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Oral polio vaccine response in breast fed infants with malnutrition and diarrhea.

ABSTRACT: Oral vaccines for polio (OPV) and rotavirus are less effective in children in the developing world. The reasons for this are not well understood. We tested for risk factors for poor response to OPV in infants from an urban slum of Dhaka, Bangladesh. Diminished serum neutralizing response to OPV, but not failure of intramuscularly administered vaccines, was associated with malnutrition, diarrhea, and shorter breastfeeding duration. Children with malnutrition (WAZ <-2) had significantly lower OPV 3 titers (p=0.029). Children who had 2 or more diarrhea episodes during the 1st months of life were more than twice as likely to experience OPV failure as those who had 1 diarrhea episode or no diarrhea (p=0.0245). In contrast, each additional month in exclusive breastfeeding was associated with an increase in OPV 3 titer by 0.41 (p=0.0072) and 0.16 (p=0.0065) at the 25th and 50th percentiles of OPV 3 titers respectively. These data are consistent with a defect in induction of immunity in the gut for OPV but not parenteral vaccines, a defect that may be amenable to intervention in part via promotion of exclusive breastfeeding.

SUBMITTER: Haque R

PROVIDER: S-EPMC4936916 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Oral polio vaccine response in breast fed infants with malnutrition and diarrhea.

Haque Rashidul R Snider Cynthia C Liu Yue Y Ma Jennie Z JZ Liu Lei L Nayak Uma U Mychaleckyj Josyf C JC Korpe Poonum P Mondal Dinesh D Kabir Mamun M Alam Masud M Pallansch Mark M Oberste M Steven MS Weldon William W Kirkpatrick Beth D BD Petri William A WA

Vaccine 20131202 4

Oral vaccines for polio (OPV) and rotavirus are less effective in children in the developing world. The reasons for this are not well understood. We tested for risk factors for poor response to OPV in infants from an urban slum of Dhaka, Bangladesh. Diminished serum neutralizing response to OPV, but not failure of intramuscularly administered vaccines, was associated with malnutrition, diarrhea, and shorter breastfeeding duration. Children with malnutrition (WAZ <-2) had significantly lower OPV ...[more]

PMID: 24300591

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Project description:BackgroundImmunization 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.MethodsPolio 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.FindingsSerotype 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.InterpretationUnder 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.

Dataset Information

Oral polio vaccine response in breast fed infants with malnutrition and diarrhea.

Publications

Oral polio vaccine response in breast fed infants with malnutrition and diarrhea.

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