title: Effects of undernutrition on infection with Vibrio cholerae O1 and on response to oral cholera vaccine.
abstract: The association between undernutrition and the risk of colonization and disease with Vibrio cholerae O1, concentrations of salivary IgA and the serologic response to infection and to orally administered cholera B subunit were examined prospectively in a family study in Bangladesh. Children ages 1 to 8 years who were family contacts of patients hospitalized with culture-confirmed cholera were visited within 24 hours of the hospitalization and daily for 10 days, queried for the presence of diarrhea and cultured for V. cholerae O1. On Day 1 each child was weighed and saliva was collected to measure total IgA. On Days 1 and 21 blood was taken to assess vibriocidal and antitoxin titers, and on Days 1 and 2 B subunit or placebo was given orally as part of a trial to look for a toxin-blocking effect. Of 412 children enrolled in the study 35% (143) became infected with V. cholerae O1 and 49% (70) of these developed diarrhea. Undernutrition, defined in a child as weight less than 70% of the Harvard reference weight-for-age, was not associated with colonization, disease or the duration or severity of cholera. Moreover well-nourished children did not differ from undernourished children in their concentrations of salivary total IgA, initial serum antitoxin or vibriocidal antibodies or in their serologic response to colonization, disease or B subunit. The immune system in its response to cholera appears to be quite resistant to nutritional insults. The good antitoxin response to B subunit among undernourished children is of particular importance in considering the use of future oral cholera vaccines in areas where such undernutrition is common.
authors.affiliation: International Center for Diarrheal Disease Research, Dhaka, Bangladesh.
authors.forename: R I
authors.initials: RI
authors.lastname: Glass
authors.forename: A M
authors.initials: AM
authors.lastname: Svennerholm
authors.forename: B J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: M R
authors.initials: MR
authors.lastname: Khan
authors.forename: S
authors.initials: S
authors.lastname: Huda
authors.forename: M I
authors.initials: MI
authors.lastname: Huq
authors.forename: J
authors.initials: J
authors.lastname: Holmgren
mesh_terms: D000284:Administration, Oral; D001835:Body Weight; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications*; D002675:Child, Preschool; D002771:Cholera / Q000150:complications* / Q000517:prevention & control; D022121:Cholera Vaccines; D003967:Diarrhea / Q000150:complications; D006801:Humans; D007071:Immunoglobulin A, Secretory / Q000032:analysis*; D007223:Infant; D011446:Prospective Studies; D012463:Saliva; D013997:Time Factors; D014611:Vaccination
chemical_list: D022121:Cholera Vaccines; D007071:Immunoglobulin A, Secretory