries. This evaluation of vaccine response in the context of low- and middle-income countries is intended to address the gaps in knowledge of the heterogeneity in vaccine response in diverse epidemiological settings and the interplay between infections, nutrition, and immune response.
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Affiliation(s)
- Christel Hoest
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Jessica C Seidman
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - William Pan
- Department of Environmental Science and Policy and the Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Ramya Ambikapathi
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | | | - Margaret Kosek
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stacey Knobler
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Carl J Mason
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Mark Miller
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
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31
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Adeniji JA, Osundare FA, Adewumi OM, Onoja AB, Fagbami AH. Immunity to poliovirus serotypes in children population of selected communities in South-west, Nigeria. Afr J Infect Dis 2015; 9:1-5. [PMID: 25722843 PMCID: PMC4325351 DOI: 10.4314/ajid.v9i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Poliovirus outbreaks are still reported in Nigeria despite renewed efforts to improve vaccine coverage, thus suggesting the existence of susceptible hosts. Also, there is anecdotal evidence of variation in vaccine coverage by region and specifically between urban and rural communities. Consequently, this study assessed neutralizing antibodies to poliovirus serotypes among children in selected urban and rural communities in south western Nigeria. METHODOLOGY Two hundred and forty-four {(M=119, F=125); Urban: 142 (M=63, F=79); Rural: 102 (M=56, F=46)} children of consenting parent/guardian aged one week to 15 years were enrolled for the study. About 2-3ml of blood was collected from each child by venepuncture into a labelled sterile container free of anticoagulants. Subsequently, questionnaire was administered to the parent/guardian of each child to retrieve relevant information. Recovered sera were analysed for detectable neutralizing antibodies to poliovirus serotypes by the standard method of constant virus, varying serum dilutions. RESULTS Overall, 64.3% (n=157) of the children had detectable neutralizing antibodies to the three poliovirus serotypes. Also, 84.8% (n=207), 91.0% (n=222) and 75.0% (n=183) of the children had detectable antibodies to poliovirus serotypes 1, 2 and 3 respectively. Eighty seven (35.7%) of the children had no detectable neutralizing antibody to at least one of the three poliovirus serotypes, while 9 (3.7%) children had no detectable neutralizing antibody to the three poliovirus serotypes. Geometric mean titre (GMT) of neutralizing antibodies to the three poliovirus serotypes varied significantly (p=0.0005). CONCLUSION Disparity in immunity to poliovirus infection and existence of children with low or zero neutralizing antibody levels were confirmed.
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Affiliation(s)
- Johnson Adekunle Adeniji
- Department of Virology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Folakemi Abiodun Osundare
- Department of Science Laboratory Technology, School of Applied Science, The Federal Polytechnic, Ede, Nigeria
| | - Olubusuyi Moses Adewumi
- Department of Virology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Anyebe Bernard Onoja
- Department of Virology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Ademola Hezekiah Fagbami
- Department of Biological Sciences, Faculty of Science, Ondo State University of Science and Technology, Okitipupa, Nigeria
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32
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Habib MA, Soofi S, Sheraz A, Bhatti ZS, Okayasu H, Zaidi SZ, Molodecky NA, Pallansch MA, Sutter RW, Bhutta ZA. Zinc supplementation fails to increase the immunogenicity of oral poliovirus vaccine: a randomized controlled trial. Vaccine 2014; 33:819-25. [PMID: 25500307 DOI: 10.1016/j.vaccine.2014.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 10/25/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polio eradication remains a challenge in Pakistan and the causes for the failure to eradicate poliomyelitis are complex. Undernutrition and micronutrient deficiencies, especially zinc deficiency, are major public health problems in Pakistan and could potentially affect the response to enteric vaccines, including oral poliovirus vaccine (OPV). OBJECTIVE To assess the impact of zinc supplementation among infants on immune response to oral poliovirus vaccine (OPV). METHODS A double-blind, randomized placebo-controlled trial was conducted in newborns (aged 0-14 days). Subjects were assigned to either receive 10mg of zinc or placebo supplementation daily for 18 weeks. Both groups received OPV doses at birth, at 6 weeks, 10 weeks and 14 weeks. Data was collected on prior immunization status, diarrheal episodes, breastfeeding practices and anthropometric measurements at recruitment and at 6 and 18 weeks. Blood samples were similarly collected to determine the antibody response to OPV and for micronutrient analysis. Logistic regression was used to determine the relationship between seroconversion and zinc status. RESULTS Overall, 404 subjects were recruited. At recruitment, seropositivity was already high for poliovirus (PV) serotype 1 (zinc: 91.1%; control: 90.5%) and PV2 (90.0%; 92.7%), with lower estimates for PV3 (70.0%; 64.8%). By week 18, the proportion of subjects with measured zinc levels in the normal range (i.e. ≥60 μg/dL) was significantly greater in the intervention group compared to the control group (71.9%; 27.4%; p<0.001). No significant difference in seroconversion was demonstrated between the groups for PV1, PV2, or PV3. CONCLUSIONS There was no effect of zinc supplementation on OPV immunogenicity. These conclusions were confirmed when restricting the analysis to those with measured higher zinc levels.
