Inhibitory Effect of Breast Milk on Infectivity of Live Oral Rotavirus Vaccines

• Type of Material: Article
• Authors: Sung-Sil Moon, Centers for Disease Control and Prevention; Yuhuan Wang, Centers for Disease Control and Prevention; Andrea Shane, Emory University; Trang Nguyen, The National Institute of Hygiene and Epidemiology; Pratima Ray, All India Institute of Medical Sciences; Penelope Dennehy, Rhode Island Hospital; Luck Ju Baek, Korea University; Umesh Parashar, Centers for Disease Control and Prevention; Roger Glass, Emory University; Baoming Jiang, Centers for Disease Control and Prevention
• Language: English
• Date: 2010-10-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010 by Lippincott Williams & Wilkins.
• Final Published Version (URL): http://dx.doi.org/10.1097/INF.0b013e3181e232ea
• Title of Journal or Parent Work: Pediatric Infectious Disease Journal
• ISSN: 0891-3668
• Volume: 29
• Issue: 10
• Start Page: 919
• End Page: 923
• Grant/Funding Information: Also supported (in part) by the NIH National Center for Research Resources, grants K12RR017643 and 1KL2RR025009 (to S.A.L.).; Supported (in part) by CDC program funds.
• Keywords: IMMUNOGENICITY; Infectious Diseases; rotavirus; CHILDREN; neutralizing activity; RV1; PROTECTION; RV5; SAFETY; Science & Technology; Pediatrics; breast milk; RIT-4237; SEROTYPES; RIX4414; EFFICACY; Life Sciences & Biomedicine; Immunology; DIARRHEA; INFANTS
• Research Categories: Health Sciences, Pathology; Health Sciences, General; Health Sciences, Immunology

Abstract

Background: Live oral rotavirus vaccines have been less immunogenic and efficacious among children in poor developing countries compared with middle income and industrialized countries for reasons that are not yet completely understood. We assessed whether the neutralizing activity of breast milk could lower the titer of vaccine virus and explain this difference in vitro. Methods: Breast milk samples were collected from mothers who were breast-feeding infants 4 to 29 weeks of age (ie, vaccine eligible age) in India (N = 40), Vietnam (N = 77), South Korea (N = 34), and the United States (N = 51). We examined breast milk for rotavirus-specific IgA and neutralizing activity against 3 rotavirus vaccine strains-RV1, RV5 G1, and 116E using enzyme immunoassays. The inhibitory effect of breast milk on RV1 was further examined by a plaque reduction assay. FINDINGS:: Breast milk from Indian women had the highest IgA and neutralizing titers against all 3 vaccine strains, while lower but comparable median IgA and neutralizing titers were detected in breast milk from Korean and Vietnamese women, and the lowest titers were seen in American women. Neutralizing activity was greatest against the 2 vaccine strains of human origin, RV1 and 116E. This neutralizing activity in one half of the breast milk specimens from Indian women could reduce the effective titer of RV1 by ∼2 logs, of 116E by 1.5 logs, and RV5 G1 strain by ∼1 log more than that of breast milk from American women. INTERPRETATION:: The lower immunogenicity and efficacy of rotavirus vaccines in poor developing countries could be explained, in part, by higher titers of IgA and neutralizing activity in breast milk consumed by their infants at the time of immunization that could effectively reduce the potency of the vaccine. Strategies to overcome this negative effect, such as delaying breast-feeding at the time of immunization, should be evaluated.