Transfer of antirotaviral antibodies from mothers to their infants

Spatial and temporal key steps in early-life intestinal immune system development and education

Education of our intestinal immune system early in life strongly influences adult health. This education strongly relies on series of events that must occur in well-defined time windows. From initial colonization by maternal-derived microbiota during delivery to dietary changes from mother's milk to solid foods at weaning, these early-life events have indeed long-standing consequences on our immunity, facilitating tolerance to environmental exposures or, on the contrary, increasing the risk of developing noncommunicable diseases such as allergies, asthma, obesity, and inflammatory bowel diseases. In this review, we provide an outline of the recent advances in our understanding of these events and how they are mechanistically related to intestinal immunity development and education. First, we review the susceptibility of neonates to infections and inflammatory diseases, related to their immune system and microbiota changes. Then, we highlight the maternal factors involved in protection and education of the mucosal immune system of the offspring, the role of the microbiota, and the nature of neonatal immune system until weaning. We also present how the development of some immune responses is intertwined in temporal and spatial windows of opportunity. Finally, we discuss pending questions regarding the neonate particular immune status and the activation of the intestinal immune system at weaning.

Overview of the Development, Impacts, and Challenges of Live-Attenuated Oral Rotavirus Vaccines

Safety, efficacy, and cost-effectiveness are paramount to vaccine development. Following the isolation of rotavirus particles in 1969 and its evidence as an aetiology of severe dehydrating diarrhoea in infants and young children worldwide, the quest to find not only an acceptable and reliable but cost-effective vaccine has continued until now. Four live-attenuated oral rotavirus vaccines (LAORoVs) (Rotarix^®, RotaTeq^®, Rotavac^®, and RotaSIIL^®) have been developed and licensed to be used against all forms of rotavirus-associated infection. The efficacy of these vaccines is more obvious in the high-income countries (HIC) compared with the low- to middle-income countries (LMICs); however, the impact is far exceeding in the low-income countries (LICs). Despite the rotavirus vaccine efficacy and effectiveness, more than 90 countries (mostly Asia, America, and Europe) are yet to implement any of these vaccines. Implementation of these vaccines has continued to suffer a setback in these countries due to the vaccine cost, policy, discharging of strategic preventive measures, and infrastructures. This review reappraises the impacts and effectiveness of the current live-attenuated oral rotavirus vaccines from many representative countries of the globe. It examines the problems associated with the low efficacy of these vaccines and the way forward. Lastly, forefront efforts put forward to develop initial procedures for oral rotavirus vaccines were examined and re-connected to today vaccines.

Contribution of Maternal Immunity to Decreased Rotavirus Vaccine Performance in Low- and Middle-Income Countries

The role of maternal immunity, received by infants either transplacentally or orally from breast milk, in rotavirus vaccine (RV) performance is evaluated here. Breastfeeding withholding has no effect on vaccine responses, but higher levels of transplacental rotavirus-specific IgG antibody contribute to reduced vaccine seroconversion. The gaps in knowledge on the factors associated with low RV efficacy in low- and middle-income countries (LMIC) remain, and further research is needed to shed more light on these issues.

Breast Milk and Solid Food Shaping Intestinal Immunity

After birth, the intestinal immune system enters a critical developmental stage, in which tolerogenic and pro-inflammatory cells emerge to contribute to the overall health of the host. The neonatal health is continuously challenged by microbial colonization and food intake, first in the form of breast milk or formula and later in the form of solid food. The microbiota and dietary compounds shape the newborn immune system, which acquires the ability to induce tolerance against innocuous antigens or induce pro-inflammatory immune responses against pathogens. Disruption of these homeostatic mechanisms might lead to undesired immune reactions, such as food allergies and inflammatory bowel disease. Hence, a proper education and maturation of the intestinal immune system is likely important to maintain life-long intestinal homeostasis. In this review, the most recent literature regarding the effects of dietary compounds in the development of the intestinal immune system are discussed.

Reduced rotavirus vaccine effectiveness among children born during the rotavirus season: a pooled analysis of 5 case-control studies from the Americas

Using data from rotavirus vaccine effectiveness (VE) studies, we assessed whether rotavirus season modifies rotavirus VE in infants. In the first year of life, adjusted VE was 72% for children born during rotavirus season and 84% for children born in other months (P = .01). Seasonal factors may interfere with vaccine performance.

