Impact of enterovirus and other enteric pathogens on oral polio and rotavirus vaccine performance in Bangladeshi infants

Taniuchi, Mami; Platts-Mills, James A; Begum, Sharmin; Mj, Uddin; Sobuz, Shihab U.; Liu, Jie; Kirkpatrick, Beth D.; Colgate, E. Ross; Carmolli, Marya P.; Dickson, Dorothy M.; Nayak, Uma; Haque, Rashidul; Petri, William A.; Houpt, Eric R.

doi:10.1016/j.vaccine.2016.04.080

Cited by 94 publications

(106 citation statements)

References 37 publications

(45 reference statements)

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“…36 A study conducted in 2016 also revealed that Bangladeshi infants with detectable enterovirus infection at the time of their first dose of the Rotarix vaccine demonstrated lower rotavirus-specific serum IgA responses, lower rates of seroconversion and higher rates of rotavirus gastroenteritis. 37 These findings support the hypothesis that concurrent enteric infections may reduce the immunogenicity and efficacy of rotavirus vaccines.…”

Section: Hypotheses For Reduced Efficacy Of Rotavirus Vaccines In Devsupporting

confidence: 70%

Options for improving effectiveness of rotavirus vaccines in developing countries

Tissera

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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Section: Hypotheses For Reduced Efficacy Of Rotavirus Vaccines In Devsupporting

confidence: 70%

Options for improving effectiveness of rotavirus vaccines in developing countries

Tissera

Cowley

Bogdanovic-Sakran

et al. 2017

Human Vaccines & Immunotherapeutics

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“…The association between the presence of NPEVs and OPV immunogenicity has since been confirmed by studies in south India [28] and Bangladesh [131] that used sensitive PCR-based methods for the detection of multiple enteric pathogens, including enteroviruses, at the time of OPV administration. In the latter study, enterovirus quantity at 10 weeks of age was also negatively correlated with the immunogenicity and efficacy of Rotarix (administered at 10 and 17 weeks) -an effect that was not observed for any other viral, bacterial or eukaryotic pathogen, or for Sabin polioviruses [131]. Thus, the negative repercussions of enterovirus exposure for oral vaccines may extend beyond OPV.…”

Section: Enteric Infectionsmentioning

confidence: 89%

“…In a systematic review of OPV trials dating back to 1959, the presence of NPEVs at the time of vaccination (detected in stool samples in the absence of symptoms) was consistently associated with a reduction in the odds of seroconversion per dose of OPV, though it remains unclear whether this inhibitory effect varies among enterovirus species [130]. The association between the presence of NPEVs and OPV immunogenicity has since been confirmed by studies in south India [28] and Bangladesh [131] that used sensitive PCR-based methods for the detection of multiple enteric pathogens, including enteroviruses, at the time of OPV administration. In the latter study, enterovirus quantity at 10 weeks of age was also negatively correlated with the immunogenicity and efficacy of Rotarix (administered at 10 and 17 weeks) -an effect that was not observed for any other viral, bacterial or eukaryotic pathogen, or for Sabin polioviruses [131].…”

Section: Enteric Infectionsmentioning

confidence: 98%

“…Concurrent diarrhea has consistently been linked with a reduction in the immunogenicity of OPV [21,130,136]. Several studies have also highlighted the potential inhibitory effect of bacterial or eukaryotic pathogens on OPV, often in the absence of gastrointestinal symptoms [131,137,138]. However, a 3-day course of azithromycin (a broad-spectrum macrolide antibiotic) did not alter the immunogenicity of a subsequent dose of type 3 monovalent OPV among 6-11 month-old infants in India despite reducing the prevalence of bacterial pathogens (including Campylobacter, Salmonella and several pathotypes of E. coli) [28].…”

