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Open Access Highly Accessed Opinion

Immunogenicity and efficacy of oral vaccines in developing countries: lessons from a live cholera vaccine

Myron M Levine

Author Affiliations

Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201, USA

BMC Biology 2010, 8:129  doi:10.1186/1741-7007-8-129

Published: 4 October 2010


Oral vaccines, whether living or non-living, viral or bacterial, elicit diminished immune responses or have lower efficacy in developing countries than in developed countries. Here I describe studies with a live oral cholera vaccine that include older children no longer deriving immune support from breast milk or maternal antibodies and that identify some of the factors accounting for the lower immunogenicity, as well as suggesting counter-measures that may enhance the effectiveness of oral immunization in developing countries. The fundamental breakthrough is likely to require reversing effects of the 'environmental enteropathy' that is often present in children living in fecally contaminated, impoverished environments.