title: A comparison of clinical and immunologic features in children and older patients hospitalized with severe cholera in Bangladesh.
abstract: BACKGROUND
  : Infection with Vibrio cholerae induces protection from subsequent severe disease, suggesting that an effective vaccine could be an important preventive strategy. Available vaccines provide less protection against cholera than natural infection, particularly in children.
  
  
  METHODS
  : We examined a cohort of 121 children (2 years-12 years of age) and 276 older patients (>12 years of age) hospitalized with cholera in Dhaka, Bangladesh over a 4-year period, to compare clinical features in older patients and children and immune responses to key antigens.
  
  
  RESULTS
  : Older patients had more severe disease. Children with cholera were more commonly retinol deficient, while zinc deficiency was equally prevalent in both groups. Children developed higher vibriocidal and serum immune responses to the B subunit of cholera toxin (CTB). In contrast, older patients mounted higher immune responses to 2 other key V. cholerae antigens, the lipopolysaccharide (LPS) and toxin coregulated pilus antigens (TcpA). We compared immune responses following infection with those occurring after receipt of a live, oral vaccine in both children and older patients in Bangladesh, during a similar time period. The response rates for vibriocidal and LPS antibodies were higher after infection than after vaccination. Both vaccinated older patients and children responded poorly to CTB and TcpA.
  
  
  CONCLUSIONS
  : Although children developed vigorous vibriocidal and CTB-specific responses following infection, they had lessened responses to LPS and TcpA compared with older patients, as well as lessened responses to vaccination. More studies need to be carried out to determine factors, including micronutrient interventions that can improve responses in children to both natural infection and vaccination.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Fahima
authors.initials: F
authors.lastname: Chowdhury
authors.forename: Ashraful I
authors.initials: AI
authors.lastname: Khan
authors.forename: Jason B
authors.initials: JB
authors.lastname: Harris
authors.forename: Regina C
authors.initials: RC
authors.lastname: LaRocque
authors.forename: Mohiul Islam
authors.initials: MI
authors.lastname: Chowdhury
authors.forename: Edward T
authors.initials: ET
authors.lastname: Ryan
authors.forename: A S G
authors.initials: AS
authors.lastname: Faruque
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Calderwood
authors.forename: Firdausi
authors.initials: F
authors.lastname: Qadri
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology / Q000276:immunology* / Q000503:physiopathology* / Q000517:prevention & control; D002772:Cholera Toxin / Q000276:immunology; D022121:Cholera Vaccines / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D036781:Fimbriae Proteins / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008070:Lipopolysaccharides / Q000276:immunology; D008297:Male; D008875:Middle Aged; D041241:Vibrio cholerae O1 / Q000276:immunology / Q000302:isolation & purification; D041242:Vibrio cholerae O139 / Q000276:immunology / Q000302:isolation & purification; D014801:Vitamin A / Q000097:blood; D015032:Zinc / Q000097:blood / Q000172:deficiency
chemical_list: D022121:Cholera Vaccines; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D008070:Lipopolysaccharides; C497037:Peru 15; C085807:TcpA protein, Vibrio cholerae; D014801:Vitamin A; D036781:Fimbriae Proteins; D002772:Cholera Toxin; D015032:Zinc