Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jul;13(9):1055-1070.
doi: 10.2217/fmb-2018-0016. Epub 2018 Jun 21.

Exploring the relationship between environmental enteric dysfunction and oral vaccine responses

James A Church  1   2 , Edward Pk Parker  3 , Margaret N Kosek  4 , Gagandeep Kang  5 , Nicholas C Grassly  3 , Paul Kelly  2   6 , Andrew J Prendergast  1   2   4
Affiliations
Review

Exploring the relationship between environmental enteric dysfunction and oral vaccine responses

James A Church et al. Future Microbiol. 2018 Jul.

Abstract

Oral vaccines significantly underperform in low-income countries. One possible contributory factor is environmental enteric dysfunction (EED), a subclinical disorder of small intestinal structure and function among children living in poverty. Here, we review studies describing oral vaccine responses and EED. We identified eight studies evaluating EED and oral vaccine responses. There was substantial heterogeneity in study design and few consistent trends emerged. Four studies reported a negative association between EED and oral vaccine responses; two showed no significant association; and two described a positive correlation. Current evidence is therefore insufficient to determine whether EED contributes to oral vaccine underperformance. We identify roadblocks in the field and future research needs, including carefully designed studies those can investigate this hypothesis further.

Keywords: EED; infant; oral vaccine.

PubMed Disclaimer

Conflict of interest statement

Financial & competing interests disclosure

JAC (Grant 201293/Z/16/Z) and AJP (Grant 108065/Z/15/Z) are funded by the Wellcome Trust. JAC and AJP also received funding from DfID via the Sanitation & Hygiene Applied Research for Equity (SHARE) Consortium. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b>
Figure 1.. Proposed biological pathway demonstrating the hypothesized role of EED (incorporating four domains depicted by four colours) in the underperformance of oral vaccines.
<b>Figure 2.</b>
Figure 2.. Summary of evidence for association between markers in four domains of environmental enteric dysfunction and oral vaccine response.
See this image and copyright information in PMC

References

    1. GBD Diarrhoeal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect. Dis. 2017;17(9):909–948. - PMC - PubMed
    1. Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015;385(9966):430–440. - PubMed
    1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–1259. - PMC - PubMed
    1. VIEW-hub. Interactive mapping tool. www.view-hub.org/viz/
    1. Patel M, Shane AL, Parashar UD, Jiang B, Gentsch JR, Glass RI. Oral rotavirus vaccines: how well will they work where they are needed most? J. Infect. Dis. 2009;200(Suppl. 1):S39–S48. - PMC - PubMed

Publication types