Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK.
Baylor College of Medicine, Houston, TX 77060, USA.
Future Microbiol. 2018 Jan;13(1):97-118. doi: 10.2217/fmb-2017-0128. Epub 2017 Dec 8.
Oral vaccines are less immunogenic when given to infants in low-income compared with high-income countries, limiting their potential public health impact. Here, we review factors that might contribute to this phenomenon, including transplacental antibodies, breastfeeding, histo blood group antigens, enteric pathogens, malnutrition, microbiota dysbiosis and environmental enteropathy. We highlight several clear risk factors for vaccine failure, such as the inhibitory effect of enteroviruses on oral poliovirus vaccine. We also highlight the ambiguous and at times contradictory nature of the available evidence, which undoubtedly reflects the complex and interconnected nature of the factors involved. Mechanisms responsible for diminished immunogenicity may be specific to each oral vaccine. Interventions aiming to improve vaccine performance may need to reflect the diversity of these mechanisms.
口服疫苗在低收入国家的婴儿中免疫原性较低，与高收入国家相比，限制了其潜在的公共卫生影响。在这里，我们回顾了可能导致这种现象的因素，包括胎盘抗体、母乳喂养、组织血型抗原、肠道病原体、营养不良、微生物群落失调和环境肠病。我们强调了一些导致疫苗失败的明确危险因素，例如肠道病毒对口服脊髓灰质炎疫苗的抑制作用。我们还强调了现有证据的模糊性和有时的矛盾性，这无疑反映了所涉及因素的复杂性和相互关联性。导致免疫原性降低的机制可能针对每种口服疫苗而有所不同。旨在提高疫苗性能的干预措施可能需要反映这些机制的多样性。
