Church James A, Rukobo Sandra, Govha Margaret, Gough Ethan K, Chasekwa Bernard, Lee Benjamin, Carmolli Marya P, Panic Gordana, Giallourou Natasa, Ntozini Robert, Mutasa Kuda, McNeal Monica M, Majo Florence D, Tavengwa Naume V, Swann Jonathan R, Moulton Lawrence H, Kirkpatrick Beth D, Humphrey Jean H, Prendergast Andrew J
Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK.
EClinicalMedicine. 2021 Nov 15;41:101173. doi: 10.1016/j.eclinm.2021.101173. eCollection 2021 Nov.
Oral rotavirus vaccines (RVV) are poorly immunogenic in low-income countries. Environmental enteric dysfunction (EED) resulting from poor water, sanitation and hygiene (WASH) may contribute. We therefore tested associations between EED and RVV immunogenicity, and evaluated the effect of improved WASH on EED.
We measured nine biomarkers of EED among Zimbabwean infants born to mothers enrolled in a cluster-randomised 2 × 2 factorial trial of improved WASH and improved feeding between November 2012 and March 2015 (NCT01824940). We used multivariable regression to determine associations between EED biomarkers and RVV seroconversion, seropositivity and geometric mean titer. Log-binomial regression was used to evaluate the effect of improved WASH on EED.
Among 303 infants with EED biomarkers and immunogenicity data, plasma intestinal fatty-acid binding protein and stool myeloperoxidase were positively associated with RVV seroconversion; adjusted RR 1.63 (95%CI 1.04, 2.57) and 1.29 (95%CI 1.01, 1.65), respectively. There were no other associations between RVV immunogenicity and either individual biomarkers or EED domains (intestinal permeability, intestinal damage, intestinal inflammation and microbial translocation). EED biomarkers did not differ between randomised WASH and non-WASH groups.
We found no evidence that EED was associated with poor RVV immunogenicity. Contrary to our hypothesis, there was weak evidence that EED was associated with increased seroconversion. EED biomarkers were not affected by a package of household-level WASH interventions.
口服轮状病毒疫苗（RVV）在低收入国家免疫原性较差。水、环境卫生和个人卫生条件（WASH）不佳导致的环境肠道功能障碍（EED）可能是原因之一。因此，我们测试了EED与RVV免疫原性之间的关联，并评估了改善WASH对EED的影响。
在2012年11月至2015年3月期间，我们对参与改善WASH和改善喂养的整群随机2×2析因试验的母亲所生的津巴布韦婴儿，测量了九种EED生物标志物（NCT01824940）。我们使用多变量回归来确定EED生物标志物与RVV血清转化、血清阳性率和几何平均滴度之间的关联。使用对数二项回归来评估改善WASH对EED的影响。
在303名有EED生物标志物和免疫原性数据的婴儿中，血浆肠脂肪酸结合蛋白和粪便髓过氧化物酶与RVV血清转化呈正相关；调整后的RR分别为1.63（95%CI 1.04，2.57）和1.29（95%CI 1.01，1.65）。RVV免疫原性与单个生物标志物或EED领域（肠道通透性、肠道损伤、肠道炎症和微生物易位）之间没有其他关联。随机分组的WASH组和非WASH组之间的EED生物标志物没有差异。
我们没有发现EED与RVV免疫原性差有关的证据。与我们的假设相反，有微弱证据表明EED与血清转化率增加有关。EED生物标志物不受一系列家庭层面WASH干预措施的影响。
