Causes of impaired oral vaccine efficacy in developing countries

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,...

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Bibliographic Details
Published in:Future microbiology 2018-01, Vol.13 (1), p.97-118
Main Authors: Parker, Edward PK, Ramani, Sasirekha, Lopman, Benjamin A, Church, James A, Iturriza-Gómara, Miren, Prendergast, Andrew J, Grassly, Nicholas C
Format: Article
Language:English
Subjects:
Administration, Oral
Age
Antibodies - immunology
Antigens
Binding sites
Blood groups
Breast feeding
Cholera
Developing Countries
Dysbacteriosis
enteropathy
histo blood group antigens
Humans
Immunogenicity
Immunoglobulins
Infants
LDCs
Low income groups
Malnutrition
Microbiota
Newborn babies
oral vaccines
Pathogens
poliovirus
Public health
Review
Risk factors
rotavirus
Tropical diseases
Typhoid
Vaccine efficacy
Vaccines
Vaccines - administration & dosage
Vaccines - immunology
Viruses
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Summary: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.
ISSN:1746-0913
1746-0921
DOI:10.2217/fmb-2017-0128