Effect of breastfeeding on immunogenicity of oral live-attenuated human rotavirus vaccine: a randomized trial in HIV-uninfected infants in Soweto, South Africa

Groome, Michelle; Moon, Sung-Sil; Velásquez, Daniel E.; Jones, Stephanie; Koen, Anthonet; Niekerk, Nadia van; Jiang, Baoming; Parashar, Umesh D.; Madhi, Shabir А.

doi:10.2471/blt.13.128066

Cited by 79 publications

(63 citation statements)

References 25 publications

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“…While several trials have observed a reduction in immunogenicity among breastfed infants [66,67], the effect has typically been modest. Recent trials of Rotarix in South Africa, India and Pakistan did not document a significant improvement in seroconversion rate in conjunction with the temporary withholding of breastfeeding immediately before and after vaccination [49,68,69]. Indeed, in the latter study Rotarix immunogenicity was significantly higher among infants who were breastfed at the time of immunization [69].…”

Section: Breastfeedingmentioning

confidence: 69%

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Causes of Impaired Oral Vaccine Efficacy in Developing Countries

et al. 2017

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Oral vaccines are less immunogenic when given to infants in low-income compared with high-income countries, limiting their potential public health impact. Here, we review factors that might contribute to this phenomenon, including transplacental antibodies, breastfeeding, histo blood group antigens, enteric pathogens, malnutrition, microbiota dysbiosis and environmental enteropathy. We highlight several clear risk factors for vaccine failure, such as the inhibitory effect of enteroviruses on oral poliovirus vaccine. We also highlight the ambiguous and at times contradictory nature of the available evidence, which undoubtedly reflects the complex and interconnected nature of the factors involved. Mechanisms responsible for diminished immunogenicity may be specific to each oral vaccine. Interventions aiming to improve vaccine performance may need to reflect the diversity of these mechanisms. Enteric pathogens are a substantial threat to public health. This threat takes many forms, from the toxin-producing bacteria (e.g., Vibrio cholerae) and flagellated protozoa (e.g., Giardia lamblia) that colonize the mucosal surface of the small intestine to the enteroviruses that are capable of spreading via the bloodstream to the CNS, causing acute flaccid paralysis (e.g., poliovirus). Each year, enteric pathogens cause hundreds of millions of cases of diarrhea and approximately 800,000 deaths, the vast majority of which occur among children in low-income countries [1]. The most common causes of childhood diarrheal morbidity include rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli and Shigella [2].Vaccines against enteric pathogens are important tools for mitigating this disease burden. Oral vaccines offer several distinct benefits compared with parenteral vaccines. They can be produced in large quantities at relatively low cost, are easy to administer and have the capacity to induce local immunity in the intestinal mucosa, thereby protecting vaccinated individuals against subsequent infection and -by blocking onward transmission -enhancing herd immunity [3,4]. Currently licensed oral vaccines include live-attenuated poliovirus vaccines containing one, two or three serotypes, live-attenuated rotavirus vaccines (Rotarix R , RotaTeq R , Lanzhou lamb rotavirus vaccine [China only] and Rotavac R [India only]), live-attenuated cholera vaccine (CVD 103-HgR or Vaxchora TM ), inactivated cholera vaccines (Dukoral R and Shanchol R ) and live-attenuated typhoid vaccine (Ty21a). Other oral vaccines are in development, including those against Shigella, enterotoxigenic E. coli, Campylobacter and Clostridium difficile, as well as several novel rotavirus vaccine candidates (including the human neonatal vaccine RV3-BB [5] and an oral bovine pentavalent vaccine [6]).Yet oral vaccines have an Achilles' heel -their immunogenicity and efficacy is impaired in low-income countries that experience the greatest burden of enteric disease (Box 1). For example, Rotarix has a 1-year protective efficacy against severe rotavirus-associated gas...

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Section: Breastfeedingmentioning

confidence: 69%

“…[65], [98], [108], [135], [171], [196] [67], [133][134][135], [198][199][200][201] [8], [181], [182], [201], [203], [204] [28], [92], [93], [128], [131], [137], [138], [140], [130], [131], [157], [202] [ [43][44][45], [49], [61][62][63][64][65][66][67][68][69][70], [197] [ [155][156][157] [28], [98], [170][171][172]…”

Section: Conclusion and Future Perspectiveunclassified

Causes of Impaired Oral Vaccine Efficacy in Developing Countries

et al. 2017

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Section: Hypotheses For Reduced Efficacy Of Rotavirus Vaccines In Devmentioning

confidence: 99%

“…38,39 However, 2 studies demonstrated no impact of withholding breast feeding around the time of rotavirus vaccination on seroconversion rates in South African or Indian infants. 39,40 A more recent study in Mexican infants once again demonstrated that breastfeeding was associated with reduced immune responses to rotavirus vaccines. 41 These findings suggest that the inhibitory effect of breast milk constituents while less applicable than originally thought, at least upon humoral immune responses, remain a potential factor behind reduced immunogenicity and efficacy of rotavirus vaccines.…”

Section: Hypotheses For Reduced Efficacy Of Rotavirus Vaccines In Devmentioning

confidence: 99%

Options for improving effectiveness of rotavirus vaccines in developing countries

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Cowley

Bogdanovic-Sakran

et al. 2017

Human Vaccines & Immunotherapeutics

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Rotavirus gastroenteritis is a leading global cause of mortality and morbidity in young children due to diarrhea and dehydration. Over 85% of deaths occur in developing countries. In industrialised countries, 2 live oral rotavirus vaccines licensed in 2006 quickly demonstrated high effectiveness, dramatically reducing severe rotavirus gastroenteritis admissions in many settings by more than 90%. In contrast, the same vaccines reduced severe rotavirus gastroenteritis by only 30-60% in developing countries, but have been proven life-saving. Bridging this "efficacy gap" offers the possibility to save many more lives of children under the age of 5. The reduced efficacy of rotavirus vaccines in developing settings may be related to differences in transmission dynamics, as well as host luminal, mucosal and immune factors. This review will examine strategies currently under study to target the issue of reduced efficacy and effectiveness of oral rotavirus vaccines in developing settings.

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“…The immunogenicity of RV using the 6-and 14-week schedule, including with the first dose being administered concurrently with the oral polio vaccine, has also been confirmed. [16] Coverage with PCV and RV The National Department of Health monitors the EPI programme performance using routine data submitted through the District Health Information System (DHIS). Coverage for a particular vaccine is calculated by dividing the number of doses that are reported to have been administered (predominantly in primary healthcare facilities) by the target population (based on mid-year population estimates published by Statistics South Africa and derived from census data).…”

Section: Pcv and Rv Dosing Schedule In Samentioning

confidence: 99%