Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
Vaccine. 2013 Jan 7;31(3):452-60. doi: 10.1016/j.vaccine.2012.11.012. Epub 2012 Nov 12.
Oral mucosal vaccines have great promise for generating protective immunity against intestinal infections for the benefit of large numbers of people especially young children. There however appears to be a caveat since these vaccines have to overcome the inbuilt resistance of mucosal surfaces and secretions to inhibit antigen stimulation and responses. Unfortunately, these vaccines are not equally immunogenic nor protective in different populations. When compared to industrialized countries, children living in developing countries appear to have lower responses, but the reasons for these lowered responses are not clearly defined. The most likely explanations relate to undernutrition, micronutrient deficiencies, microbial overload on mucosal surfaces, alteration of microbiome and microbolom and irreversible changes on the mucosa as well as maternal antibodies in serum or breast milk may alter the mucosal pathology and lower immune responses to interventions using oral vaccines. The detrimental effect of adverse environment and malnutrition may bring about irreversible changes in the mucosa of children especially in the first 1000 days of life from conception to after birth and up to two years of age. This review aims to summarize the information available on lowered immune responses to mucosal vaccines and on interventions that may help address the constraints of these vaccines when they are used for children living under the greatest stress and under harmful adverse circumstances.
口腔黏膜疫苗在产生针对肠道感染的保护性免疫方面具有巨大的潜力，这将使大量人群受益，尤其是幼儿。然而，这些疫苗似乎存在一个警告，因为它们必须克服黏膜表面和分泌物固有的抵抗力，以抑制抗原刺激和反应。不幸的是，这些疫苗在不同人群中的免疫原性和保护效果并不相同。与发达国家相比，生活在发展中国家的儿童似乎反应较低，但这些较低反应的原因尚不清楚。最可能的解释与营养不良、微量营养素缺乏、黏膜表面微生物过度负荷、微生物组和微生态的改变以及黏膜不可逆变化以及血清或母乳中的母抗体有关，这些可能改变黏膜病理，降低对口服疫苗干预的免疫反应。不良环境和营养不良的有害影响可能会导致儿童的黏膜发生不可逆变化，特别是在受孕到出生后和两岁之前的生命最初 1000 天内。本综述旨在总结有关黏膜疫苗免疫反应降低的信息，以及可能有助于解决这些疫苗在儿童面临最大压力和有害不利环境下使用时所受到限制的干预措施。
