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The effect of diarrhea on oral poliovirus vaccine failure in Brazil
D L Posey1, R W Linkins, M J Oliveria
1Birth Defects and Genetic Diseases Branch, Division of Birth Defects and Developmental Disabilities, National Center for Environmental Health, and National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Insights
Infants experiencing diarrhea showed increased oral poliovirus vaccine (OPV) failure, particularly after the second dose. This suggests re-immunization for children with recent diarrhea history may improve vaccine efficacy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Diarrheal diseases are a significant global health concern, particularly in infants.
- Oral poliovirus vaccine (OPV) is crucial for polio eradication efforts.
- The impact of concurrent or recent diarrhea on OPV immunogenicity requires further investigation.
Purpose of the Study:
- To evaluate the association between diarrhea and oral poliovirus vaccine (OPV) failure in Brazilian infants.
- To determine if a recent history of diarrhea impacts OPV effectiveness.
Main Methods:
- Retrospective analysis of 728 infants immunized with OPV at birth, 6, 10, and 14 weeks.
- Statistical modeling to assess the effect of diarrhea on vaccine failure, controlling for confounding factors.
Main Results:
- Recent diarrhea history was significantly linked to increased OPV failure for poliovirus types 2 and 3 after the second OPV dose (OPV2).
- Diarrhea at the time of OPV receipt was associated with vaccine failure for poliovirus types 1 and 3, also primarily after OPV2.
- Multivariate analysis, accounting for breastfeeding and other factors, strengthened the association between diarrhea and vaccine failure.
Conclusions:
- Current recommendations to vaccinate children with diarrhea and re-immunize after recovery are supported.
- Consideration should be given to extending recommendations to include infants with a recent history of diarrhea.
- While the effect might be dose-specific (e.g., OPV2), practical implementation may necessitate broader recommendations.
Abstract:
The effect of diarrhea on oral poliovirus vaccine (OPV) failure was evaluated using data from Brazil, where 728 infants were immunized at birth (OPV1) and approximately 6 (OPV2), 10 (OPV3), and 14 (OPV4) weeks. Recent diarrhea history was significantly associated with increased vaccine failure only after OPV2 for poliovirus types 2 and 3. In multivariate models, controlling for breast feeding, season of vaccine administration (type 3 only), maternal antibody (type 3 only), and immunization campaign exposure (type 3 only) strengthened this effect. Diarrhea at OPV receipt was associated with vaccine failure to poliovirus types 1 and 3 only after OPV2. These data support the current recommendation that children with diarrhea receive OPV and be reimmunized once their illness resolves. Expanding this recommendation to include children with a recent diarrhea history should be considered. While the effect of diarrhea on vaccine failure may be limited to OPV2, programmatic realities may preclude dose-specific recommendations.