Influenza vaccination during early pregnancy contributes to neurogenesis and behavioral function in offspring

Prenatal influenza virus infection has been associated with an increased risk of schizophrenia. Thus, inactivated flu vaccines are widely recommended for pregnant women. In a mouse model of pregnancy, immune activation via exposure to viruses or lipopolysaccharide (LPS) impaired brain development and behavioral function in offspring. The objective of our study was to determine if flu vaccination as an immune activation could affect postnatal neurogenesis and behavior. Female C57BL/6J mice were administered A(H1N1) influenza vaccine (AIV) or seasonal influenza vaccine (SIV) early in pregnancy. We found that the offspring of vaccinated mice, especially AIV group, presented superior performance in terms of exploratory behavior and spatial ability compared with controls at postnatal day 28 (P28), but at P56, there was no significance differences among these pups. Quantification of BrdU(+)/DCX(+) and BrdU(+)/NeuN(+) cells in the dentate gyrus (DG) indicated an increase in the hippocampal neurogenesis of the pups born to both vaccinated mothers. The cytokine levels in both the serum and hippocampus changed to varying degrees. Furthermore, administration of the A(H1N1) vaccine blocked LPS-induced cognitive impairment in the progeny. Altogether, the results suggest that maternal influenza vaccination promotes neurogenesis and behavioral function, as well as protection from LPS insults in the developing offspring.

Absence of genetic differences among G10P[11] rotaviruses associated with asymptomatic and symptomatic neonatal infections in Vellore, India

Rotaviruses (RVs) are leading causes of severe diarrhea and vomiting in infants and young children. RVs with G10P[11] genotype specificity have been associated with symptomatic and asymptomatic neonatal infections in Vellore, India. To identify possible viral genetic determinants responsible for differences in symptomology, the genome sequences of G10P[11] RVs in stool samples of 19 neonates with symptomatic infections and 20 neonates with asymptomatic infections were determined by Sanger and next-generation sequencing. The data showed that all 39 viruses had identical genotype constellations (G10-P[11]-I2-R2-C2-M2-A1-N1-T1-E2-H3), the same as those of the previously characterized symptomatic N155 Vellore isolate. The data also showed that the RNA and deduced protein sequences of all the Vellore G10P[11] viruses were nearly identical; no nucleotide or amino acid differences were found that correlated with symptomatic versus asymptomatic infection. Next-generation sequencing data revealed that some stool samples, both from neonates with symptomatic infections and from neonates with asymptomatic infections, also contained one or more positive-strand RNA viruses (Aichi virus, astrovirus, or salivirus/klassevirus) suspected of being potential causes of pediatric gastroenteritis. However, none of the positive-strand RNA viruses could be causally associated with the development of symptoms. These results indicate that the diversity of clinical symptoms in Vellore neonates does not result from genetic differences among G10P[11] RVs; instead, other undefined factors appear to influence whether neonates develop gastrointestinal disease symptoms.

IMPORTANCE

Rotavirus (RV) strains have been identified that preferentially replicate in neonates, in some cases, without causing gastrointestinal disease. Surveillance studies have established that G10P[11] RVs are a major cause of neonatal infection in Vellore, India, with half of infected neonates exhibiting symptoms. We used Sanger and next-generation sequencing technologies to contrast G10P[11] RVs recovered from symptomatic and asymptomatic neonates. Remarkably, the data showed that the RNA genomes of the viruses were virtually indistinguishable and lacked any differences that could explain the diversity of clinical outcomes among infected Vellore neonates. The sequencing results also indicated that some symptomatic and some asymptomatic Vellore neonates were infected with other enteric viruses (Aichi virus, astrovirus, salvirus/klassevirus); however, none could be correlated with the presence of symptoms in neonates. Together, our findings suggest that other poorly defined factors, not connected to the genetic makeup of the Vellore G10P[11] viruses, influence whether neonates develop gastrointestinal disease symptoms.

Maternal antibodies to rotavirus: could they interfere with live rotavirus vaccines in developing countries?

INTRODUCTION

Past experience with live oral vaccines including licensed rotavirus vaccines demonstrates a trend towards reduced vaccine efficacy in developing countries compared with developed countries. The reasons behind this disparity are not well understood. Transplacental transfer of maternal antibodies and breast milk ingestion may attenuate vaccine responses in infants in developing countries where rotavirus infections are endemic, and maternal antibody levels are high. We examined the prevalence and level of rotavirus antibody in maternal and cord serum, colostrum and breast milk in a developing country setting.

METHODS

100 mother-infant pairs were prospectively recruited from December 2008 to February 2009 at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Maternal and cord sera were collected during delivery. Colostrum and transitional breast milk were collected between day 0-3 and day 7-10 postpartum respectively. Rotavirus-specific IgA and IgG were estimated for all specimens and virus neutralization assays were conducted on a subset of milk specimens.

RESULTS

All maternal and cord serum samples were positive for rotavirus-specific IgG antibodies with a strong correlation between levels of rotavirus-specific IgG in mothers and levels transferred to infants in cord blood (r=0.86; p=0.001). 78% of colostrum and 67% of transitional breast milk specimens were positive for rotavirus-specific IgA. There was a median 4-fold decrease in rotavirus-specific IgA from colostrum to transitional breast milk. Neutralizing antibodies were present in 56% of colostrum specimens assayed (19/34) and in 41% of transitional milk specimens assayed (14/34).

