TY - JOUR
T1 - Oral polio vaccine response in the MAL-ED birth cohort study
T2 - Considerations for polio eradication strategies
AU - The MAL-ED Network Investigators
AU - Pan, William K.
AU - Seidman, Jessica C.
AU - Ali, Asad
AU - Hoest, Christel
AU - Mason, Carl
AU - Mondal, Dinesh
AU - Knobler, Stacey L.
AU - Bessong, Pascal
N1 - Funding Information:
The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the National Institutes of Health, and the National Institutes of Health, Fogarty International Center. We particularly want to thank the children and caregivers who participated in the study for their invaluable contributions. We thank the US Centers for Disease Control and Prevention, Atlanta, Georgia, and the Enterovirus Research Centre, Mumbai, India for completing the poliovirus neutralization assays. Tom Brewer and Gretchen Meller are also thanked for their early support of the project. We are truly indebted to the following individuals for their advisory role in the MAL-ED study: Henry Binder, Maureen Black, Kathleen Braden, Robert Breiman, Katherine Dewey, Christopher Duggan, Christine Grady, Gerry Keusch, Nancy Krebs, Claudio Lanata, James Nataro, Jerome Singh, Peter Smith, Phillip Tarr, Katherine Tucker and Theodore Wachs. We thank Leslie Pray and Alicia Livinski for their editorial assistance. Special thanks go to Roger Glass and George Griffin for their continued support and guidance.
Funding Information:
The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation , the Foundation for the National Institutes of Health , and the National Institutes of Health , Fogarty International Center . We particularly want to thank the children and caregivers who participated in the study for their invaluable contributions. We thank the US Centers for Disease Control and Prevention, Atlanta, Georgia, and the Enterovirus Research Centre, Mumbai, India for completing the poliovirus neutralization assays. Tom Brewer and Gretchen Meller are also thanked for their early support of the project. We are truly indebted to the following individuals for their advisory role in the MAL-ED study: Henry Binder, Maureen Black, Kathleen Braden, Robert Breiman, Katherine Dewey, Christopher Duggan, Christine Grady, Gerry Keusch, Nancy Krebs, Claudio Lanata, James Nataro, Jerome Singh, Peter Smith, Phillip Tarr, Katherine Tucker and Theodore Wachs. We thank Leslie Pray and Alicia Livinski for their editorial assistance. Special thanks go to Roger Glass and George Griffin for their continued support and guidance.
Publisher Copyright:
© 2018 The Authors
PY - 2019/1/7
Y1 - 2019/1/7
N2 - Background: Immunization 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. Methods: Polio 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. Findings: Serotype 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. Interpretation: Under 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.
AB - Background: Immunization 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. Methods: Polio 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. Findings: Serotype 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. Interpretation: Under 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.
KW - Enteropathogen infection
KW - Home environment
KW - Oral polio vaccination
KW - Poliomyelitis
UR - http://www.scopus.com/inward/record.url?scp=85056388209&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2018.05.080
DO - 10.1016/j.vaccine.2018.05.080
M3 - Article
C2 - 30442479
AN - SCOPUS:85056388209
SN - 0264-410X
VL - 37
SP - 352
EP - 365
JO - Vaccine
JF - Vaccine
IS - 2
ER -
