The Effect of Oral Polio Vaccine at Birth on Infant Mortality: A Randomized Trial

Lund, Najaaraq; Andersen, Andreas; Hansen, Anna Sofie; Jepsen, Frida S; Barbosa, Amarildo; Biering-Sørensen, Sofie; Rodrigues, Amabélia; Ravn, Henrik; Aaby, Péter; Benn, Christine Stabell

doi:10.1093/cid/civ617

Cited by 153 publications

(140 citation statements)

References 31 publications

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“…The strongest evidence of such effects in humans relates to the apparent ability of the Bacille Calmette-Guerin (BCG) vaccine (live attenuated Mycobacterium bovis ) to reduce all-cause infant mortality in high mortality settings 5-7 (see Table 1). Similar benefits have been reported for other live attenuated vaccines, specifically measles vaccine and oral polio vaccine 8, 9 . The observed reductions in all-cause mortality appear to extend beyond the direct protection induced by these vaccines against their target pathogens, and likely reflect the induction of resistance to unrelated pathogens via enhancement of heterologous adaptive immune responses and/or antigen non-specific innate immune mechanisms.…”

Section: Heterologous Effects Of Vaccinationsupporting

confidence: 75%

Harnessing the beneficial heterologous effects of vaccination

et al. 2016

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Clinical evidence strongly suggests that certain live vaccines, in particular Bacille Calmette–Guérin (BCG) and measles vaccines, can reduce all-cause mortality, likely via protection against non-targeted pathogens in addition to the targeted pathogen. The underlying mechanisms are currently unknown. We discuss how heterologous lymphocyte activation and innate immune memory could promote protection beyond the intended target pathogen and consider how vaccinologists could leverage heterologous immunity to improve outcomes in vulnerable populations, in particular the very young and the elderly.

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Section: Heterologous Effects Of Vaccinationsupporting

confidence: 75%

Harnessing the beneficial heterologous effects of vaccination

et al. 2016

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“…A recent RCT evaluated the effect of a birth dose of OPV on all-cause mortality in Guinea Bissau and found no statistically significant effect of the vaccine on mortality (HR 0.83, 95% CI 0.61 to 1.13) 17. Various subanalyses found some evidence of significant NSE, particularly if the vaccine was given early, but this study does not provide conclusive evidence for an effect of OPV in reducing all-cause mortality.…”

Section: Poliocontrasting

confidence: 60%

Non-specific effects of vaccines: plausible and potentially important, but implications uncertain

Pollard¹,

2017

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Non-specific effects (NSE) or heterologous effects of vaccines are proposed to explain observations in some studies that certain vaccines have an impact beyond the direct protection against infection with the specific pathogen for which the vaccines were designed. The importance and implications of such effects remain controversial. There are several known immunological mechanisms which could lead to NSE, since it is widely recognised that the generation of specific immunity is initiated by non-specific innate immune mechanisms that may also have wider effects on adaptive immune function. However, there are no published studies that demonstrate a mechanistic link between such immunological phenomena and clinically relevant NSE in humans. While it is highly plausible that some vaccines do have NSE, their magnitude and duration, and thus importance, remain uncertain. Although the WHO recently concluded that current evidence does not justify changes to immunisation policy, further studies of sufficient size and quality are needed to assess the importance of NSE for all-cause mortality. This could provide insights into vaccine immunobiology with important implications for infant health and survival.

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“…Sex differential non-specific effects of vaccines are common in developing countries with negative nonspecific effects (NSE) of inactivated vaccines more common in girls than boys in some countries, but with no differences in high income countries 16,17 . Though the general pattern is both negative and positive NSE are stronger in females 18 , a randomized controlled trial in Guinea-Bissau negated the hypothesis that mortality rates in boys would be lower if they had not received OPV 19 . The reasons why OPV uptake is slightly higher for females in our study area are unknown.…”

Section: Yemen Introduced Universal Immunization Againstmentioning

confidence: 99%

Evaluation of the Immune Response to Polio Vaccine in Malnourished Children in Sana'a City

Nassar

Al-Shamahy

AL-Barq

2018

UJPR

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This study was made to evaluate the immune response to polio virus vaccine among PEM children by measuring the level of circulating Immunoglobulin G (IgG) antibodies against polio virus (IgG-PV) after immunization with the primary series of POV, and determining the coverage rate of universal childhood vaccine for polio virus. A cross-sectional laboratory study was conducted in Department of Medical Microbiology and Clinical Immunology, Faculty of Medicine and Health Sciences, and Al-Sabeen University Hospital, Sana'a University. A total of 279 PEM children were selected and investigated for universal childhood vaccination coverage rate for polio vaccine. Blood samples were collected from all, then tested for levels of IgG-PV by ELISA method. For assessment IgG-PV levels more than 10 units/ml were considered protected against polio virus infection. The coverage rate of polio virus vaccine for first year vaccine was 96.8%; and 91.1% of vaccinated PEM children responded to the vaccine with mean level of 46.2 U/ml. A statistically significant difference was observed with respect to sero-protective IgG-PV between males and females (85.7% and 94.1% respectively, p=0.002); and older children (>37 months) (97.7%).We conclude that a small proportion of malnourished vaccinated children with a normal immune status were not serologically immune to polio virus infection, and remain to be reconsidered for either revaccination or booster doses due to lack of or inadequate response. PEM group gave slightly reduced response to OPV hence there is need to give this group IPV (injectable polio vaccine) along with OPV and different micro-nutrition deficiencies like Zinc and iron.

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The Effect of Oral Polio Vaccine at Birth on Infant Mortality: A Randomized Trial

Abstract: Neonates were randomized to oral polio vaccine (OPV) and followed for mortality. Among those enrolled within the first 2 days, OPV was associated with a 42% (10%–62%) reduction in infant infectious disease mortality. OPV at birth may provide nonspecific protection against infections.

Cited by 153 publications

References 31 publications

Harnessing the beneficial heterologous effects of vaccination

Harnessing the beneficial heterologous effects of vaccination

Non-specific effects of vaccines: plausible and potentially important, but implications uncertain

Evaluation of the Immune Response to Polio Vaccine in Malnourished Children in Sana'a City

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