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Affiliation(s)
- M A Habib
- Aga Khan University, Karachi, Pakistan
| | - S Soofi
- Aga Khan University, Karachi, Pakistan
| | - A Sheraz
- Aga Khan University, Karachi, Pakistan
| | | | - H Okayasu
- WHO, Headquarters, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - S Z Zaidi
- National Institute of Health (NIH), Islamabad, Pakistan
| | - N A Molodecky
- WHO, Headquarters, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - M A Pallansch
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - R W Sutter
- WHO, Headquarters, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
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Swaminathan A, Lucas RM, Harley D, McMichael AJ. Will Global Climate Change Alter Fundamental Human Immune Reactivity: Implications for Child Health? CHILDREN (BASEL, SWITZERLAND) 2014; 1:403-23. [PMID: 27417487 PMCID: PMC4928742 DOI: 10.3390/children1030403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/07/2014] [Accepted: 10/12/2014] [Indexed: 12/31/2022]
Abstract
The human immune system is an interface across which many climate change sensitive exposures can affect health outcomes. Gaining an understanding of the range of potential effects that climate change could have on immune function will be of considerable importance, particularly for child health, but has, as yet, received minimal research attention. We postulate several mechanisms whereby climate change sensitive exposures and conditions will subtly impair aspects of the human immune response, thereby altering the distribution of vulnerability within populations-particularly for children-to infection and disease. Key climate change-sensitive pathways include under-nutrition, psychological stress and exposure to ambient ultraviolet radiation, with effects on susceptibility to infection, allergy and autoimmune diseases. Other climate change sensitive exposures may also be important and interact, either additively or synergistically, to alter health risks. Conducting directed research in this area is imperative as the potential public health implications of climate change-induced weakening of the immune system at both individual and population levels are profound. This is particularly relevant for the already vulnerable children of the developing world, who will bear a disproportionate burden of future adverse environmental and geopolitical consequences of climate change.
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Affiliation(s)
- Ashwin Swaminathan
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
- Departments of General Medicine and Infectious Diseases, Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory 2605, Australia
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory 0200, Australia
| | - Robyn M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, Australia
| | - David Harley
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
| | - Anthony J. McMichael
- National Centre for Epidemiology and Population Health, Australian National University, Corner of Mills and Eggleston Roads, Canberra, Australian Capital Territory 2601, Australia; E-Mails: ;
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Bobat S, Cunningham AF. Bacterial infections and vaccines. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 828:75-98. [PMID: 25253028 DOI: 10.1007/978-1-4939-1489-0_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- Saeeda Bobat
- The Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, West Midlands, UK,
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35
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Jafari H, Deshpande JM, Sutter RW, Bahl S, Verma H, Ahmad M, Kunwar A, Vishwakarma R, Agarwal A, Jain S, Estivariz C, Sethi R, Molodecky NA, Grassly NC, Pallansch MA, Chatterjee A, Aylward RB. Polio eradication. Efficacy of inactivated poliovirus vaccine in India. Science 2014; 345:922-5. [PMID: 25146288 PMCID: PMC10389671 DOI: 10.1126/science.1255006] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Inactivated poliovirus vaccine (IPV) is efficacious against paralytic disease, but its effect on mucosal immunity is debated. We assessed the efficacy of IPV in boosting mucosal immunity. Participants received IPV, bivalent 1 and 3 oral poliovirus vaccine (bOPV), or no vaccine. A bOPV challenge was administered 4 weeks later, and excretion was assessed 3, 7, and 14 days later. Nine hundred and fifty-four participants completed the study. Any fecal shedding of poliovirus type 1 was 8.8, 9.1, and 13.5% in the IPV group and 14.4, 24.1, and 52.4% in the control group by 6- to 11-month, 5-year, and 10-year groups, respectively (IPV versus control: Fisher's exact test P < 0.001). IPV reduced excretion for poliovirus types 1 and 3 between 38.9 and 74.2% and 52.8 and 75.7%, respectively. Thus, IPV in OPV-vaccinated individuals boosts intestinal mucosal immunity.
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Affiliation(s)
- Hamid Jafari
- World Health Organization, India-National Polio Surveillance Project, R. K. Khanna Stadium, Africa Avenue, Safdarjung Enclave, New Delhi 110029, India
| | | | | | - Sunil Bahl
- World Health Organization, India-National Polio Surveillance Project, R. K. Khanna Stadium, Africa Avenue, Safdarjung Enclave, New Delhi 110029, India
| | - Harish Verma
- World Health Organization, Ave Appia, Geneva, Switzerland
| | - Mohammad Ahmad
- World Health Organization, India-National Polio Surveillance Project, R. K. Khanna Stadium, Africa Avenue, Safdarjung Enclave, New Delhi 110029, India
| | - Abhishek Kunwar
- World Health Organization, India-National Polio Surveillance Project, R. K. Khanna Stadium, Africa Avenue, Safdarjung Enclave, New Delhi 110029, India
| | - Rakesh Vishwakarma
- World Health Organization, India-National Polio Surveillance Project, R. K. Khanna Stadium, Africa Avenue, Safdarjung Enclave, New Delhi 110029, India
| | - Ashutosh Agarwal
- World Health Organization, India-National Polio Surveillance Project, R. K. Khanna Stadium, Africa Avenue, Safdarjung Enclave, New Delhi 110029, India
| | | | | | - Raman Sethi
- World Health Organization, India-National Polio Surveillance Project, R. K. Khanna Stadium, Africa Avenue, Safdarjung Enclave, New Delhi 110029, India
| | | | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Abstract
Vaccines are now available to combat rotavirus, the most common cause of severe diarrhea among children worldwide. We review clinical trial data for available rotavirus vaccines and summarize postlicensure data on effectiveness, impact, and safety from countries routinely using these vaccines in national programs. In these countries, rotavirus vaccines have reduced all-cause diarrhea and rotavirus hospitalizations by 17%-55% and 49%-92%, respectively, and all-cause diarrhea deaths by 22%-50% in some settings. Indirect protection of children who are age-ineligible for rotavirus vaccine has also been observed in some high and upper middle income countries. Experience with routine use of rotavirus vaccines in lower middle income countries has been limited to date, but vaccine introductions in such countries have been increasing in recent years. The risk-benefit analysis of rotavirus vaccines is extremely favorable but other strategies to improve the effectiveness of the vaccine, particularly in lower middle income settings, should be considered.
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Affiliation(s)
- Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Böhles N, Böhles N, Busch K, Busch K, Hensel M, Hensel M. Vaccines against human diarrheal pathogens: current status and perspectives. Hum Vaccin Immunother 2014; 10:1522-35. [PMID: 24861668 PMCID: PMC5396248 DOI: 10.4161/hv.29241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 12/16/2022] Open
Abstract
Worldwide, nearly 1.7 billion people per year contract diarrheal infectious diseases (DID) and almost 760 000 of infections are fatal. DID are a major problem in developing countries where poor sanitation prevails and food and water may become contaminated by fecal shedding. Diarrhea is caused by pathogens such as bacteria, protozoans and viruses. Important diarrheal pathogens are Vibrio cholerae, Shigella spp. and rotavirus, which can be prevented with vaccines for several years. The focus of this review is on currently available vaccines against these three pathogens, and on development of new vaccines. Currently, various types of vaccines based on traditional (killed, live attenuated, toxoid or conjugate vaccines) and reverse vaccinology (DNA/mRNA, vector, recombinant subunit, plant vaccines) are in development or already available. Development of new vaccines demands high levels of knowledge, experience, budget, and time, yet promising new vaccines often fail in preclinical and clinical studies. Efficacy of vaccination also depends on the route of delivery, and mucosal immunization in particular is of special interest for preventing DID. Furthermore, adjuvants, delivery systems and other vaccine components are essential for an adequate immune response. These aspects will be discussed in relation to the improvement of existing and development of new vaccines against DID.
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Affiliation(s)
| | | | | | | | - Michael Hensel
- Abt. Mikrobiologie; Universität Osnabrück; Osnabrück, Germany
| | - Michael Hensel
- Abt. Mikrobiologie; Universität Osnabrück; Osnabrück, Germany
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Behrend MR, Hu H, Nigmatulina KR, Eckhoff P. A quantitative survey of the literature on poliovirus infection and immunity. Int J Infect Dis 2013; 18:4-13. [PMID: 24246740 DOI: 10.1016/j.ijid.2013.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/05/2013] [Accepted: 09/07/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To examine forces that drive vaccination policy to eradicate wild- and vaccine-derived poliovirus, and to focus on the efficacy of vaccines to support decision-making and further research. METHODS We searched PubMed and Ovid databases for English-language publications, without date restrictions. We also collected references from major reviews on polio vaccine immunogenicity or protection. We conducted a meta-analysis of human immunity to polio infections using multiple non-linear regression, and built a database from a broad (but not systematic) set of polio vaccine studies (46 studies, >10000 subjects). RESULTS The outcome was an immunological model representative of many different datasets. Parameters measured immunogenicity to both humoral and mucosal immune compartments for Salk and Sabin vaccines. The immunity model was more highly correlated with the data than a simpler per-dose efficacy model. CONCLUSIONS The model offers new insights for immunization policy. We measured the mucosal immunogenicity of IPV to a precision that is useful in decision-making for end-game polio immunization policies.
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Affiliation(s)
- Matthew R Behrend
- Intellectual Ventures Laboratory, 1555 132(nd) Ave. NE, Bellevue, WA 98005, USA.
| | - Hao Hu
- Intellectual Ventures Laboratory, 1555 132(nd) Ave. NE, Bellevue, WA 98005, USA
| | | | - Philip Eckhoff
- Intellectual Ventures Laboratory, 1555 132(nd) Ave. NE, Bellevue, WA 98005, USA
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39
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Duintjer Tebbens RJ, Pallansch MA, Chumakov KM, Halsey NA, Hovi T, Minor PD, Modlin JF, Patriarca PA, Sutter RW, Wright PF, Wassilak SGF, Cochi SL, Kim JH, Thompson KM. Expert review on poliovirus immunity and transmission. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2013; 33:544-605. [PMID: 22804479 PMCID: PMC7896540 DOI: 10.1111/j.1539-6924.2012.01864.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Successfully managing risks to achieve wild polioviruses (WPVs) eradication and address the complexities of oral poliovirus vaccine (OPV) cessation to stop all cases of paralytic poliomyelitis depends strongly on our collective understanding of poliovirus immunity and transmission. With increased shifting from OPV to inactivated poliovirus vaccine (IPV), numerous risk management choices motivate the need to understand the tradeoffs and uncertainties and to develop models to help inform decisions. The U.S. Centers for Disease Control and Prevention hosted a meeting of international experts in April 2010 to review the available literature relevant to poliovirus immunity and transmission. This expert review evaluates 66 OPV challenge studies and other evidence to support the development of quantitative models of poliovirus transmission and potential outbreaks. This review focuses on characterization of immunity as a function of exposure history in terms of susceptibility to excretion, duration of excretion, and concentration of excreted virus. We also discuss the evidence of waning of host immunity to poliovirus transmission, the relationship between the concentration of poliovirus excreted and infectiousness, the importance of different transmission routes, and the differences in transmissibility between OPV and WPV. We discuss the limitations of the available evidence for use in polio risk models, and conclude that despite the relatively large number of studies on immunity, very limited data exist to directly support quantification of model inputs related to transmission. Given the limitations in the evidence, we identify the need for expert input to derive quantitative model inputs from the existing data.