CONCLUSIONS

Maternal serum and breast milk antibodies to rotavirus are highly prevalent in a developing country setting. Evaluation of the impact of maternal anti-rotavirus serum and breast milk antibody upon vaccine immunogenicity would help to inform rotavirus vaccination strategies, especially in developing settings.

A mathematical model of the indirect effects of rotavirus vaccination

Rotavirus (RV) infections progressively confer natural immunity against subsequent infection. Similarly to natural infection, vaccination with a live attenuated vaccine potentially reduces RV transmission and induces herd protection. A mathematical transmission model was developed to project the impact of a vaccination programme on the incidence of RV infection and disease for five countries in the European Union. With vaccination coverage rates of 70%, 90% and 95% the model predicted that, in addition to the direct effect of vaccination, herd protection induced a reduction in RV-related gastroenteritis (GE) incidence of 25%, 22% and 20%, respectively, for RV-GE of any severity, and of 19%, 15%, and 13%, respectively, for moderate-to-severe RV-GE, 5 years after implementation of a vaccination programme.

Prevention of the murine model of biliary atresia after live rotavirus vaccination of dams

PURPOSE

Biliary atresia (BA) is a neonatal disease that results in the obliteration of the biliary tree. The murine model of BA has been established where rhesus rotavirus (RRV) infection of newborn mice leads to an obstructive cholangiopathy. We determined whether maternal postconception rotavirus vaccination could prevent the murine model of BA.

MATERIALS AND METHODS

Female mice were mated and injected intraperitoneally with one of the following materials: purified rotavirus strains RRV or Wa, high or low-dose Rotateq (Merck and Co Inc, Whitehouse Station, NJ) (a pentavalent rotavirus vaccine [PRV]), purified recombinant viral antigens of rotavirus (VP6) or influenza (NP), or saline. B-cell-deficient females also underwent postconception PRV injection.

RESULTS

Maternal vaccination with PRV improves survival of pups infected with RRV. Serum rotavirus IgG, but not IgA, levels were increased in pups delivered from dams who received RRV, Wa, PRV, or VP6, but in the case of the Wa, PRV, and VP6 groups, these antibodies were not neutralizing. Postconception injection of high-dose PRV did not improve survival of pups born to B-cell-deficient dams.

CONCLUSION

Maternal vaccination against RRV can prevent the rotavirus-induced murine model of BA in newborn mouse pups.

Absence of infliximab in infants and breast milk from nursing mothers receiving therapy for Crohn's disease before and after delivery

GOALS

The objective of this study was to determine whether infliximab, an antitumor necrosis factor monoclonal antibody, is transferred in utero or through breast milk from nursing Crohn's disease patients to their newborns.

BACKGROUND

Crohn's disease most often occurs in women of childbearing age. Many of these women receive treatment for their disease, but are advised to terminate therapy while pregnant or nursing.

STUDY

Three patients diagnosed with Crohn's disease who had a history of infliximab use during and after pregnancy were followed prospectively. Patients received 5-mg/kg infliximab at regular intervals until approximately gestational week 30, and resumed infliximab treatment within 3 to 14 days after giving birth. Serum samples from patients and children and breast milk samples were collected postpartum. The concentration of infliximab in the serum and milk samples was measured using an enzyme-linked immmunosorbent assay.

RESULTS

The levels of infliximab detected in the mothers' serum samples postpartum were 74.27, 62.62, and 59.97 microg/mL, respectively. However, infliximab was undetectable (<0.10 microg/mL) in the sera of the newborn children. Likewise, infliximab was undetectable in the breast milk of the nursing mothers.

CONCLUSIONS

Infliximab was detected in the mothers' sera, but not in the breast milk of nursing mothers or in the sera of the breast-fed newborns. Data from this small series of patients suggest that infliximab was not transferred from mother to child, either in utero or through breast milk. These data suggest that mothers receiving infliximab should not be discouraged from nursing their children.

Absence of infliximab in infants and breast milk from nursing mothers receiving therapy for Crohn's disease before and after delivery

GOALS

The objective of this study was to determine whether infliximab, an antitumor necrosis factor monoclonal antibody, is transferred in utero or through breast milk from nursing Crohn's disease patients to their newborns.

BACKGROUND

Crohn's disease most often occurs in women of childbearing age. Many of these women receive treatment for their disease, but are advised to terminate therapy while pregnant or nursing.

STUDY

Three patients diagnosed with Crohn's disease who had a history of infliximab use during and after pregnancy were followed prospectively. Patients received 5-mg/kg infliximab at regular intervals until approximately gestational week 30, and resumed infliximab treatment within 3 to 14 days after giving birth. Serum samples from patients and children and breast milk samples were collected postpartum. The concentration of infliximab in the serum and milk samples was measured using an enzyme-linked immmunosorbent assay.

