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Review
. 2014 Sep 15;210(6):853-64.
doi: 10.1093/infdis/jiu182. Epub 2014 Mar 31.

Influence of enteric infections on response to oral poliovirus vaccine: a systematic review and meta-analysis

Edward P K Parker  1 , Beate Kampmann  2 , Gagandeep Kang  3 , Nicholas C Grassly  1
Affiliations
Review

Influence of enteric infections on response to oral poliovirus vaccine: a systematic review and meta-analysis

Edward P K Parker et al. J Infect Dis. .

Abstract

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.

Keywords: diarrhea; enterovirus; immunogenicity; interference; oral poliovirus vaccine.

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Figures

Figure 1.
Figure 1.
Flow chart of study selection process. A study by Swartz et al [45] was classified as ineligible based on details in a separate report [46], which clarified that the presence of NPEVs infections in the week following (as opposed to preceding) OPV delivery had been used as an indicator of concurrent infection. Citation details of the eligible studies are provided in Table 1. Abbreviations: NPEVs, nonpolio enteroviruses, OPV, oral poliovirus vaccine.
Figure 2.
Figure 2.
Forest plot of the impact of concurrent nonpolio enterovirus infections on the odds of seroconversion per dose of oral poliovirus vaccine. ORs and 95% CIs, calculated using random-effects models, are presented for each serotype by boxes and black lines, with box area proportional to study weight. Summary ORs for each serotype are indicated by a diamond, the width of which represents the 95% CI. The overall OR was calculated by maximum likelihood estimation using a multilevel meta-analytic model based on structural equation modeling, incorporating study as a cluster effect. Abbreviations: CI, confidence interval; JLPRC, Japan Live Poliovaccine Research Commission; mOPV, monovalent oral poliovirus vaccine; N, number of vaccinees; OR, odds ratio; tOPV, trivalent oral poliovirus vaccine.
Figure 3.
Figure 3.
Funnel plots for the influence of nonpolio enterovirus infections on the odds of seroconversion per dose of oral poliovirus vaccine. Data are presented for serotype 1 (A), serotype 2 (B), and serotype 3 (C). Abbreviations: OR, odds ratio; SE, standard error.
Figure 4.
Figure 4.
Forest plot of the impact of concurrent nonpolio enterovirus infections on the odds of vaccine shedding per dose of oral poliovirus vaccine. See Figure 2 for labeling. Abbreviations: CI, confidence interval; JLPRC, Japan Live Poliovaccine Research Commission; mOPV, monovalent oral poliovirus vaccine; N, number of vaccinees; OR, odds ratio; tOPV, trivalent oral poliovirus vaccine.
Figure 5.
Figure 5.
Forest plot of the impact of concurrent diarrhea on the odds of seroconversion per dose of oral poliovirus vaccine. See Figure 2 for labeling. Abbreviations: CI, confidence interval; N, number of vaccinees; OR, odds ratio; tOPV, trivalent oral poliovirus vaccine.
Figure 6.
Figure 6.
Forest plot of the impact of concurrent diarrhea on the odds of seroconversion following multiple doses of oral poliovirus vaccine. See Figure 2 for labeling. Data were obtained from 1 article [20], reporting on separate trials of tOPV in Brazil ([WHO] 1995a) and the Gambia ([WHO] 1995b). Abbreviations: CI, confidence interval; N, number of vaccinees; OR, odds ratio; tOPV, trivalent oral poliovirus vaccine; WHO, World Health Organization.
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