Abstract
Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising non-invasive alternative. The objectives of this research were to compare salivary antibody levels in children to enteric infections and biomarkers of environmental enteric dysfunction (EED). We collected saliva samples from children aged one to six years enrolled in a sanitation trial in Maputo, Mozambique, and characterized salivary secretory immunoglobulin A (SIgA) concentrations with enzyme-linked immunosorbent assays. We used multilevel linear models to analyze cross-sectional associations between salivary SIgA and the number of concurrent enteric pathogen infections, as well as EED biomarkers in matched stool samples. Median salivary SIgA concentrations in this study population were 54 μg/mL (inter-quartile range (IQR): 34, 85 μg/mL), and SIgA levels were similar between children of different ages. SIgA was lower in children experiencing a higher number of concurrent infections −0.04 log μg/mL (95% confidence interval (CI): −0.08 to −0.005 log μg/mL), but was not associated with any of the included EED biomarkers. Contrary to evidence from high-income countries that suggests salivary SIgA increases rapidly with age in young children, the high prevalence of enteric infections may have led to a suppression of immunological development in this study sample and could in part explain the similar SIgA levels between children of different ages.
Highlights
In low- and middle-income countries, children experience a high prevalence of enteric infections [1,2]and subsequently suffer disproportionally from diarrheal disease morbidity [3]
We found median salivary Secretory Immunoglobulin A (SIgA) levels of 54 μg/mL (inter-quartile range (IQR): 34, 85 μg/mL) in this study population, and salivary SIgA was similar between children of different ages (Figure 1)
Sample volume was significantly negatively associated with salivary SIgA, whereas we found no statistical difference of salivary SIgA with child age or higher cumulative rainfall in the same model
Summary
In low- and middle-income countries, children experience a high prevalence of enteric infections [1,2]. Subsequently suffer disproportionally from diarrheal disease morbidity [3]. Enteric infections are associated with chronic gastrointestinal health outcomes, such as environmental enteric dysfunction (EED) induced from repeated infections [4]. EED is a subclinical disorder associated with intestinal inflammation and a reduced ability to absorb nutrients [5]. Findings from a recent systematic review suggest that intestinal inflammation is linked to child stunting [6], the burden of which is greatest in low- and middle-income countries [7]. Res. Public Health 2020, 17, 3035; doi:10.3390/ijerph17093035 www.mdpi.com/journal/ijerph
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