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Latifi T, Kachooei A, Jalilvand S, Zafarian S, Roohvand F, Shoja Z. Correlates of immune protection against human rotaviruses: natural infection and vaccination. Arch Virol 2024; 169:72. [PMID: 38459213 DOI: 10.1007/s00705-024-05975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/12/2023] [Indexed: 03/10/2024]
Abstract
Species A rotaviruses are the leading viral cause of acute gastroenteritis in children under 5 years of age worldwide. Despite progress in the characterization of the pathogenesis and immunology of rotavirus-induced gastroenteritis, correlates of protection (CoPs) in the course of either natural infection or vaccine-induced immunity are not fully understood. There are numerous factors such as serological responses (IgA and IgG), the presence of maternal antibodies (Abs) in breast milk, changes in the intestinal microbiome, and rotavirus structural and non-structural proteins that contribute to the outcome of the CoP. Indeed, while an intestinal IgA response and its surrogate, the serum IgA level, are suggested as the principal CoPs for oral rotavirus vaccines, the IgG level is more likely to be a CoP for parenteral non-replicating rotavirus vaccines. Integrating clinical and immunological data will be instrumental in improving rotavirus vaccine efficacy, especially in low- and middle-income countries, where vaccine efficacy is significantly lower than in high-income countries. Further knowledge on CoPs against rotavirus disease will be helpful for next-generation vaccine development. Herein, available data and literature on interacting components and proposed CoPs against human rotavirus disease are reviewed, and limitations and gaps in our knowledge in this area are discussed.
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Affiliation(s)
- Tayebeh Latifi
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Atefeh Kachooei
- Department of Virology, Pasteur Institute of Iran, Tehran, Iran
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Jalilvand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Zafarian
- Department of Microbial Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | - Farzin Roohvand
- Department of Virology, Pasteur Institute of Iran, Tehran, Iran
| | - Zabihollah Shoja
- Department of Virology, Pasteur Institute of Iran, Tehran, Iran.
- Research Center for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.
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Francese R, Peila C, Donalisio M, Lamberti C, Cirrincione S, Colombi N, Tonetto P, Cavallarin L, Bertino E, Moro GE, Coscia A, Lembo D. Viruses and Human Milk: Transmission or Protection? Adv Nutr 2023; 14:1389-1415. [PMID: 37604306 PMCID: PMC10721544 DOI: 10.1016/j.advnut.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
Human milk (HM) is considered the best source of nutrition for infant growth and health. This nourishment is unique and changes constantly during lactation to adapt to the physiological needs of the developing infant. It is also recognized as a potential route of transmission of some viral pathogens although the presence of a virus in HM rarely leads to a disease in an infant. This intriguing paradox can be explained by considering the intrinsic antiviral properties of HM. In this comprehensive and schematically presented review, we have described what viruses have been detected in HM so far and what their potential transmission risk through breastfeeding is. We have provided a description of all the antiviral compounds of HM, along with an analysis of their demonstrated and hypothesized mechanisms of action. Finally, we have also analyzed the impact of HM pasteurization and storage methods on the detection and transmission of viruses, and on the antiviral compounds of HM. We have highlighted that there is currently a deep knowledge on the potential transmission of viral pathogens through breastfeeding and on the antiviral properties of HM. The current evidence suggests that, in most cases, it is unnecessarily to deprive an infant of this high-quality nourishment and that the continuation of breastfeeding is in the best interest of the infant and the mother.
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Affiliation(s)
- Rachele Francese
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano (TO), Italy
| | - Chiara Peila
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy
| | - Manuela Donalisio
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano (TO), Italy
| | - Cristina Lamberti
- Institute of the Science of Food Production - National Research Council, Grugliasco, TO, Italy
| | - Simona Cirrincione
- Institute of the Science of Food Production - National Research Council, Grugliasco, TO, Italy
| | - Nicoletta Colombi
- Biblioteca Federata di Medicina "Ferdinando Rossi", University of Turin, Turin, Italy
| | - Paola Tonetto
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy
| | - Laura Cavallarin
- Institute of the Science of Food Production - National Research Council, Grugliasco, TO, Italy
| | - Enrico Bertino
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy
| | - Guido E Moro
- Italian Association of Human Milk Banks (AIBLUD), Milan, Italy.
| | - Alessandra Coscia
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy.
| | - David Lembo
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano (TO), Italy.
