title: Pneumococcal Vaccine Response After Exposure to Parasites in Utero, in Infancy, or Mid-Childhood.
abstract: OBJECTIVE
  Streptococcus pneumoniaeis a leading cause of mortality before age 5, but few studies examine details of childhood response to pneumococcal vaccine in less-developed settings. Although malnutrition, HIV, and concurrent infections can impair response, evidence suggests that chronic parasitic infections can also contribute to poor vaccination results. The objective of this study was to determine whether response to pneumococcal vaccine varied among children either exposed to parasitic infections in utero, previously infected in infancy, or infected at the time of immunization.
  
  
  METHODS
  Children from a 2006 to 2010 maternal-infant cohort were eligible for the current study. Children were screened for malaria, schistosomiasis, filariasis, intestinal helminths, and protozoa. Data on in utero exposure and early life infections were linked, and baseline antipneumococcal immunoglobulin G levels and nasopharyngeal carrier status were determined. Participants received decavalent pneumococcal vaccine, and 4 weeks later, serology was repeated to assess vaccine response.
  
  
  RESULTS
  A total of 281 children were included. Preimmunity was associated with greater postvaccination increments in anti-pneumococcal polysaccharide immunoglobulin G, especially serotypes 4, 7, 9, 18C, and 19. Present-day growth stunting was independently associated with weaker responses to 1, 4, 6B, 7, 9V, and 19. Previous exposure toTrichuriswas associated with stronger responses to 1, 5, 6B, 7, 18C, and 23, but other parasite exposures were not consistently associated with response.
  
  
  CONCLUSIONS
  In our cohort, hyporesponsiveness to pneumococcal conjugate vaccine was associated with growth stunting but not parasite exposure. Parasite-related vaccine response deficits identified before age 3 do not persist into later childhood.
authors.affiliation: Division of Pediatric Infectious Diseases, UCSF Benioff Children's Hospital Oakland and Children's Hospital Oakland Research Institute, Oakland, California; msinger@mail.cho.org.
authors.forename: Monica
authors.initials: M
authors.lastname: Nayakwadi Singer
authors.affiliation: Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California.
authors.forename: Claire
authors.initials: C
authors.lastname: Heath
authors.affiliation: Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Jackson
authors.initials: J
authors.lastname: Muinde
authors.affiliation: Division of Pediatric Infectious Diseases, UCSF Benioff Children's Hospital Oakland and Children's Hospital Oakland Research Institute, Oakland, California.
authors.forename: Virginia
authors.initials: V
authors.lastname: Gildengorin
authors.affiliation: Technical University of Mombasa, Mombasa, Kenya; and.
authors.forename: Francis M
authors.initials: FM
authors.lastname: Mutuku
authors.affiliation: Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California.
authors.forename: David
authors.initials: D
authors.lastname: Vu
authors.affiliation: Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
authors.forename: Dunstan
authors.initials: D
authors.lastname: Mukoko
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: King
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Indu J
authors.initials: IJ
authors.lastname: Malhotra
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Charles H
authors.initials: CH
authors.lastname: King
authors.affiliation: Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California.
authors.forename: A Desirée
authors.initials: AD
authors.lastname: LaBeaud
mesh_terms: D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D010271:Parasites; D010272:Parasitic Diseases / Q000276:immunology*; D011008:Pneumococcal Infections / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000276:immunology*; D013296:Streptococcus pneumoniae / Q000276:immunology*; D018074:Vaccines, Conjugate / Q000276:immunology*
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate