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INFLUENCE OF ENTERIC INFECTIONS ON RESPONSE TO ORAL POLIOVIRUS VACCINE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Tuesday, 19th of August 2014

INFLUENCE OF ENTERIC INFECTIONS ON RESPONSE TO ORAL POLIOVIRUS VACCINE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Journal of Infectious Diseasesjid.oxfordjournals.org

J Infect Dis. (2014) 210 (6): 853-864. doi: 10.1093/infdis/jiu182 First published online: March 31, 2014

Edward P. K. Parker1, Beate Kampmann2,3, Gagandeep Kang4 and Nicholas C. Grassly1

+ Author Affiliations

1Department of Infectious Disease Epidemiology

2Department of Paediatrics, St Marys Campus, Imperial College London, United Kingdom

3MRC Unit, The Gambia, Fajara

4Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India

Correspondence: Edward P. K. Parker, MSc, Department of Infectious Disease Epidemiology, Imperial College London, Medical School Bldg, St Marys Campus, Norfolk Place, London W2 1PG, UK (e.parker12@imperial.ac.uk).

Presented in part: Seventh International Conference on Vaccines for Enteric Diseases (VED 2013), Bangkok, Thailand, 6–8 November 2013.

Abstract below; full text, with graphics, is at http://jid.oxfordjournals.org/content/210/6/853.full

Background. The impaired immunogenicity of oral poliovirus vaccine (OPV) in low-income countries has been apparent since the early field trials of this vaccine. Infection with enteropathogens at the time of vaccination may contribute to this phenomenon. However, the relative influence of these infections on OPV performance remains uncertain.

Methods. We conducted a systematic review to examine the impact of concurrent enteric infections on OPV response. Using random-effects models, we assessed the effects of nonpolio enteroviruses (NPEVs) and diarrhea on the odds of seroconversion and/or vaccine virus shedding.

Results. We identified 25 trials in which OPV outcomes were compared according to the presence or absence of enteric infections, the majority of which (n = 17) reported only on NPEVs. Concurrent NPEVs significantly reduced the odds of per-dose seroconversion for type 1 poliovirus (odds ratio [OR] 0.44, 95% confidence interval 0.23−0.84), but not type 2 (OR 0.53 [0.19−1.46]) or type 3 (OR 0.56 [0.27−1.12]). A similar reduction, significant for type 1 poliovirus (OR 0.50 [0.28−0.89]), was observed in the odds of vaccine virus shedding among NPEV-infected individuals. Concurrent diarrhea significantly inhibited per-dose seroconversion overall (OR 0.61 [0.38−0.87]).

Conclusions. Our findings are consistent with an inhibitory effect of concurrent enteric infections on OPV response.

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.