RESULTS

The levels of infliximab detected in the mothers' serum samples postpartum were 74.27, 62.62, and 59.97 microg/mL, respectively. However, infliximab was undetectable (<0.10 microg/mL) in the sera of the newborn children. Likewise, infliximab was undetectable in the breast milk of the nursing mothers.

CONCLUSIONS

Infliximab was detected in the mothers' sera, but not in the breast milk of nursing mothers or in the sera of the breast-fed newborns. Data from this small series of patients suggest that infliximab was not transferred from mother to child, either in utero or through breast milk. These data suggest that mothers receiving infliximab should not be discouraged from nursing their children.

Acute viral hepatitis morbidity and mortality associated with hepatitis E virus infection: Uzbekistan surveillance data

Background

In Uzbekistan, routine serologic testing has not been available to differentiate etiologies of acute viral hepatitis (AVH). To determine the age groups most affected by hepatitis E virus (HEV) during documented AVH epidemics, trends in AVH-associated mortality rate (MR) per 100,000 over a 15-year period and reported incidence of AVH over a 35-year period were examined.

Methods

Reported AVH incidence data from 1971 to 2005 and AVH-associated mortality data from 1981 to 1995 were examined. Serologic markers for infection with hepatitis viruses A, B, D, and E were determined from a sample of hospitalized patients with AVH from an epidemic period (1987) and from a sample of pregnant women with AVH from a non-epidemic period (1992).

Results

Two multi-year AVH outbreaks were identified: one during 1975–1976, and one during 1985–1987. During 1985–1987, AVH-associated MRs were 12.3–17.8 per 100,000 for the general population. Highest AVH-associated MRs occurred among children in the first 3 years of life (40–190 per 100,000) and among women aged 20–29 (15–21 per 100,000). During 1988–1995 when reported AVH morbidity was much lower in the general population, AVH-associated MRs were markedly lower among these same age groups. In 1988, AVH-associated MRs were higher in rural (21 per 100,000) than in urban (8 per 100,000) populations (RR 2.6; 95% CI 1.16–5.93; p < 0.05). Serologic evidence of acute HEV infection was found in 280 of 396 (71%) patients with AVH in 1987 and 12 of 99 (12%) pregnant patients with AVH in 1992.

Conclusion

In the absence of the availability of confirmatory testing, inferences regarding probable hepatitis epidemic etiologies can sometimes be made using surveillance data, comparing AVH incidence with AVH-associated mortality with an eye to population-based viral hepatitis control measures. Data presented here implicate HEV as the probable etiology of high mortality observed in pregnant women and in children less than 3 years of age in Uzbekistan during 1985–1987. High mortality among pregnant women but not among children less than 3 years has been observed in previous descriptions of epidemic hepatitis E. The high mortality among younger children observed in an AVH outbreak associated with hepatitis E merits corroboration in future outbreaks.

Development of intestinal microbiota in mice and its possible interaction with the evolution of luminal IgA in the intestine

The development of the intestinal microbiota and the evolution of the fecal IgA in mice were analyzed from 18 to 40 days old by PCR temperature gradient gel electrophoresis (TGGE) and ELISA, respectively. There were two events for the diversification of the intestinal microbiota from suckling to maturity. The first change occurred between days 21 and 22 after birth, when the diversity of the intestinal microbiota showed a remarkable increase at this time. The second change occurred from days 27 to 30 after birth, and the increase in the diversity of the intestinal microbiota ceased. The amount of fecal IgA decreased from days 18 to 20, remained low until day 22, on day 23, it recovered and then continued to increase. This study suggests that there are possible interactions between the development of intestinal microbiota and the evolution of intestinal secretion of IgA in mice, the same as in rats, although the second change in mice intestinal microbiota occurred a few days later than in rats. The decline in maternal IgA supply as the suckling period proceeded presumably allowed the bacterial colonization. As a consequence of this increase in bacterial colonization, the secretion of the self-SIgA was accelerated in the pups.

Chapter 9 Infections caused by rubella, reoviridae, retro, Norwalk and ronaviruses

This chapter focuses on infections caused by rubella, reoviridae, retro, Norwalk and coronaviruses. High incidence of acute gastroenteritis caused by rotaviruses calls for prophylactic and therapeutic measures. Although no vaccine is presently available, it seems likely that vaccines will be developed in the next few years. There are also several rotavirus enzymes useful as targets for antiviral drugs. However, no antiviral drugs have shown therapeutic effects against rotavirus infections. The newly discovered human retrovirus (HTLV) has not yet been investigated in such detail as to predict the usefulness of vaccine or antiviral drugs. Several compounds are known to inhibit other retrovirus enzymes but the implication of this for chemotherapy of HTLV infection is unknown at present. The possibility and need for vaccination or chemotherapy against Norwalk virus and related agents is unclear. Very little work has been carried out to date with human coronaviruses, either from the point of view of vaccine development or specific antivirals. Both approaches may be usefully investigated in the future. Genetic cloning may be particularly useful for development of inactivated vaccines because the virus itself would be difficult to replicate and purify in large quantities for conventional vaccines.