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Pujol FH, Vásquez G, Rojas AM, Fuenmayor ME, Loureiro CL, Pérez-Schael I, Estes MK, Liprandi F. Norwalk virus infection in Venezuela. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.1998.11813281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Das S, Sahoo GC, Das P, Singh UK, Jaiswal AK, Singh P, Kumar R, Kumar R. Evaluating the Impact of Breastfeeding on Rotavirus Antigenemia and Disease Severity in Indian Children. PLoS One 2016; 11:e0146243. [PMID: 26828823 PMCID: PMC4734603 DOI: 10.1371/journal.pone.0146243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023] Open
Abstract
Objectives To evaluate the contribution of breastfeeding to Rotavirus (RV)-induced antigenemia and/or RNAemia and disease severity in Indian children (<2 yrs age). Methods Paired stool and serum samples were collected from (a) hospitalized infants with diarrhea (n = 145) and (b) healthy control infants without diarrhea (n = 28). Stool RV-antigen was screened in both groups by commercial rapid-test and enzyme immunoassay. The disease severity was scored and real-time-PCR was used for viral-load estimation. Serum was evaluated for RV-antigenemia by EIA and RV-RNAemia by RT-PCR. Data was stratified by age-group and breastfeeding status and compared. Results Presence of RV-antigenemia and RV-RNAemia was positively related with presence of RV in stool. Disease severity and stool viral-load was significantly associated with RV-antigenemia[(r = 0.74; CI:0.66 to 0.84; P<0.0001,R2 = 0.59) and (r = -0.55; CI:-0.68 to -0.39; P<0.0001,R2 = 0.31) respectively], but not with RV-RNAemia. There was significant reduction in RV-antigenemiarate in the breast-fed group compared to non-breastfed infants, especially in 0–6 month age group (P<0.001). Non-breastfed infants were at risk for RV-antigenemia with severe disease manifestations in form of high Vesikari scores correlating with high fever, more vomiting episodes and dehydration. Conclusion RV-antigenemia was common in nonbreastfed children with severe RV-diarrhea and correlated with stool RV-load and disease severity.
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Affiliation(s)
- Sushmita Das
- Department of Microbiology, All-India Institute of Medical Sciences (AIIMS), Patna, India
- * E-mail:
| | - Ganesh Chandra Sahoo
- Virology Unit, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Pradeep Das
- Virology Unit, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Utpal Kant Singh
- Department of Paediatrics, Nalanda Medical College and Hospital, Patna, India
| | - Anil Kumar Jaiswal
- Department of Paediatrics, Nalanda Medical College and Hospital, Patna, India
| | - Prachi Singh
- Department of Paediatrics, Nalanda Medical College and Hospital, Patna, India
| | - Ranjeet Kumar
- Virology Unit, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Rishikesh Kumar
- Virology Unit, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
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Novak D, Svennerholm AM. A comparison of seasonal variations in rotavirus antibodies in the breast milk of Swedish and Bangladeshi mothers. Acta Paediatr 2015; 104:247-51. [PMID: 25355609 DOI: 10.1111/apa.12841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/11/2014] [Accepted: 10/24/2014] [Indexed: 12/27/2022]
Abstract
AIM The rotavirus has been identified as the most common cause of severe gastroenteritis in young children. This study compared the levels of rotavirus-specific antibodies in breast milk and serum samples in Swedish and Bangladeshi mothers to identify any seasonal variations. METHODS Breast milk and serum samples were collected from 69 Swedish and 52 Bangladeshi mothers during all months of the year. Sera were analysed for Immunoglobulin A (IgA) and Immunoglobulin G (IgG) titres and breast milk for secretory IgA (SIgA) antibody levels against rotavirus. RESULTS Significantly, higher SIgA antibody levels against rotavirus were found in breast milk from Bangladeshi than Swedish mothers (p < 0.0001). Seasonality of rotavirus antibody levels was only detected in breast milk from Swedish mothers, with samples collected during the spring having significantly higher rotavirus titres than samples collected during the autumn (p = 0.0203). CONCLUSION This study found significantly higher SIgA antibody levels against rotavirus in breast milk from Bangladeshi than Swedish mothers, together with a seasonal variation among Swedish mothers only. These results suggest that Swedish children who are being breastfed should ideally be vaccinated during seasons when the rotavirus antibody levels in breast milk are low.