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40
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Habib MA, Soofi S, Ali N, Sutter R, Palansch M, Qureshi H, Akhtar T, Molodecky N, Okayasu H, Bhutta ZA. A study evaluating poliovirus antibodies and risk factors associated with polio seropositivity in low socioeconomic areas of Pakistan. Vaccine 2013; 31:1987-93. [DOI: 10.1016/j.vaccine.2013.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 01/21/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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Abstract
Renewed awareness of the substantial morbidity and mortality that Shigella infection causes among young children in developing countries, combined with technological innovations in vaccinology, has led to the development of novel vaccine strategies in the past 5 years. Along with advancement of classic vaccines in clinical trials and new sophisticated measurements of immunological responses, much new data has been produced, lending promise to the potential for production of safe and effective Shigella vaccines. Herein, we review the latest progress in Shigella vaccine development within the framework of persistent obstacles.
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Chen L, Liu WQ, Lei JH, Guan F, Li MJ, Song WJ, Li YL, Wang T. Chronic Schistosoma japonicum infection reduces immune response to vaccine against hepatitis B in mice. PLoS One 2012; 7:e51512. [PMID: 23272112 PMCID: PMC3522692 DOI: 10.1371/journal.pone.0051512] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 11/01/2012] [Indexed: 02/05/2023] Open
Abstract
Background Hepatitis B and schistosomiasis are most prevalent in Africa and Asia, and co-infections of both are frequent in these areas. The immunomodulation reported to be induced by schistosome infections might restrict immune control of hepatitis B virus (HBV) leading to more severe viral infection. Vaccination is the most effective measure to control and prevent HBV infection, but there is evidence for a reduced immune response to the vaccine in patients with chronic schistosomiasis japonica. Methodology/Principal Findings In this paper, we demonstrate in a mouse model that a chronic Schistosoma japonicum infection can inhibit the immune response to hepatitis B vaccine (HBV vaccine) and lead to lower production of anti-HBs antibodies, interferon-γ (IFN-γ) and interleukin-2 (IL-2). After deworming with Praziquantel (PZQ), the level of anti-HBs antibodies gradually increased and the Th2-biased profile slowly tapered. At 16 weeks after deworming, the levels of anti-HBs antibodies and Th1/Th2 cytokines returned to the normal levels. Conclusions/Significance The results suggest that the preexisting Th2-dominated immune profile in the host infected with the parasite may down–regulate levels of anti-HBs antibodies and Th1 cytokines. To improve the efficacy of HBV vaccination in schistosome infected humans it may be valuable to treat them with praziquantel (PZQ) some time prior to HBV vaccination.
