Meningococcal vaccines and protein-energy undernutrition in children in the African meningitis belt

Maria E Sundaram, Julian Wolfson, Michael Osterholm, Samba Sow, Patrick Odum Ansah, Aldiouma Diallo, Sarah E. Cusick

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Vaccines to prevent meningococcal meningitis in the African meningitis belt include PsACWY, a polysaccharide-only vaccine; and PsA-TT, a polysaccharide-protein conjugate vaccine. Protein-energy undernutrition, a condition where children do not receive enough macro- or micronutrients, is related to increased risk of infectious diseases and poor immune function. Reduced immune function could affect vaccine immunogenicity. We investigated connections between protein-energy undernutrition and vaccine immunogenicity and antibody waning to PsACWY and PsA-TT in children in the African meningitis belt. Methods: This is a secondary analysis of data collected as part of four clinical trials testing the safety and efficacy of PsA-TT in children in Mali, Ghana, and Senegal. We identified whether anthropometric growth indices (low height-for-age, weight-for-height, or weight-for-age Z-score categories) were related to reduced vaccine-elicited antibody (measured with rabbit complement) from pre- to 1 month post-vaccination, in linear regression models. We also identified whether these growth indices were related to increased waning for vaccine-elicited antibody over time, in linear regression models. Results: A total of 697 children were included in our analysis, of which 350 (50.2%) were female; the mean (SD) age was 1.0 (1.1) years, and 578 (83.0%) received PsA-TT. In linear regression models, no consistent statistical relationship was seen between pre-vaccination anthropometric Z-score categories and vaccine immunogenicity, or decline in antibody over time, for either vaccine, although children with low weight-for-height had a greater decline in antibody from 1 to 6 months post-vaccination. Conclusions: Our analysis did not find protein-energy undernutrition to be associated with immunogenicity or waning of PsACWY- or PsA-TT-elicited antibody in children living in the African meningitis belt. Future studies should consider measuring antibody titers at additional time points post-vaccination, and for longer periods of time, to determine if the rate of antibody waning over a period of several years is associated with protein-energy undernutrition.

Original languageEnglish (US)
Pages (from-to)8351-8356
Number of pages6
JournalVaccine
Volume38
Issue number52
DOIs
StatePublished - Dec 14 2020

Bibliographical note

Funding Information:
The authors gratefully acknowledge the research teams at Public Health England, CVD-Mali, and the contributions of the study participants themselves. The authors are additionally grateful for the scientific input and nutritional expertise of Dr. Ellen Demerath (University of Minnesota). The authors also acknowledge the Serum Institute of India (SIIPL), Meningitis Vaccine Project (MVP), and Program for Appropriate Technology in Health (PATH) for funding the original trials, access to data for this analysis and review of this manuscript. Dr. Sundaram’s work was supported by the Frieda Martha Kunze Graduate Fellowship from the University of Minnesota Graduate School and by award T32AI074492 from the Emory Vaccinology Training Program of the National Institute of Allergy and Infectious Diseases.

Funding Information:
The authors gratefully acknowledge the research teams at Public Health England, CVD-Mali, and the contributions of the study participants themselves. The authors are additionally grateful for the scientific input and nutritional expertise of Dr. Ellen Demerath (University of Minnesota). The authors also acknowledge the Serum Institute of India (SIIPL), Meningitis Vaccine Project (MVP), and Program for Appropriate Technology in Health (PATH) for funding the original trials, access to data for this analysis and review of this manuscript. Dr. Sundaram's work was supported by the Frieda Martha Kunze Graduate Fellowship from the University of Minnesota Graduate School and by award T32AI074492 from the Emory Vaccinology Training Program of the National Institute of Allergy and Infectious Diseases.

Publisher Copyright:
© 2020 Elsevier Ltd

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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