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Interventions to improve oral vaccine performance: a systematic review and meta-analysis

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Title: Interventions to improve oral vaccine performance: a systematic review and meta-analysis
Authors: Church, JA
Parker, EP
Kirkpatrick, BD
Grassly, NC
Prendergast, AJ
Item Type: Journal Article
Abstract: Background Oral vaccines underperform in low-income and middle-income countries compared with in high-income countries. Whether interventions can improve oral vaccine performance is uncertain. Methods We did a systematic review and meta-analysis of interventions designed to increase oral vaccine efficacy or immunogenicity. We searched Ovid-MEDLINE and Embase for trials published until Oct 23, 2017. Inclusion criteria for meta-analysis were two or more studies per intervention category and available seroconversion data. We did random-effects meta-analyses to produce summary relative risk (RR) estimates. This study is registered with PROSPERO (CRD42017060608). Findings Of 2843 studies identified, 87 were eligible for qualitative synthesis and 66 for meta-analysis. 22 different interventions were assessed for oral poliovirus vaccine (OPV), oral rotavirus vaccine (RVV), oral cholera vaccine (OCV), and oral typhoid vaccines. There was generally high heterogeneity. Seroconversion to RVV was significantly increased by delaying the first RVV dose by 4 weeks (RR 1·37, 95% CI 1·16–1·62) and OPV seroconversion was increased with monovalent or bivalent OPV compared with trivalent OPV (RR 1·51, 95% CI 1·20–1·91). There was some evidence that separating RVV and OPV increased RVV seroconversion (RR 1·21, 95% CI 1·00–1·47) and that higher vaccine inoculum improved OCV seroconversion (RR 1·12, 95% CI 1·00–1·26). There was no evidence of effect for anthelmintics, antibiotics, probiotics, zinc, vitamin A, withholding breastfeeding, extra doses, or vaccine buffering. Interpretation Most strategies did not improve oral vaccine performance. Delaying RVV and reducing OPV valence should be considered within immunisation programmes to reduce global enteric disease. New strategies to address the gap in oral vaccine efficacy are urgently required.
Issue Date: 1-Feb-2019
Date of Acceptance: 1-Jan-2019
URI: http://hdl.handle.net/10044/1/67708
DOI: https://dx.doi.org/10.1016/S1473-3099(18)30602-9
ISSN: 1473-3099
Publisher: Elsevier
Start Page: 203
End Page: 214
Journal / Book Title: Lancet Infectious Diseases
Volume: 19
Issue: 2
Copyright Statement: © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).
Sponsor/Funder: Bill & Melinda Gates Foundation
Medical Research Council (MRC)
Funder's Grant Number: OPP1039135
JXR11990
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
ATTENUATED ROTAVIRUS VACCINE
PLACEBO-CONTROLLED TRIAL
POLIOVIRUS VACCINE
DOUBLE-BLIND
VIBRIOCIDAL ANTIBODY
IMMUNE-RESPONSE
TYPHOID VACCINE
VITAMIN-A
IMMUNOGENICITY
INFANTS
1103 Clinical Sciences
1108 Medical Microbiology
Microbiology
Publication Status: Published
Open Access location: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30602-9/fulltext
Online Publication Date: 2019-01-30
Appears in Collections:Epidemiology, Public Health and Primary Care



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