Pneumococcal Vaccine Response After Exposure to Parasites in Utero, in Infancy, or Mid-Childhood.

Autor:	Nayakwadi Singer M; Division of Pediatric Infectious Diseases, UCSF Benioff Children's Hospital Oakland and Children's Hospital Oakland Research Institute, Oakland, California; msinger@mail.cho.org., Heath C; Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California., Muinde J; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya., Gildengorin V; Division of Pediatric Infectious Diseases, UCSF Benioff Children's Hospital Oakland and Children's Hospital Oakland Research Institute, Oakland, California., Mutuku FM; Technical University of Mombasa, Mombasa, Kenya; and., Vu D; Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California., Mukoko D; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya., King CL; Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio., Malhotra IJ; Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio., King CH; Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio., LaBeaud AD; Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2017 Apr; Vol. 139 (4). Date of Electronic Publication: 2017 Mar 16.
DOI:	10.1542/peds.2016-2781
Abstrakt:	Background and Objective: Streptococcus pneumoniae is a leading cause of mortality before age 5, but few studies examine details of childhood response to pneumococcal vaccine in less-developed settings. Although malnutrition, HIV, and concurrent infections can impair response, evidence suggests that chronic parasitic infections can also contribute to poor vaccination results. The objective of this study was to determine whether response to pneumococcal vaccine varied among children either exposed to parasitic infections in utero, previously infected in infancy, or infected at the time of immunization. Methods: Children from a 2006 to 2010 maternal-infant cohort were eligible for the current study. Children were screened for malaria, schistosomiasis, filariasis, intestinal helminths, and protozoa. Data on in utero exposure and early life infections were linked, and baseline antipneumococcal immunoglobulin G levels and nasopharyngeal carrier status were determined. Participants received decavalent pneumococcal vaccine, and 4 weeks later, serology was repeated to assess vaccine response. Results: A total of 281 children were included. Preimmunity was associated with greater postvaccination increments in anti-pneumococcal polysaccharide immunoglobulin G, especially serotypes 4, 7, 9, 18C, and 19. Present-day growth stunting was independently associated with weaker responses to 1, 4, 6B, 7, 9V, and 19. Previous exposure to Trichuris was associated with stronger responses to 1, 5, 6B, 7, 18C, and 23, but other parasite exposures were not consistently associated with response. Conclusions: In our cohort, hyporesponsiveness to pneumococcal conjugate vaccine was associated with growth stunting but not parasite exposure. Parasite-related vaccine response deficits identified before age 3 do not persist into later childhood. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2017 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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