Landscape Analysis of Interactions between Nutrition and Vaccine Responses in Children

Savy, Mathilde; Edmond, Karen; Fine, Paul E. M.; Hall, Andrew J.; Hennig, Branwen J.; Moore, Sophie E.; Mulholland, Kim; Schaible, Ulrich E.; Prentice, Andrew M.

doi:10.3945/jn.109.105312

Cited by 132 publications

(156 citation statements)

References 177 publications

(251 reference statements)

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“…[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

“…Several abnormalities in immune function have been linked with malnutrition, including deficits in secretory IgA, complement production, gut barrier function and T-cell memory maintenance, among others [107]. In spite of these immunological deficits, a consistent link between malnutrition and oral vaccine performance has not been found [108,109]. A recent study among infants in Bangladesh documented significantly lower serotype 3 poliovirus antibody titers in conjunction with underweight (weight-for-age Z score ≤2) after at least three doses of OPV [65].…”

Section: Malnutrition and Micronutrient Deficienciesmentioning

confidence: 99%

“…Data regarding the potential impact of malnutrition on oral vaccines other than OPV are limited [108]. During a trial of CVD 103-HgR in Bangladesh, supplementation with zinc (but not vitamin A) significantly boosted vibriocidal antibody response [118].…”

Section: Malnutrition and Micronutrient Deficienciesmentioning

confidence: 99%

“…However, other studies in India, Nigeria and Pakistan have not observed an association between malnutrition and OPV immunogenicity [110][111][112]. Similarly, supplementation with vitamin A did not significantly impact OPV seroconversion rates during trials in Bangladesh, Indonesia and Ghana [113][114][115], while the receipt of zinc supplements (which are known to have a significant therapeutic effect during the treatment of acute gastroenteritis [116]) had no effect on OPV seroconversion during a recent placebo-controlled trial in Pakistan [117].Data regarding the potential impact of malnutrition on oral vaccines other than OPV are limited [108]. During a trial of CVD 103-HgR in Bangladesh, supplementation with zinc (but not vitamin A) significantly boosted vibriocidal antibody response [118].…”

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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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Section: Conclusion and Future Perspectiveunclassified

Section: Malnutrition and Micronutrient Deficienciesmentioning

confidence: 99%

Section: Malnutrition and Micronutrient Deficienciesmentioning

confidence: 99%

mentioning

confidence: 99%

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Causes of Impaired Oral Vaccine Efficacy in Developing Countries

et al. 2017

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“…Therefore, it is the intricate interplay between these variables that results in a particular metabolic state, and a key question is how immunity to vaccination is affected by such metabolic states. There are several studies documenting impaired immune responses associated with obesity (69,70) and undernutrition (71)(72)(73). Systems vaccinology offers a promising way to dissect the molecular mechanisms that result in impaired vaccine immunity in such abnormal conditions.…”

Section: Vaccines For Which There Are No Knownmentioning

confidence: 99%

Systems vaccinology: Probing humanity’s diverse immune systems with vaccines

Pulendran

2014

Proc. Natl. Acad. Sci. U.S.A.

177

123

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Homo sapiens are genetically diverse, but dramatic demographic and socioeconomic changes during the past century have created further diversification with respect to age, nutritional status, and the incidence of associated chronic inflammatory disorders and chronic infections. These shifting demographics pose new challenges for vaccination, as emerging evidence suggests that age, the metabolic state, and chronic infections can exert major influences on the immune system. Thus, a key public health challenge is learning how to reprogram suboptimal immune systems to induce effective vaccine immunity. Recent advances have applied systems biological analysis to define molecular signatures induced early after vaccination that correlate with and predict the later adaptive immune responses in humans. Such "systems vaccinology" approaches offer an integrated picture of the molecular networks driving vaccine immunity, and are beginning to yield novel insights about the immune system. Here we discuss the promise of systems vaccinology in probing humanity's diverse immune systems, and in delineating the impact of genes, the environment, and the microbiome on protective immunity induced by vaccination. Such insights will be critical in reengineering suboptimal immune systems in immunocompromised populations.

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