Eskenazi Brenda, Rauch Stephen, Elsiwi Basant, Bornman Riana, Obida Muvhulawa, Brewer Angela, Ward Brian J, Chevrier Jonathan
Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California at Berkeley, Berkeley, CA 94720, USA.
Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California at Berkeley, Berkeley, CA 94720, USA.
Vaccine. 2025 Feb 6;46:126564. doi: 10.1016/j.vaccine.2024.126564. Epub 2024 Dec 10.
Under-vaccination is undoubtedly driving recent worldwide measles outbreaks, but undernutrition may also be playing a role in low- and middle-income countries. Studies have shown reduced immune response to vaccines in undernourished children but few have followed children beyond infancy, when they are more likely to be exposed to infectious diseases.
In the Venda Health Examination of Mothers, Babies and the Environment (VHEMBE) South African birth cohort study, we examined the relationship between undernutrition, as measured by stunting and other growth measures, and vaccine-specific serum antibody level to three different vaccine types: measles, tetanus and Haemophilus influenzae type b (Hib). We included 621 fully-vaccinated children with anthropometric measurements at ages 1, 2, and 3.5 years and antibody levels at 3.5 and 5 years.
At 5 years of age, 90.4% of fully-vaccinated children were protected against measles, 66.7% against tetanus, and 56.1% against Hib. Children who were stunted or had any indicator of diminished growth at 3.5 years averaged a 24.1% (95% CI = -44.2, 0.6) or a 27.2% (95% CI = -45.1, -1.3) lower antibody titer for measles, respectively, relative to those with normal growth. In addition, girls, but not boys, with any indicator of diminished growth at 3.5 years averaged a 36.8% (-59.3, -7.0) lower antibody titer for tetanus. We found no association between undernutrition and Hib antibody titers.
Early life undernutrition may be associated with lower induction or persistence of antibody responses to certain vaccines. Addressing child undernutrition may improve vaccine efficacy and reduce the burden of vaccine-preventable diseases.
疫苗接种不足无疑是近期全球麻疹疫情爆发的原因，但营养不良在低收入和中等收入国家可能也起到了一定作用。研究表明，营养不良儿童对疫苗的免疫反应会降低，但很少有研究追踪儿童婴儿期之后的情况，而这一时期他们更易接触传染病。
在南非文达母婴与环境健康检查（VHEMBE）出生队列研究中，我们通过发育迟缓及其他生长指标衡量营养不良状况，并研究其与三种不同疫苗（麻疹、破伤风和b型流感嗜血杆菌（Hib））特异性血清抗体水平之间的关系。我们纳入了621名在1岁、2岁和3.5岁时进行过人体测量且在3.5岁和5岁时检测过抗体水平的全程接种疫苗儿童。
5岁时，90.4%的全程接种疫苗儿童对麻疹具有免疫力，66.7%对破伤风具有免疫力，56.1%对Hib具有免疫力。3.5岁时发育迟缓或有任何生长指标降低的儿童，相对于生长正常的儿童，麻疹抗体滴度分别平均低24.1%（95%CI=-44.2,0.6）或27.2%（95%CI=-45.1,-1.3）。此外，3.5岁时有任何生长指标降低的女孩（而非男孩），破伤风抗体滴度平均低36.8%（-59.3,-7.0）。我们发现营养不良与Hib抗体滴度之间无关联。
生命早期的营养不良可能与某些疫苗抗体反应的诱导或持续能力较低有关。解决儿童营养不良问题可能会提高疫苗效力并减轻疫苗可预防疾病的负担。
