Abstract
BackgroundOral rotavirus vaccines (RVV) are poorly immunogenic in low-income countries. Environmental enteric dysfunction (EED) resulting from poor water, sanitation and hygiene (WASH) may contribute. We therefore tested associations between EED and RVV immunogenicity, and evaluated the effect of improved WASH on EED.MethodsWe measured nine biomarkers of EED among Zimbabwean infants born to mothers enrolled in a cluster-randomised 2 × 2 factorial trial of improved WASH and improved feeding between November 2012 and March 2015 (NCT01824940). We used multivariable regression to determine associations between EED biomarkers and RVV seroconversion, seropositivity and geometric mean titer. Log-binomial regression was used to evaluate the effect of improved WASH on EED.FindingsAmong 303 infants with EED biomarkers and immunogenicity data, plasma intestinal fatty-acid binding protein and stool myeloperoxidase were positively associated with RVV seroconversion; adjusted RR 1.63 (95%CI 1.04, 2.57) and 1.29 (95%CI 1.01, 1.65), respectively. There were no other associations between RVV immunogenicity and either individual biomarkers or EED domains (intestinal permeability, intestinal damage, intestinal inflammation and microbial translocation). EED biomarkers did not differ between randomised WASH and non-WASH groups.InterpretationWe found no evidence that EED was associated with poor RVV immunogenicity. Contrary to our hypothesis, there was weak evidence that EED was associated with increased seroconversion. EED biomarkers were not affected by a package of household-level WASH interventions.
Highlights
Increased coverage of oral rotavirus vaccines (RVV) has contributed to global declines in diarrheal disease burden [1]
Our findings showed no deleterious impact of enteric dysfunction (EED) biomarkers on oral rotavirus vaccine responses
Among the subgroup of 303 infants with EED measured pre-RVV, 37% were born in the rotavirus season
Summary
Increased coverage of oral rotavirus vaccines (RVV) has contributed to global declines in diarrheal disease burden [1]. These vaccines fail to reach their full potential in regions of high child mortality. Environmental enteric dysfunction (EED) is a near ubiquitous disorder of small intestinal structure and function in low- and middle-income countries (LMIC), which has been hypothesised to contribute to reduced oral vaccine performance. We used multivariable regression to determine associations between EED biomarkers and RVV seroconversion, seropositivity and geometric mean titer. Findings: Among 303 infants with EED biomarkers and immunogenicity data, plasma intestinal fatty-acid binding protein and stool myeloperoxidase were positively associated with RVV seroconversion; adjusted RR 1.63 (95%CI 1.04, 2.57) and 1.29 (95%CI 1.01, 1.65), respectively.
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