Research article

A randomised controlled trial of the effects of albendazole in pregnancy on maternal responses to mycobacterial antigens and infant responses to bacille Calmette-Guérin (BCG) immunisation [ISRCTN32849447]

Alison M Elliott^1,5 , Proscovia B Namujju¹ , Patrice A Mawa¹ , Maria A Quigley^3,5 , Margaret Nampijja¹ , Peter M Nkurunziza¹ , John T Belisle⁴ , Moses Muwanga² and James AG Whitworth^1,5 for the "Mother and Baby" study team

¹  Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda

²  Entebbe Hospital, P.O. Box 29, Entebbe, Uganda

³  National Perinatal Epidemiology Unit, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, UK

⁴  Department of Microbiology, Colorado State University, Fort Collins, Colorado 80523, USA

⁵  London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK

author email corresponding author email

BMC Infectious Diseases 2005, 5:115doi:10.1186/1471-2334-5-115

Published:	21 December 2005

Abstract

Background

Maternal schistosomiasis and filariasis have been shown to influence infant responses to neonatal bacille Calmette-Guérin (BCG) immunisation but the effects of maternal hookworm, and of de-worming in pregnancy, are unknown.

Methods

In Entebbe, Uganda, we conducted a randomised, double-blind, placebo-controlled trial of a single dose of 400 mg of albendazole in the second trimester of pregnancy. Neonates received BCG. Interferon-gamma (IFN-γ) and interleukin (IL)-5 responses to a mycobacterial antigen (crude culture filtrate proteins (CFP) of Mycobacterium tuberculosis) were measured in a whole blood assay. We analysed results for binary variables using χ² tests and logistic regression. We analysed continuous variables using Wilcoxon's tests.

Results

Maternal hookworm was associated with reduced maternal IFN-γ responses to CFP (adjusted odds ratio for IFN-γ > median response: 0.14 (95% confidence interval 0.02–0.83, p = 0.021). Conversely, maternal hookworm was associated with subsequent increased IFN-γ responses in their one-year-old infants (adjusted OR 17.65 (1.20–258.66; p = 0.013)). Maternal albendazole tended to reduce these effects.

Conclusion

Untreated hookworm infection in pregnancy was associated with reduced maternal IFN-γ responses to mycobacterial antigens, but increased responses in their infants one year after BCG immunisation. The mechanisms of these effects, and their implications for protective immunity remain, to be determined.