title: The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal.
abstract: A globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1+3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown.
  
  
  
  Infants aged 6 weeks to 11 months, who had received <3 doses of OPV and had mild-moderate diarrhea or no diarrhea, were recruited at five health facilities in Nepal. Neutralizing antibody titers to poliovirus types 1 and 3 were measured before and 28 days after bOPV administration. The effect of diarrhea and other factors on seroconversion or boosting in antibody titers to poliovirus was assessed by multivariable analysis.
  
  
  
  Infants with diarrhea, versus those without diarrhea, had reduced response for poliovirus types 1 (56% [87/156] vs 66% [109/164]) and 3 (34% [70/209] vs 52% [122/236]). After adjusting for other factors, infants with diarrhea had significantly reduced response for type 3 (odds ratio [OR]=0.44, 95% CI 0.29-0.68), as did infants with >5 loose stools per day (OR=0.36, 95% CI 0.21-0.62).
  
  
  
  Diarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease.
  
  
  
  This study is registered at clinicaltrials.gov as NCT01559636.
authors.affiliation: Centers for Disease Control and Prevention, Global Immunization Division, United States. Electronic address: ccardemil@cdc.gov.
authors.forename: Cristina V
authors.initials: CV
authors.lastname: Cardemil
authors.affiliation: Centers for Disease Control and Prevention, Global Immunization Division, United States.
authors.forename: Concepcion
authors.initials: C
authors.lastname: Estivariz
authors.affiliation: Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Laxman
authors.initials: L
authors.lastname: Shrestha
authors.affiliation: Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Jeevan B
authors.initials: JB
authors.lastname: Sherchand
authors.affiliation: Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Arun
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Centers for Disease Control and Prevention, Global Immunization Division, United States.
authors.forename: Howard E
authors.initials: HE
authors.lastname: Gary
authors.affiliation: Centers for Disease Control and Prevention, Division of Viral Diseases, United States.
authors.forename: M Steven
authors.initials: MS
authors.lastname: Oberste
authors.affiliation: Centers for Disease Control and Prevention, Division of Viral Diseases, United States.
authors.forename: William C
authors.initials: WC
authors.lastname: Weldon
authors.affiliation: Centers for Disease Control and Prevention, Division of Viral Diseases, United States.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Bowen
authors.affiliation: Centers for Disease Control and Prevention, Division of Viral Diseases, United States.
authors.forename: Jan
authors.initials: J
authors.lastname: Vinjé
authors.affiliation: World Health Organization, Kathmandu, Nepal.
authors.forename: W William
authors.initials: WW
authors.lastname: Schluter
authors.affiliation: Centers for Disease Control and Prevention, Global Immunization Division, United States.
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Anand
authors.affiliation: Centers for Disease Control and Prevention, Global Immunization Division, United States.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Mach
authors.affiliation: Centers for Disease Control and Prevention, Global Immunization Division, United States.
authors.forename: Susan Y
authors.initials: SY
authors.lastname: Chu
mesh_terms: D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood*; D003967:Diarrhea / Q000276:immunology*; D005243:Feces / Q000821:virology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011051:Poliomyelitis / Q000517:prevention & control / Q000821:virology; D017955:Poliovirus / Q000276:immunology*; D011055:Poliovirus Vaccine, Oral / Q000276:immunology*; D000069078:Seroconversion
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D011055:Poliovirus Vaccine, Oral
keywords: Bivalent oral polio vaccine; Diarrhea; Nepal; Poliomyelitis; Seroconversion