title: Impact of malaria and helminth infections on immunogenicity of the human papillomavirus-16/18 AS04-adjuvanted vaccine in Tanzania.
abstract: BACKGROUND
  Endemic malaria and helminth infections in sub-Saharan Africa can act as immunological modulators and impact responses to standard immunizations. We conducted a cohort study to measure the influence of malaria and helminth infections on the immunogenicity of the bivalent HPV-16/18 vaccine.
  
  
  METHODS
  We evaluated the association between malaria and helminth infections, and HPV-16/18 antibody responses among 298 Tanzanian females aged 10-25 years enrolled in a randomized controlled trial of the HPV-16/18 vaccine. Malaria parasitaemia was diagnosed by examination of blood smears, and helminth infections were diagnosed by examination of urine and stool samples, respectively. Geometric mean antibody titres (GMT) against HPV-16/18 antibodies were measured by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Parasitic infections were common; one-third (30.4%) of participants had a helminth infection and 10.2% had malaria parasitaemia. Overall, the vaccine induced high HPV-16/18 GMTs, and there was no evidence of a reduction in HPV-16 or HPV-18 GMT at Month 7 or Month 12 follow-up visits among participants with helminths or malaria. There was some evidence that participants with malaria had increased GMTs compared to those without malaria.
  
  
  CONCLUSIONS
  The data show high HPV immunogenicity regardless of the presence of malaria and helminth infections. The mechanism and significance for the increase in GMT in those with malaria is unknown.
authors.affiliation: University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA; University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Joelle
authors.initials: J
authors.lastname: Brown
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Bazil
authors.initials: B
authors.lastname: Kavishe
authors.affiliation: National Institute for Medical Research, Isamilo, Mwanza, Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: Aura
authors.initials: A
authors.lastname: Andreasen
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mayaud
authors.affiliation: Bugando Medical Centre, Mwanza, Tanzania.
authors.forename: Balthazar
authors.initials: B
authors.lastname: Gumodoka
authors.affiliation: Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Hayes
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania. Electronic address: deborah.watson-jones@lshtm.ac.uk.
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000536:Aluminum Hydroxide; D000914:Antibodies, Viral / Q000097:blood; D000917:Antibody Formation; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006373:Helminthiasis / Q000175:diagnosis / Q000276:immunology*; D052162:Human papillomavirus 16; D052161:Human papillomavirus 18; D006801:Humans; D008050:Lipid A / Q000031:analogs & derivatives; D008288:Malaria / Q000175:diagnosis / Q000276:immunology*; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000276:immunology* / Q000627:therapeutic use; D013636:Tanzania; D055815:Young Adult
chemical_list: C532963:ASO4 mixture; D000276:Adjuvants, Immunologic; D000914:Antibodies, Viral; D008050:Lipid A; D053918:Papillomavirus Vaccines; D000536:Aluminum Hydroxide
keywords: HPV; Helminth; Human papillomavirus; Immunogenicity; Malaria; Parasitic infection; Sub-Saharan Africa; Tanzania; Vaccine