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Affiliation(s)
- Daniel Novak
- Department of Pediatrics Queen Silvia Children's Hospital Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Ann-Mari Svennerholm
- Department of Microbiology and Immunology; Gothenburg University Vaccine Research Institute (GUVAX); University of Gothenburg; Gothenburg Sweden
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Wilhelm B, Waddell L, Greig J, Rajić A, Houde A, McEwen SA. A scoping review of the evidence for public health risks of three emerging potentially zoonotic viruses: hepatitis E virus, norovirus, and rotavirus. Prev Vet Med 2015; 119:61-79. [PMID: 25681862 DOI: 10.1016/j.prevetmed.2015.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/13/2015] [Accepted: 01/19/2015] [Indexed: 01/15/2023]
Abstract
Emerging zoonoses are defined as those newly recognized, or increasing in incidence or geographic range. Hepatitis E virus (HEV), norovirus (NoV), and rotavirus (RV), while well known to be transmitted person-person, have also been hypothesized to be emerging zoonoses. Our objective was to investigate their potential public health risks from animal reservoirs. Given the diversity of evidence sources, a scoping review incorporating a mixed methods synthesis approach was used. A broad search was conducted in five electronic databases. Each citation was appraised independently by two reviewers using screening tools designed and tested a priori. Level 1 relevance screening excluded irrelevant citations; level 2 confirmed relevance and categorized. At level 3 screening, data were extracted to support a risk profile. A stakeholder group provided input on study tools and knowledge translation and transfer. Level 1 screening captured 2471 citations, with 1270 advancing to level 2 screening, and 1094 to level 3. We defined criteria for case attribution to zoonosis for each virus. Using these criteria, we identified a small number of zoonotic cases (HEV n=3, NoV=0, RV=40 (zoonoses=3; human-animal re-assortants=37)) categorized as 'likely'. The available evidence suggests the following potential HEV human exposure sources: swine, other domestic animals, wildlife, surface waters, and asymptomatic human shedders. Possible at-risk groups include the immunocompromised and the elderly. Reports of NoV intergenogroup recombinants suggest potential for human-animal recombination. Greatest public health impact for RV zoonoses may be the potential effect of human-animal reassortants on vaccination efficacy.
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Affiliation(s)
- Barbara Wilhelm
- University of Guelph, Department of Population Medicine, Guelph, ON N1G 2W1, Canada.
| | - Lisa Waddell
- University of Guelph, Department of Population Medicine, Guelph, ON N1G 2W1, Canada; Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON N1G 5B2, Canada.
| | - Judy Greig
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON N1G 5B2, Canada.
| | - Andrijana Rajić
- University of Guelph, Department of Population Medicine, Guelph, ON N1G 2W1, Canada; Nutrition and Consumer Protection Division, Food and Agriculture Organization, Viale delle Terme di Caracalla, Roma, Italy.
| | - Alain Houde
- Agriculture and Agri-Food Canada, Food Research and Development Centre, 3600 Casavant Boulevard West, Saint-Hyacinthe, QC J2S 8E3, Canada.
| | - Scott A McEwen
- University of Guelph, Department of Population Medicine, Guelph, ON N1G 2W1, Canada.
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Correlates of protection against human rotavirus disease and the factors influencing protection in low-income settings. Mucosal Immunol 2015; 8:1-17. [PMID: 25465100 DOI: 10.1038/mi.2014.114] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 10/16/2014] [Indexed: 02/04/2023]
Abstract
Rotaviruses (RV) are the leading cause of gastroenteritis in infants and children worldwide and are associated with high mortality predominately in low-income settings. The virus is classified into G and P serotypes and further into P genotypes based on differences in the surface-exposed proteins VP7 and VP4, respectively. Infection results in a variable level of protection from subsequent reinfection and disease. This protection is predominantly homotypic in some settings, whereas broader heterotypic protection is reported in other cohorts. Two antigenically distinct oral RV vaccines are licensed and are being rolled out widely, including in resource-poor setting, with funding provided by the GAVI alliance. First is a monovalent vaccine derived from a live-attenuated human RV strain, whereas the second is a pentavalent bovine-human reassortment vaccine. Both vaccines are highly efficacious in high-income settings, but greatly reduced levels of protection are reported in low-income countries. Here, the current challenges facing mucosal immunologists and vaccinologists aiming to define immunological correlates and to understand the variable levels of protection conferred by these vaccines in humans is considered. Such understanding is critical to maximize the public health impact of the current vaccines and also to the development of the next generation of RV vaccines, which are needed.
