Impact of maternal antibodies and microbiota development on the immunogenicity of oral rotavirus vaccine in African, Indian, and European infants
Edward P K Parker, Christina Bronowski, Kulandaipalayam Natarajan Sindhu, Sudhir Babji, Blossom Benny, Noelia Carmona‐Vicente, Nedson Chasweka, End Chinyama, Nigel A. Cunliffe, Queen Dube, Sidhartha Giri, Nicholas C. Grassly, Annai Gunasekaran, Deborah Howarth, Sushil Immanuel, Khuzwayo C. Jere, Beate Kampmann, Jenna Lowe, Jonathan Mandolo, Ira Praharaj, Bakthavatsalam Sandya Rani, Sophia Silas, Vivek Kumar Srinivasan, M. Turner, Srinivasan Venugopal, Valsan Philip Verghese, Alistair C. Darby, Gagandeep Kang, Miren Iturriza‐Gómara
Abstract
Identifying risk factors for impaired oral rotavirus vaccine (ORV) efficacy in low-income countries may lead to improvements in vaccine design and delivery. In this prospective cohort study, we measure maternal rotavirus antibodies, environmental enteric dysfunction (EED), and bacterial gut microbiota development among infants receiving two doses of Rotarix in India (n = 307), Malawi (n = 119), and the UK (n = 60), using standardised methods across cohorts. We observe ORV shedding and seroconversion rates to be significantly lower in Malawi and India than the UK. Maternal rotavirus-specific antibodies in serum and breastmilk are negatively correlated with ORV response in India and Malawi, mediated partly by a reduction in ORV shedding. In the UK, ORV shedding is not inhibited despite comparable maternal antibody levels to the other cohorts. In both India and Malawi, increased microbiota diversity is negatively correlated with ORV immunogenicity, suggesting that high early-life microbial exposure may contribute to impaired vaccine efficacy.