A randomised controlled trial of the effects of albendazole in pregnancy on maternal responses to mycobacterial antigens and infant responses to Bacille Calmette-Guérin (BCG) immunisation [ISRCTN32849447].
BACKGROUND
Maternal schistosomiasis and filariasis have been shown to influence infant responses to neonatal bacille Calmette-Guérin (BCG) immunisation but the effects of maternal hookworm, and of de-worming in pregnancy, are unknown.


METHODS
In Entebbe, Uganda, we conducted a randomised, double-blind, placebo-controlled trial of a single dose of 400 mg of albendazole in the second trimester of pregnancy. Neonates received BCG. Interferon-gamma (IFN-gamma) and interleukin (IL)-5 responses to a mycobacterial antigen (crude culture filtrate proteins (CFP) of Mycobacterium tuberculosis) were measured in a whole blood assay. We analysed results for binary variables using chi2 tests and logistic regression. We analysed continuous variables using Wilcoxon's tests.


RESULTS
Maternal hookworm was associated with reduced maternal IFN-gamma responses to CFP (adjusted odds ratio for IFN-gamma > median response: 0.14 (95% confidence interval 0.02-0.83, p = 0.021). Conversely, maternal hookworm was associated with subsequent increased IFN-gamma responses in their one-year-old infants (adjusted OR 17.65 (1.20-258.66; p = 0.013)). Maternal albendazole tended to reduce these effects.


CONCLUSIONS
Untreated hookworm infection in pregnancy was associated with reduced maternal IFN-gamma responses to mycobacterial antigens, but increased responses in their infants one year after BCG immunisation. The mechanisms of these effects, and their implications for protective immunity remain, to be determined.
Elliott
Alison M
AM
Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda. alison.tom@infocom.co.ug
Namujju
Proscovia B
PB
Mawa
Patrice A
PA
Quigley
Maria A
MA
Nampijja
Margaret
M
Nkurunziza
Peter M
PM
Belisle
John T
JT
Muwanga
Moses
M
Whitworth
James A G
JA
D000328:Adult; D015766:Albendazole / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D000818:Animals; D000942:Antigens, Bacterial / Q000276:immunology*; D001500:BCG Vaccine / Q000276:immunology*; D004311:Double-Blind Method; D005260:Female; D006376:Helminths / Q000276:immunology; D006725:Hookworm Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007223:Infant; D007371:Interferon-gamma / Q000276:immunology / Q000378:metabolism; D009169:Mycobacterium tuberculosis / Q000276:immunology* / Q000378:metabolism; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000276:immunology*
D000942:Antigens, Bacterial; D001500:BCG Vaccine; D007371:Interferon-gamma; D015766:Albendazole