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Groome MJ, Moon SS, Velasquez D, Jones S, Koen A, van Niekerk N, Jiang B, Parashar UD, Madhi SA. Effect of breastfeeding on immunogenicity of oral live-attenuated human rotavirus vaccine: a randomized trial in HIV-uninfected infants in Soweto, South Africa. Bull World Health Organ 2014; 92:238-45. [PMID: 24700991 DOI: 10.2471/blt.13.128066] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the effect of abstention from breastfeeding, for an hour before and after each vaccination, on the immune responses of infants to two doses of rotavirus vaccine. METHODS In Soweto, South Africa, mother-infant pairs who were uninfected with human immunodeficiency virus (HIV) were enrolled as they presented for the "6-week" immunizations of the infants. Each infant was randomly assigned to Group 1 - in which breastfeeding was deferred for at least 1 h before and after each dose of rotavirus vaccine - or Group 2 - in which unrestricted breastfeeding was encouraged. Enzyme-linked immunosorbent assays were used to evaluate the titres of rotavirus-specific IgA in samples of serum collected from each infant immediately before each vaccine dose and 1 month after the second dose. Among the infants, a fourfold or greater increase in titres of rotavirus-specific IgA following vaccination was considered indicative of seroconversion. FINDINGS The evaluable infants in Group 1 (n=98) were similar to those in Group 2 (n=106) in their baseline demographic characteristics and their pre-vaccination titres of anti-rotavirus IgA. After the second vaccine doses, geometric mean titres of anti-rotavirus IgA in the sera of Group-1 infants were similar to those in the sera of Group-2 infants (P=0.685) and the frequency of seroconversion in the Group-1 infants was similar to that in the Group-2 infants (P=0.485). CONCLUSION Among HIV-uninfected South African infants, abstention from breastfeeding for at least 1 h before and after each vaccination dose had no significant effect on the infants' immune response to a rotavirus vaccine.
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Affiliation(s)
- Michelle J Groome
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, PO Box 90753, Bertsham, 2013, Gauteng, South Africa
| | - Sung-Sil Moon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Daniel Velasquez
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Stephanie Jones
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, PO Box 90753, Bertsham, 2013, Gauteng, South Africa
| | - Anthonet Koen
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, PO Box 90753, Bertsham, 2013, Gauteng, South Africa
| | - Nadia van Niekerk
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, PO Box 90753, Bertsham, 2013, Gauteng, South Africa
| | - Baoming Jiang
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Shabir A Madhi
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, PO Box 90753, Bertsham, 2013, Gauteng, South Africa
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Chan J, Nirwati H, Triasih R, Bogdanovic-Sakran N, Soenarto Y, Hakimi M, Duke T, Buttery JP, Bines JE, Bishop RF, Kirkwood CD, Danchin MD. Maternal antibodies to rotavirus: could they interfere with live rotavirus vaccines in developing countries? Vaccine 2010; 29:1242-7. [PMID: 21147127 DOI: 10.1016/j.vaccine.2010.11.087] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 11/25/2010] [Accepted: 11/26/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Past experience with live oral vaccines including licensed rotavirus vaccines demonstrates a trend towards reduced vaccine efficacy in developing countries compared with developed countries. The reasons behind this disparity are not well understood. Transplacental transfer of maternal antibodies and breast milk ingestion may attenuate vaccine responses in infants in developing countries where rotavirus infections are endemic, and maternal antibody levels are high. We examined the prevalence and level of rotavirus antibody in maternal and cord serum, colostrum and breast milk in a developing country setting. METHODS 100 mother-infant pairs were prospectively recruited from December 2008 to February 2009 at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Maternal and cord sera were collected during delivery. Colostrum and transitional breast milk were collected between day 0-3 and day 7-10 postpartum respectively. Rotavirus-specific IgA and IgG were estimated for all specimens and virus neutralization assays were conducted on a subset of milk specimens. RESULTS All maternal and cord serum samples were positive for rotavirus-specific IgG antibodies with a strong correlation between levels of rotavirus-specific IgG in mothers and levels transferred to infants in cord blood (r=0.86; p=0.001). 78% of colostrum and 67% of transitional breast milk specimens were positive for rotavirus-specific IgA. There was a median 4-fold decrease in rotavirus-specific IgA from colostrum to transitional breast milk. Neutralizing antibodies were present in 56% of colostrum specimens assayed (19/34) and in 41% of transitional milk specimens assayed (14/34). CONCLUSIONS Maternal serum and breast milk antibodies to rotavirus are highly prevalent in a developing country setting. Evaluation of the impact of maternal anti-rotavirus serum and breast milk antibody upon vaccine immunogenicity would help to inform rotavirus vaccination strategies, especially in developing settings.
