Causes of impaired oral vaccine efficacy in developing countries
- PMID: 29218997
- PMCID: PMC7026772
- DOI: 10.2217/fmb-2017-0128
Causes of impaired oral vaccine efficacy in developing countries
Abstract
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.
Keywords: cholera; enteropathy; histo blood group antigens; immunogenicity; malnutrition; microbiota; oral vaccines; poliovirus; rotavirus.
Conflict of interest statement
EPK Parker has received funding from the UK Medical Research Council. M Iturriza-Gómara has received research grant support form GlaxoSmithKline and Sanofi Pasteur MSD. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
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