title: Evaluating associations between vaccine response and malnutrition, gut function, and enteric infections in the MAL-ED cohort study: methods and challenges.
abstract: Most vaccine assessments have occurred in well-nourished populations of higher socioeconomic status. However, vaccines are often used in populations with high incidences of malnutrition and infections, in whom the effectiveness of some vaccines is inferior for unknown reasons. The degree and extent of vaccine underperformance have not been systematically studied for most vaccines across differing epidemiologic settings. This paper outlines the methods used and challenges associated with measuring immunological responses to oral vaccines against poliovirus and rotavirus, and parenteral vaccines against pertussis, tetanus, and measles in an observational study that monitored daily illness, monthly growth, intestinal inflammation and permeability, pathogen burden, dietary intake, and micronutrient status in children in 8 countries. This evaluation of vaccine response in the context of low- and middle-income countries is intended to address the gaps in knowledge of the heterogeneity in vaccine response in diverse epidemiological settings and the interplay between infections, nutrition, and immune response.
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Christel
authors.initials: C
authors.lastname: Hoest
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Seidman
authors.affiliation: Department of Environmental Science and Policy and the Duke Global Health Institute, Duke University, Durham, North Carolina.
authors.forename: William
authors.initials: W
authors.lastname: Pan
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Ramya
authors.initials: R
authors.lastname: Ambikapathi
authors.affiliation: Christian Medical College, Vellore, India.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Stacey
authors.initials: S
authors.lastname: Knobler
authors.affiliation: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Mason
authors.affiliation: Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Mark
authors.initials: M
authors.lastname: Miller
mesh_terms: D015362:Child Nutrition Disorders / Q000453:epidemiology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D015340:Epidemiologic Research Design; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology*; D008137:Longitudinal Studies; D044342:Malnutrition / Q000453:epidemiology*; D014612:Vaccines / Q000276:immunology*
chemical_list: D014612:Vaccines
keywords: MAL-ED; enteric infections; gut function; malnutrition; vaccines