Anti-rotavirus antibodies in human milk: quantification and neutralizing activity

OBJECTIVE

To analyze anti-rotavirus antibodies in human milk in order to determine their isotypes and neutralizing activity on rotavirus strains representing different viral serotypes.

METHODS

One hundred seventy-three milk samples (65 colostrum, 55 transitional milk and 53 mature milk) obtained from 65 mothers were analyzed along with 49 serum samples collected just before delivery. Total immunoglobulin A (IgA) and rotavirus-specific IgA and immunoglobulins G (IgG) antibodies were determined in milk and serum by enzyme-linked immunosorbent assay. Neutralizing activity was evaluated by an immunoperoxidase focus reduction assay. Milk IgA was purified by binding to the lectin jacalin, elution and ultrafiltration.

RESULTS

Total IgA antibodies were detected in all serum and milk samples analyzed. IgA levels decreased sharply during the replacement of colostrum by transitional milk, and more gradually from transitional to mature milk. These differences in IgA concentration during the 3 periods were statistically significant. Anti-rotavirus antibodies detected in human milk were exclusively of the IgA type, whereas both IgA and IgG anti-rotavirus antibodies were present in serum samples. Both milk and serum samples showed in vitro neutralization of the infectivity of rotavirus strains SA11, Wa and VA70, this activity being stronger toward the human rotavirus strain Wa. No correlation was however found between the inhibitory effect on rotavirus and the concentrations of IgA in human milk and serum samples.

CONCLUSION

Anti-rotavirus antibodies are only partly responsible for the neutralizing activity detected in milk and serum. This result suggests that other components possessing suppressive activity against rotavirus must also be present.

Measurement of antirotavirus IgM/IgA/IgG responses in the serum samples of Indian children following rotavirus diarrhoea and their mothers

Rotavirus specific, serum IgM/IgA/IgG levels among hospitalized children and their respective mothers were determined. Children were grouped as having rotavirus diarrhoea (RVD) and non-rotavirus diarrhoea (NRVD) on the basis of fecal excretion measured by ELISA and RT-PCR. Although IgM seropositivity was observed among children of both the groups, it was significantly higher in the acute as well as convalescent phase serum samples (P < 0.05 for both) of RVD group. Five out of ten acute sera from the NRVD group were positive for IgM and seven showed IgA/IgG seroconversion indicating rotavirus infection among these children in the past. It was noted that, three out of 24 mothers' sera from RVD group, showed presence of IgM in the serum collected during convalescence of their children. The observation suggests, subclinical rotavirus infection among mothers probably contacted from their children. This is supported by the seroconversion for IgA/IgG among these three mothers. Such a phenomenon was not noticed among the mothers from NRVD group. In general, IgA positivity did not vary significantly among the children from both the groups. IgA seropositivity was significantly higher (P < 0.001) from children of RVD group as compared to healthy group of children following rotavirus infection. From RVD group, all the child patients and 12 mothers out of 24 (50%) showed IgA/IgG seroconversion. None of the mothers from NRVD group showed seroconversion. Serum samples of healthy children and adults, showed IgM positivity at equal level (10%), but a significant difference (P < 0.01) was observed in IgA positivity. In conclusion, subclinical transmission of rotavirus infection from children to their mothers may occur. Seroconversion alone cannot be considered as a marker of rotavirus diarrhoea in children. Moreover, about 40-50% of subjects lacked rotavirus specific IgA at protective levels, making them susceptible to rotavirus infection.

Epidemiology of rotavirus infection in Thailand

Rotavirus is a major cause of acute severe diarrhea in children worldwide and an important cause of death among young children in developing countries. Group A rotaviruses are antigenically complex and multiple serotypes infect humans. Reassortant rotavirus vaccines are now available which offer protection against severe illness caused by rotavirus serotypes G1-4. Before vaccines are introduced into target populations, it is necessary to establish the baseline data of the epidemiology of rotavirus infection in those countries. The purpose of the present study is to provide information related to the epidemiology of rotavirus infection in Thailand. All rotavirus studies performed in Thailand were found through Medline and Thai Index Medicus searches. A total of 26 of the most relevant studies published in international and national journals are reviewed. Most studies reported that the prevalence of rotavirus infection in Thailand was 27-34%, although a few studies have reported a prevalence above this range. The peak seasonal distribution of rotavirus infection among children hospitalized with diarrhea in Thailand was seen in the dry cool seasons: October to February. The prevalence of rotavirus infection was most frequently found in children aged 6-11 months up to 2 years. G1 was the most prevalent serotype in Thailand, followed by G2, G4 and G3, respectively. At least three G serotypes, mostly G1, G2 and G4, are seen to coexist in Thailand each epidemic year and in some studies all four G-serotypes were reported in the same epidemics. In a 1996-1997 study, G9 was the third prevailing serotype after G1 and G2, respectively. These results indicate that rotavirus epidemics occur in Thailand every year and children are the most affected population. In Thailand, although G1-G4 have been reported, G1 is the most prevalent serotype in each epidemic and G9 is becoming increasingly common.