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Affiliation(s)
- J Chan
- Royal Children's Hospital, Melbourne, Australia
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Armah GE, Sow SO, Breiman RF, Dallas MJ, Tapia MD, Feikin DR, Binka FN, Steele AD, Laserson KF, Ansah NA, Levine MM, Lewis K, Coia ML, Attah-Poku M, Ojwando J, Rivers SB, Victor JC, Nyambane G, Hodgson A, Schödel F, Ciarlet M, Neuzil KM. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial. Lancet 2010; 376:606-14. [PMID: 20692030 DOI: 10.1016/s0140-6736(10)60889-6] [Citation(s) in RCA: 550] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rotavirus gastroenteritis causes many deaths in infants in sub-Saharan Africa. Because rotavirus vaccines have proven effective in developed countries but had not been tested in developing countries, we assessed efficacy of a pentavalent rotavirus vaccine against severe disease in Ghana, Kenya, and Mali between April, 2007, and March, 2009. METHODS In our multicentre, double-blind, placebo-controlled trial, undertaken in rural areas of Ghana and Kenya and an urban area of Mali, we randomly assigned infants aged 4-12 weeks without symptoms of gastrointestinal disorders in a 1:1 ratio to receive three oral doses of pentavalent rotavirus vaccine 2 mL or placebo at around 6 weeks, 10 weeks, and 14 weeks of age. Infants with HIV infection were not excluded. Randomisation was done by computer-generated randomisation sequence in blocks of six. We obtained data for gastrointestinal symptoms from parents on presentation to health-care facilities and clinical data were obtained prospectively by clinicians. The primary endpoint was severe rotavirus gastroenteritis (Vesikari score >or=11), detected by enzyme immunoassay, arising 14 days or more after the third dose of placebo or vaccine to end of study (March 31, 2009; around 21 months of age). Analysis was per protocol; infants who received scheduled doses of vaccine or placebo without intervening laboratory-confirmed naturally occurring rotavirus disease earlier than 14 days after the third dose and had complete clinical and laboratory results were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT00362648. FINDINGS 5468 infants were randomly assigned to receive pentavalent rotavirus vaccine (n=2733) or placebo (n=2735). 2357 infants assigned to vaccine and 2348 assigned to placebo were included in the per-protocol analysis. 79 cases of severe rotavirus gastroenteritis were reported in 2610.6 person-years in the vaccine group, compared with 129 cases in 2585.9 person-years in the placebo group, resulting in a vaccine efficacy against severe rotavirus gastroenteritis of 39.3% (95% CI 19.1-54.7, p=0.0003 for efficacy >0%). Median follow-up in both groups was 527 days starting 14 days after the third dose of vaccine or placebo was given. 42 (1.5%) of 2723 infants assigned to receive vaccine and 45 (1.7%) of 2724 infants assigned to receive placebo had a serious adverse event within 14 days of any dose. The most frequent serious adverse event was gastroenteritis (vaccine 17 [0.6%]; placebo 17 [0.6%]). INTERPRETATION Pentavalent rotavirus vaccine is effective against severe rotavirus gastroenteritis in the first 2 years of life in African countries with high mortality in infants younger than 5 years. We support WHO's recommendation for adoption of rotavirus vaccine into national expanded programmes on immunisation in Africa. FUNDING PATH (GAVI Alliance grant) and Merck.
