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Open Access Highly Accessed Research article

Factors affecting the infant antibody response to measles immunisation in Entebbe-Uganda

Dennison Kizito1*, Robert Tweyongyere2, Alice Namatovu2, Emily L Webb3, Lawrence Muhangi1, Swaib A Lule1, Henry Bukenya4, Stephen Cose13 and Alison M Elliott13

Author Affiliations

1 Co-infection Studies Programme, MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, P.O. BOX 49, Entebbe, Uganda

2 College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. BOX 7062, Kampala, Uganda

3 London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

4 Expanded Programme on Immunisation Laboratory, Uganda Virus Research Institute, P.O. BOX 49, Entebbe, Uganda

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BMC Public Health 2013, 13:619  doi:10.1186/1471-2458-13-619

Published: 1 July 2013

Abstract

Background

Vaccine failure is an important concern in the tropics with many contributing elements. Among them, it has been suggested that exposure to natural infections might contribute to vaccine failure and recurrent disease outbreaks. We tested this hypothesis by examining the influence of co-infections on maternal and infant measles-specific IgG levels.

Methods

We conducted an observational analysis using samples and data that had been collected during a larger randomised controlled trial, the Entebbe Mother and Baby Study (ISRCTN32849447). For the present study, 711 pregnant women and their offspring were considered. Helminth infections including hookworm, Schistosoma mansoni and Mansonella perstans, along with HIV, malaria, and other potential confounding factors were determined in mothers during pregnancy and in their infants at age one year. Infants received their measles immunisation at age nine months. Levels of total IgG against measles were measured in mothers during pregnancy and at delivery, as well as in cord blood and from infants at age one year.

Results

Among the 711 pregnant women studied, 66% had at least one helminth infection at enrolment, 41% had hookworm, 20% M. perstans and 19% S. mansoni. Asymptomatic malaria and HIV prevalence was 8% and 10% respectively. At enrolment, 96% of the women had measles-specific IgG levels considered protective (median 4274 mIU/ml (IQR 1784, 7767)). IgG levels in cord blood were positively correlated to maternal measles-specific IgG levels at delivery (r = 0.81, p < 0.0001). Among the infants at one year of age, median measles-specific IgG levels were markedly lower than in maternal and cord blood (median 370 mIU/ml (IQR 198, 656) p < 0.0001). In addition, only 75% of the infants had measles-specific IgG levels considered to be protective. In a multivariate regression analysis, factors associated with reduced measles-specific antibody levels in infancy were maternal malaria infection, infant malaria parasitaemia, infant HIV and infant wasting. There was no association with maternal helminth infection.

Conclusion

Malaria and HIV infection in mothers during pregnancy, and in their infants, along with infant malnutrition, may result in reduction of the antibody response to measles immunisation in infancy. This re-emphasises the importance of malaria and HIV control, and support for infant nutrition, as these interventions may have benefits for vaccine efficacy in tropical settings.

Keywords:
Infections; Co-infections; Measles; Helminth; Malaria; HIV; Maternal; Infants; Pregnancy; Immunisation