Characterisation of the primary local and systemic immune response in gnotobiotic lambs against rotavirus infection

This study characterised the primary immune response in gnotobiotic lambs after infection with a lamb rotavirus (RV). Lambs were infected and killed over a 7 week period together with controls. RV-ELISA and neutralising antibodies were determined in serum, nasal secretions, and intestinal scrapings. RV-antibody secreting cells (ASC) were enumerated in blood. Lymphocyte proliferations were determined in blood and gut-associated lymphoid tissues and cytokine expression was analysed in jejunal Peyer's patches (JPPs) and mesenteric lymph nodes (MLNs). Infected lambs cleared the virus by 8-9 days after infection without showing any clinical signs. The first indication of a specific immune response to RV was an increased expression of IL-4 mRNA in the JPPs in the infected group compared to the control group 3 days after infection. Rotavirus-specific IgA ASC in blood and IgA antibodies in serum and nasal secretions were detected from 7 days after infection followed at 10 days after infection by RV-specific IgG ASC and antibodies. Rotavirus-specific IgA antibodies were not detected in intestinal scrapings in the first 10 days after infection, but were detected by 52 days after infection. No RV-specific neutralising antibodies were seen in the intestine during the course of the experiment.

Serum IgA immune response to individual rotavirus polypeptides in young children with rotavirus infection

A human IgA-radioimmunoprecipitation assay (IgA-RIPA) utilizing the galactose-binding lectin jacalin from the jack-fruit Artrocarpus integrifolia was developed. Among the human immunoglobulins, jacalin binds specifically to immunoglobulin A. The IgA-RIPA was used to characterize the serum IgA response to individual rotavirus polypeptides in nine paired sera from children (8-34 months of age) with an acute rotavirus infection. In acute sera the IgA response was mainly directed against the inner capsid proteins VP2 and VP6, with VP2 surprisingly being the most immunogenic protein while in the convalescent sera, the IgA response was directed not only against structural but also against non-structural proteins.

Adenovirus infection and specific secretory IgA responses in the intestine of infants

We investigated adenovirus (Ad) infection of the intestine and Ad group-specific fecal IgA antibody responses in seven infants who were followed up from birth to 16 months to seven years of age. We isolated in tissue culture from fecal samples not only enteric Ad type 41 but also other Ads (types 2, 3, 5, 6, and 12). We also detected Ad antigens in the feces by ELISA at the times of infection with even non-enteric Ads, suggesting that a large amount of antigens were produced in the intestine. We found that repeated Ad infections with different serotypes were occurring and there were good fecal IgA antibody responses at each time. The infection seemed usually mild or asymptomatic: only one out of 23 occasions of the detected infections required hospitalization.

Antibodies to seven rotavirus serotypes in cord sera, maternal sera, and colostrum of German women

Forty percent of colostrum samples from German women showed neutralizing antibody titers of greater than or equal to 50 to rotavirus (RV) serotypes 1, 3, 4, and 6. Antibody to serotypes 2, 8, and 9 was less prevalent. Titers are, however, too low to indicate an important effect of colostrum on the RV vaccine take rate. On the other hand, about 50% of the cord serum samples showed high neutralizing-antibody titers to serotypes 1, 3, and 4, which could interfere with the take rate of RV vaccines based on these serotypes in very young infants.

Circulating and breast-milk anti-rotaviral antibodies and neonatal rotavirus infections: a maternal-neonatal study

In view of the high prevalence of rotavirus (RV) diarrhoea in Indian (Asian) infants in South Africa, a hospital-based study of 124 mothers and their neonates was carried out to establish the prevalence of maternal and neonatal circulating anti-RV antibodies, RV antibodies in breast-milk, and neonatal RV infections in this population. Thirty-four per cent of the mothers and 38% of the neonates had complement-fixing (CF) serum antibodies. There was a significant correlation between maternal and cord blood antibody levels (p less than 0.001; chi-square test). Fifteen per cent of hospital-born newborns showed asymptomatic RV excretion while still in hospital, mostly at 2-6 days of age, but some even earlier, with two shedding the virus before the age of 24 h. This excretion occurred in both seronegative and seropositive babies. The breast-milk of only 3.2% of the mothers was positive for CF-anti-RV antibodies, implying that either these were not present in the breast-milk or that the CF-test employed was not sufficiently sensitive for detecting these antibodies in milk specimens. Eighteen (18.2%) of 99 infants followed up showed evidence of RV infection 1-7 months after birth; none was symptomatic; 12 excreted RV in the stools while 6 others seroconverted. Asymptomatic reinfection was documented in 4 of 14 babies who had been infected initially as neonates.