Section: Enteric Infectionsmentioning

confidence: 99%

“…An inhibitory association between Helicobacter pylori colonization and CVD 103-HgR response has been reported among Chilean children <5 years of age, but not in children aged 5-9 years [93]. Notably, this species is rarely documented among children <1 year of age, and is therefore unlikely to influence the immunogenicity of oral vaccines administered in early infancy [28,131]. During a placebo-controlled trial among…”

mentioning

confidence: 99%

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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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Association of Rotavirus Vaccines With Reduction in Rotavirus Gastroenteritis in Children Younger Than 5 Years

Sun

et al. 2021

JAMA Pediatr

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IMPORTANCERotavirus vaccines have been introduced worldwide, and the clinical association of different rotavirus vaccines with reduction in rotavirus gastroenteritis (RVGE) after introduction are noteworthy.OBJECTIVE To evaluate the comparative benefit, risk, and immunogenicity of different rotavirus vaccines by synthesizing randomized clinical trials (RCTs) and observational studies.DATA SOURCES Relevant studies published in 4 databases: Embase, PubMed, the Cochrane Library, and Web of Science were searched until July 1, 2020, using search terms including "rotavirus" and "vaccin*."STUDY SELECTION Randomized clinical trials and cohort and case-control studies involving more than 100 children younger than 5 years that reported the effectiveness, safety, or immunogenicity of rotavirus vaccines were included. DATA EXTRACTION AND SYNTHESISA random-effects model was used to calculate relative risks (RRs), odds ratios (ORs), risk differences, and 95% CIs. Adjusted indirect treatment comparison was performed to assess the differences in the protection of Rotarix and RotaTeq. MAIN OUTCOMES AND MEASURESThe primary outcomes were RVGE, severe RVGE, and RVGE hospitalization. Safety-associated outcomes involved serious adverse events, intussusception, and mortality. RESULTSA meta-analysis of 20 RCTs and 38 case-control studies revealed that Rotarix (RV1) significantly reduced RVGE (RR, 0.316 [95% CI, 0.224-0.345]) and RVGE hospitalization risk (OR, 0.347 [95% CI, 0.279-0.432]) among children fully vaccinated; RotaTeq (RV5) had similar outcomes (RVGE: RR, 0.350 [95% CI, 0.275-0.445]; RVGE hospitalization risk: OR, 0.272 [95% CI,). Rotavirus vaccines also demonstrated higher protection against severe RVGE. Additionally, no significant differences in the protection of RV1 and RV5 against rotavirus disease were noted in adjusted indirect comparisons. Moderate associations were found between reduced RVGE risk and Rotavac (RR, 0.664 [95% CI, 0.548-0.804]), Rotasiil (RR, 0.705 [95% CI, 0.605-0.821]), and Lanzhou lamb rotavirus vaccine (RR, 0.407 [95% CI, 0.332-0.499]). All rotavirus vaccines demonstrated no risk of serious adverse events. A positive correlation was also found between immunogenicity and vaccine protection (eg, association of RVGE with RV1: coefficient, −1.599; adjusted R 2 , 99.7%). CONCLUSIONS AND RELEVANCEThe high protection and low risk of serious adverse events for rotavirus vaccines in children who were fully vaccinated emphasized the importance of worldwide introduction of rotavirus vaccination. Similar protection provided by Rotarix and RotaTeq relieves the pressure of vaccines selection for health care authorities.

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Impact of enterovirus and other enteric pathogens on oral polio and rotavirus vaccine performance in Bangladeshi infants

Abstract: HighlightsOral vaccines exhibit poor performance in low-income settings.Enterovirus and Campylobacter carriage are associated with lower OPV immunogenicity.Enterovirus carriage is associated with lower Rotarix immunogenicity and efficacy.

Cited by 94 publications

References 37 publications

Options for improving effectiveness of rotavirus vaccines in developing countries

Options for improving effectiveness of rotavirus vaccines in developing countries

Causes of Impaired Oral Vaccine Efficacy in Developing Countries

Association of Rotavirus Vaccines With Reduction in Rotavirus Gastroenteritis in Children Younger Than 5 Years

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