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Affiliation(s)
- Lin Chen
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wuhan Institutes of Biomedical Sciences, Jianghan University, Wuhan, China
| | - Wen-qi Liu
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-hui Lei
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Guan
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man-jun Li
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-jian Song
- Department of Parasitology, Jianghan University, Wuhan, China
| | - Yong-long Li
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Wang
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Lopman BA, Pitzer VE, Sarkar R, Gladstone B, Patel M, Glasser J, Gambhir M, Atchison C, Grenfell BT, Edmunds WJ, Kang G, Parashar UD. Understanding reduced rotavirus vaccine efficacy in low socio-economic settings. PLoS One 2012; 7:e41720. [PMID: 22879893 PMCID: PMC3412858 DOI: 10.1371/journal.pone.0041720] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/25/2012] [Indexed: 11/24/2022] Open
Abstract
Introduction Rotavirus vaccine efficacy ranges from >90% in high socio-economic settings (SES) to 50% in low SES. With the imminent introduction of rotavirus vaccine in low SES countries, understanding reasons for reduced efficacy in these settings could identify strategies to improve vaccine performance. Methods We developed a mathematical model to predict rotavirus vaccine efficacy in high, middle and low SES based on data specific for each setting on incidence, protection conferred by natural infection and immune response to vaccination. We then examined factors affecting efficacy. Results Vaccination was predicted to prevent 93%, 86% and 51% of severe rotavirus gastroenteritis in high, middle and low SES, respectively. Also predicted was that vaccines are most effective against severe disease and efficacy declines with age in low but not high SES. Reduced immunogenicity of vaccination and reduced protection conferred by natural infection are the main factors that compromise efficacy in low SES. Discussion The continued risk of severe disease in non-primary natural infections in low SES is a key factor underpinning reduced efficacy of rotavirus vaccines. Predicted efficacy was remarkably consistent with observed clinical trial results from different SES, validating the model. The phenomenon of reduced vaccine efficacy can be predicted by intrinsic immunological and epidemiological factors of low SES populations. Modifying aspects of the vaccine (e.g. improving immunogenicity in low SES) and vaccination program (e.g. additional doses) may bring improvements.
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Affiliation(s)
- Benjamin A. Lopman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Virginia E. Pitzer
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Rajiv Sarkar
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Beryl Gladstone
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manish Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Glasser
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Manoj Gambhir
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- MRC Center for Outbreaks Analysis and Modelling, Imperial College London, London, United Kingdom
| | - Christina Atchison
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan T. Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - W. John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gagandeep Kang
- MRC Center for Outbreaks Analysis and Modelling, Imperial College London, London, United Kingdom
| | - Umesh D. Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Tate JE, Patel MM, Cortese MM, Lopman BA, Gentsch JR, Fleming J, Steele AD, Parashar UD. Remaining issues and challenges for rotavirus vaccine in preventing global childhood diarrheal morbidity and mortality. Expert Rev Vaccines 2012; 11:211-20. [PMID: 22309669 DOI: 10.1586/erv.11.184] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rotavirus vaccines have had a dramatic impact on morbidity and mortality from diarrhea among children in high- and middle-income countries that have introduced the vaccine into their national immunization programs. Widespread introduction of rotavirus vaccine in developing countries is imminent and their full potential in reducing the global burden from severe childhood diarrhea may soon be realized. The objectives of this paper are to describe the remaining issues and challenges in ensuring the success of the global rotavirus vaccination program and to discuss further research needed to help address them.
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Affiliation(s)
- Jacqueline E Tate
- Centers for Disease Control and Prevention, 1600 Clifton Road, NE MS-A34, Atlanta, GA 30333, USA.