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Affiliation(s)
- George E Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Grover M, Giouzeppos O, Schnagl RD, May JT. Effect of human milk prostaglandins and lactoferrin on respiratory syncytial virus and rotavirus. Acta Paediatr 1997; 86:315-6. [PMID: 9099323 DOI: 10.1111/j.1651-2227.1997.tb08896.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effect of lactoferrin and prostaglandins E and F2 alpha on the growth of rotavirus and respiratory syncytial virus in cell culture was investigated. Lactoferrin inhibited the growth of respiratory syncytial virus at a concentration tenfold lower than that normally present in human milk. The prostaglandins had no effect on either virus growth, even at a concentration of 100-fold more than that found in human milk. Lactoferrin may have some antiviral properties in human milk in addition to its known antibacterial functions.
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Affiliation(s)
- M Grover
- School of Microbiology, Latrobe University, Bundoora, Victoria, Australia
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Brüssow H, Barclay D, Sidoti J, Rey S, Blondel A, Dirren H, Verwilghen AM, Van Geert C. Effect of malnutrition on serum and milk antibodies in Zairian women. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1996; 3:37-41. [PMID: 8770501 PMCID: PMC170244 DOI: 10.1128/cdli.3.1.37-41.1996] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Serum and human milk antimicrobial antibody titers were measured longitudinally in 17 malnourished and 14 control Zairian women during 6 to 18 months of lactation to test whether malnutrition is specifically associated with an impaired secretory antibody response. No decreases in total serum and human milk immunoglobulin concentrations, neutralizing antibody titers against rotavirus, or specific enzyme-linked immunosorbent assay antibody titers against rotavirus, respiratory syncytial virus, Escherichia coli, Streptococcus pneumoniae, and Haemophilus influenzae were detected when malnourished women were compared with control women. Malnutrition had no effect on circulating and secretory antibody concentrations in Zairian women. Daily human milk outputs, however, were about 30% lower in malnourished than in control women, resulting in a correspondingly lower ingestion of immunoglobulins by the children of malnourished women.
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Affiliation(s)
- H Brüssow
- Nestlé Research Center, Nestec Ltd., Lausanne, Switzerland
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Snodgrass DR, Campbell I, Mwenda JM, Chege G, Suleman MA, Morein B, Hart CA. Stimulation of rotavirus IgA, IgG and neutralising antibodies in baboon milk by parenteral vaccination. Vaccine 1995; 13:408-13. [PMID: 7793139 PMCID: PMC7130768 DOI: 10.1016/0264-410x(95)98265-c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/1994] [Revised: 11/07/1994] [Accepted: 11/18/1994] [Indexed: 01/27/2023]
Abstract
A rhesus rotavirus vaccine adjuvanted with ISCOMs was injected intramuscularly to 5 pregnant baboons, with repeated doses 1-2 and 14 weeks after delivery. Maternal blood and milk samples and blood samples from their babies were collected at 2-weekly intervals until 26 weeks after parturition. Samples were assayed for rotavirus antibodies by ELISAs and neutralisation tests. Vaccination produced statistically significant increases in maternal serum IgG and neutralising antibodies, and in milk IgA, IgG, and neutralising antibodies. Control baboon mothers sampled from 12 weeks after delivery had lower serum and milk antibody titres, but responded to vaccination at 16 weeks by producing a similar antibody profile in serum and milk to those previously vaccinated. Because of the endemic nature of human rotaviral infections, similar maternal vaccinations have potential as a means of increasing milk antibodies to a level at which they may be protective to infants.
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15
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Abstract
An overview of recent studies of antimicrobial factors and microbial contaminants found in human milk is presented. The incidence of gastrointestinal and respiratory infections in infants receiving human milk continues to be lower than in those not breast-fed due to the presence of specific antibody and possibly anti-adhesion factors in the milk. Whether the many other antimicrobial factors, which have been shown to be active in vitro or in animal model systems, have any influence on infant infections is still not clear. Microbial contaminants in human milk are rare, as are associated infant infections from the milk. However, some contaminants such as cytomegalovirus are commonly transferred to infants from the milk of seropositive mothers, fortunately without any adverse effects in the infants. Human T-lymphotropic virus type 1 is transferred via human milk in endemic areas, human milk being the main source of mother-to-infant transmission. While some reports suggest human immunodeficiency virus type 1 transfer may occur through human milk, this is not the predominant mode of transmission to infants.
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Affiliation(s)
- J T May
- Department of Microbiology, La Trobe University, Bundoora, Victoria, Australia
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