Human viral gastroenteritis

During the last 15 years, several different groups of fastidious viruses that are responsible for a large proportion of acute viral gastroenteritis cases have been discovered by the electron microscopic examination of stool specimens. This disease is one of the most prevalent and serious clinical syndromes seen around the world, especially in children. Rotaviruses, in the family Reoviridae, and fastidious fecal adenoviruses account for much of the viral gastroenteritis in infants and young children, whereas the small caliciviruses and unclassified astroviruses, and possibly enteric coronaviruses, are responsible for significantly fewer cases overall. In addition to electron microscopy, enzyme immunoassays and other rapid antigen detection systems have been developed to detect rotaviruses and fastidious fecal adenoviruses in the stool specimens of both nonhospitalized patients and those hospitalized for dehydration and electrolyte imbalance. Experimental rotavirus vaccines have also been developed, due to the prevalence and seriousness of rotavirus infection. The small, unclassified Norwalk virus and morphologically similar viruses are responsible for large and small outbreaks of acute gastroenteritis in older children, adolescents, and adults. Hospitalization of older patients infected with these viruses is usually not required, and their laboratory diagnoses have been limited primarily to research laboratories.

Use of serotype-specific monoclonal antibodies to study the epidemiology of rotavirus infection

The development of an enzyme immunoassay (EIA) capable of serotyping human rotavirus (HRV) in faecal extracts has enabled us to retrospectively study the epidemiology of rotavirus infection in Melbourne. Of 552 stored specimens obtained from individuals with rotavirus-associated gastroenteritis between 1975 and 1986, the serotype could be determined in 62%. Infection was most prevalent in two groups, neonates and children aged between 12 and 24 months. In these groups infection was due to different serotypes, type 1 in older children and an untypable virus in infants. Serotype 1 strains were detected in greater numbers than the other serotypes and circulated in each year of the study. Serotype 2 rotaviruses were associated with a large epidemic in 1978, but have been detected only rarely since.

Neutralizing monoclonal antibodies to human rotavirus and indications of antigenic drift among strains from neonates

Cells producing neutralizing monoclonal antibodies to a serotype 3 human neonatal rotavirus strain RV-3 were derived by fusion of hyperimmunized mouse spleen cells with mouse myeloma cells. As ascites fluid, three rotavirus-neutralizing monoclonal antibodies were characterized by hemagglutination inhibition and reacted with 17 cultivable mammalian rotaviruses representing five virus serotypes, by fluorescent focus neutralization and enzyme immunoassay. Two antibodies, Mab RV-3:1 and Mab RV-3:2, reacted with the seven serotype 3 rotaviruses only. Mab RV-3:1 was shown to bind to the outer capsid glycoprotein gp34 of rotavirus when variants of SA 11 rotavirus were used, and it therefore appears to react with the major neutralization epitope of serotype 3 rotaviruses. The antibody Mab RV-3:3 was specific for an epitope of RV-3 rotavirus not present on any other rotavirus of any serotype tested, including another neonatal isolate of identical RNA electropherotype isolated from the same ward of the same hospital as RV-3 3 months earlier. These two viruses were also distinguishable by fluorescent focus neutralization, using antiserum to RV-3 virus. Western blot analysis showed binding of Mab RV-3:3 to the trypsin cleavage product of the outer capsid protein p86 of RV-3. This suggests that antigenic drift may have occurred among neonatal rotaviruses in Melbourne. These monoclonal antibodies will be useful in serotyping assays of rotaviruses directly in stool samples, and in further analysis of antigenic variation within the serotype.

Faecal and pharyngeal shedding of rotavirus and rotavirus IgA in children with diarrhoea

In 70 children 0-4 years of age with acute diarrhoea, the shedding of rotavirus and the excretion of rotavirus-specific IgA antibody in the stools were examined throughout the period of clinical symptoms. Quantitative detection of rotavirus and IgA was performed by an ELISA technique. The maximal rotavirus shedding was found between the second and fifth day and the maximal excretion of IgA antibody about the seventh day, which marked the clinical recovery of most children. Throat swabs were examined for both virus particles and specific IgA antibody to try to document the respiratory spread of rotavirus infection. Rotavirus antigen could not be demonstrated in the throat swabs, but specific IgA antibody was detected at levels comparable to the faecal specimens obtained at clinical recovery. The observations indicate that the presence of rotavirus secretory IgA limits the duration of diarrhoea and plays a major role in the intestinal resistance to infection.