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45
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Sow SO, Tapia M, Haidara FC, Ciarlet M, Diallo F, Kodio M, Doumbia M, Dembélé RD, Traoré O, Onwuchekwa UU, Lewis KD, Victor JC, Steele AD, Neuzil KM, Kotloff KL, Levine MM. Efficacy of the oral pentavalent rotavirus vaccine in Mali. Vaccine 2012; 30 Suppl 1:A71-8. [DOI: 10.1016/j.vaccine.2011.11.094] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/18/2011] [Accepted: 11/23/2011] [Indexed: 01/23/2023]
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46
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Grassly NC, Jafari H, Bahl S, Sethi R, Deshpande JM, Wolff C, Sutter RW, Aylward RB. Waning intestinal immunity after vaccination with oral poliovirus vaccines in India. J Infect Dis 2012; 205:1554-61. [PMID: 22448007 DOI: 10.1093/infdis/jis241] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The eradication of wild-type polioviruses in areas with efficient fecal-oral transmission relies on intestinal mucosal immunity induced by oral poliovirus vaccine (OPV). Mucosal immunity is thought to wane over time but the rate of loss of protection has not been examined. METHODS We examined the degree and duration of intestinal mucosal immunity in India by measuring the prevalence of vaccine poliovirus in stool samples collected 4-28 days after a "challenge" dose of OPV among 47 574 children with acute flaccid paralysis reported during 2005-2009. RESULTS Previous vaccination with OPV was protective against excretion of vaccine poliovirus after challenge, but the odds of excretion increased significantly with the time since the child was last exposed to an immunization activity (odds ratio, 1.39 [95% confidence interval .99-1.97], 2.04 [1.28-3.25], and 1.31 [1.00-1.70] comparing ≥6 months with 1 month ago for serotypes 1, 2, and 3, respectively). Vaccine administered during the high season for enterovirus infections (April-September) was significantly less likely to result in excretion, especially in northern states (odds ratio, 0.57 [95% confidence interval, .50-.65], 0.58 [.41-.81], and 0.48 [.40-.57] for serotypes 1, 2, and 3). CONCLUSIONS Infection with OPV (vaccine "take") is highly seasonal in India and results in intestinal mucosal immunity that appears to wane significantly within a year of vaccination.
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Affiliation(s)
- Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
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The mechanisms and consequences of ultraviolet-induced immunosuppression in the skin and eye. Eye Contact Lens 2011; 37:176-84. [PMID: 21709488 DOI: 10.1097/icl.0b013e31821d7573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultraviolet radiation (UVR) of the skin results in immune suppression to antigens encountered shortly after the exposure. The pathways leading to the downregulation in immunity are complex, initiated by chromophores located at the surface of the skin and ending with the generation of immunosuppressive mediators and regulatory cells. Ultraviolet-induced immunosuppression can be considered not only as beneficial, such as in preventing chronic inflammatory responses and allergic and automimmune reactions, but it can also be detrimental, such as in the lack of control of skin tumors and infectious diseases. The eye is an immune privileged site through a wide variety of mechanisms that allow selected immune responses without causing inflammation. The role of UVR in altering immune responses in the eye is not clear and is discussed in relation to photokeratitis, herpetic stromal keratitis, and pterygium.
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48
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Levine MM. “IDEAL” vaccines for resource poor settings. Vaccine 2011; 29 Suppl 4:D116-25. [DOI: 10.1016/j.vaccine.2011.11.090] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/18/2011] [Accepted: 11/23/2011] [Indexed: 12/22/2022]
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49
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Mucosal immunity and poliovirus vaccines: Impact on wild poliovirus infection and transmission. Vaccine 2011; 29:8205-14. [DOI: 10.1016/j.vaccine.2011.08.059] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/21/2011] [Accepted: 08/01/2011] [Indexed: 01/03/2023]
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50
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The challenges of UV-induced immunomodulation for children's health. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2011; 107:323-32. [PMID: 21875613 DOI: 10.1016/j.pbiomolbio.2011.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 02/01/2023]
Abstract
Exposure to solar ultraviolet radiation (UVR) is recognised to have both beneficial and harmful effects on human health. With regard to immune responses, it can lead to suppression of immunity and to the synthesis of vitamin D, a hormone that can alter both innate and adaptive immunity. The consequences in children of such UV-induced changes are considerable: first there are positive outcomes including protection against some photoallergic (for example polymorphic light eruption) and T cell-mediated autoimmune diseases (for example multiple sclerosis) and asthma, and secondly there are negative outcomes including an increased risk of skin cancer (squamous cell carcinoma, basal cell carcinoma and cutaneous malignant melanoma) and less effective control of several infectious diseases. Many uncertainties remain regarding the amount of sun exposure that would provide children with the most effective responses against the variety of immunological challenges that they are likely to experience.
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