Factors affecting the infant antibody response to measles immunisation in Entebbe-Uganda
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Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
BMC public health,
Abstract
Background: Vaccine failure is an important concern in the tropics with many contributing elements. Among
them, it has been suggested that exposure to natural infections might contribute to vaccine failure and recurrent
disease outbreaks. We tested this hypothesis by examining the influence of co-infections on maternal and infant
measles-specific IgG levels.
Methods: We conducted an observational analysis using samples and data that had been collected during a larger
randomised controlled trial, the Entebbe Mother and Baby Study (ISRCTN32849447). For the present study, 711
pregnant women and their offspring were considered. Helminth infections including hookworm, Schistosoma
mansoni and Mansonella perstans, along with HIV, malaria, and other potential confounding factors were
determined in mothers during pregnancy and in their infants at age one year. Infants received their measles
immunisation at age nine months. Levels of total IgG against measles were measured in mothers during pregnancy
and at delivery, as well as in cord blood and from infants at age one year.
Results: Among the 711 pregnant women studied, 66% had at least one helminth infection at enrolment, 41% had
hookworm, 20% M. perstans and 19% S. mansoni. Asymptomatic malaria and HIV prevalence was 8% and 10%
respectively. At enrolment, 96% of the women had measles-specific IgG levels considered protective (median 4274
mIU/ml (IQR 1784, 7767)). IgG levels in cord blood were positively correlated to maternal measles-specific IgG levels
at delivery (r = 0.81, p < 0.0001). Among the infants at one year of age, median measles-specific IgG levels were
markedly lower than in maternal and cord blood (median 370 mIU/ml (IQR 198, 656) p < 0.0001). In addition, only
75% of the infants had measles-specific IgG levels considered to be protective. In a multivariate regression analysis,
factors associated with reduced measles-specific antibody levels in infancy were maternal malaria infection, infant
malaria parasitaemia, infant HIV and infant wasting. There was no association with maternal helminth infection.
Conclusion: Malaria and HIV infection in mothers during pregnancy, and in their infants, along with infant malnutrition,
may result in reduction of the antibody response to measles immunisation in infancy. This re-emphasises the importance
of malaria and HIV control, and support for infant nutrition, as these interventions may have benefits for vaccine efficacy
in tropical settings.
Description
Keywords
Infections, Co-infections, Measles, Helminth, Malaria, HIV, Maternal
Citation
Kizito, D., Tweyongyere, R., Namatovu, A., Webb, E. L., Muhangi, L., Lule, S. A., ... & Elliott, A. M. (2013). Factors affecting the infant antibody response to measles immunisation in Entebbe-Uganda. BMC public health, 13(1), 1-9.