Virus-specific immunity in neonatal and adult mouse rotavirus infection

Mouse rotavirus (epizootic diarrhea of infant mice) was used as a model to study the role of virus-specific immunity in infection and diarrheal disease. The distribution of viral antigen in intestinal tissues was determined by immunofluorescent staining with anti-simian rotavirus (SA-11) serum. The location and proportion of antigen-positive cells appeared to vary as a function of time postinfection and age of the animal at the time of infection. In animals infected at 1 and 7 days of age, antigen-positive cells (5 to 25%) were first detected (1 day postinfection) in the proximal segment of the small intestine, and infection progressed to the middle and distal segments. At 10 days postinfection, virus-infected cells were no longer observed in the proximal segment. In animals infected at 21 days of age (disease-free), a significantly lower proportion of cells were antigen positive (2 to 5%), and they were restricted to the middle and distal segments of the small intestine. Infection, defined according to the presence of virus and viral antigens in intestinal tissues and by seroconversion in the immunoglobulin M (IgM) isotype as determined by enzyme-linked immunosorbent assay with SA-11 antigen, was observed for all age groups (neonatal to adult), even in the presence of virus-specific serum or intestinal immunoglobulins. On the other hand, diarrheal disease was not detected in neonatal mice (1 to 3 days old) positive for passively acquired virus-specific intestinal IgG. The presence of virus-specific IgA in the intestinal tract at the time of infection did not protect from subsequent diarrheal disease. Virus-specific, cell-mediated immunity, determined by a delayed-type hypersensitivity response, did not develop in neonatal mice infected at 5 and 12 days of age. Reinfection of adult mice was associated with suppression of virus-specific delayed-type hypersensitivity and a significant decrease in the titers of the virus-specific serum IgG and IgA.

Studies on human lacteal rotavirus antibodies by immune electron microscopy

In vitro studies carried out by immune electron microscopy (IEM) indicate that rotavirus aggregation detected in the stools of newborn breast-fed infants with rotavirus infection is antibody-induced. Aggregation of rotavirus particles occurred with the IgA-containing fraction of expressed breast milk (EBM) obtained five days postpartum and with the IgA- and IgG-containing fractions of a pool of EBMs containing samples collected 2-3 days postpartum. Bovine milk fractions also demonstrated this activity in the IgG- and IgA-containing fraction. Studies on unfractionated EBMs from a mother who experienced a rotavirus infection during the 43rd week of lactation showed that following rotavirus infection all three major classes of rotavirus-specific antibodies were present in breast milk, this being confirmed by enzyme immunoassay.

Effects of antibodies, trypsin, and trypsin inhibitors on susceptibility of neonates to rotavirus infection

Levels of antirotaviral secretory immunoglobulin A were measured by enzyme-linked immunosorbent assay in colostrum and milk samples collected daily for the first 5 days postpartum from 49 mothers breast-feeding their infants. The trypsin-inhibitory capacity of these lacteal secretion samples was assessed by their ability to inhibit the hydrolysis of alpha-N-benzoyl-DL-arginine-p-nitroanilide by trypsin. Stools passed by these breast-fed infants and by an additional 43 bottle-fed infants were pooled by individual and examined by electron microscopy for rotavirus. Stool trypsin levels were estimated with the gelatin hydrolysis test. Breast-fed infants were significantly less likely to become infected with rotavirus and showed significantly lower stool tryptic activity than did bottle-fed infants. Breast-fed infants who did not excrete rotavirus over the 5-day period received milk of significantly higher antirotaviral secretory immunoglobulin A or trypsin-inhibitory capacity or both than breast-fed infants who were infected with rotavirus. A case of probable maternal rotavirus infection during pregnancy, producing greatly elevated lacteal antirotaviral secretory immunoglobulin A levels lasting for 2 years, was detected. Results of this study suggest that both antibodies and trypsin inhibitors in human milk can be associated with the protection of neonates against rotavirus infection in the first 5 days of life.

Measurement of immunoglobulin A, G, and M class rotavirus antibodies in serum and mucosal secretions

A solid-phase, enzyme-linked immunospecific assay for measurement of different immunoglobulin classes of human rotavirus antibodies is described. The antigen, which was adsorbed directly to polyvinyl microtiter plates, consisted of a clarified cell culture stock of the simian rotavirus SA 11. The assay was sensitive and reproducible and could readily be calibrated to determine concentrations of each class of antibody. The assay was applied to measurements of rotavirus antibodies in serum, colostrum, milk, and fecal samples. It particularly facilitates investigations of the role of immunoglobulin A antibodies in immunity to rotavirus infections.