Impact of withholding breastfeeding at the time of vaccination on the immunogenicity of oral rotavirus vaccine--a randomized trial.
Impact of withholding breastfeeding at the time of vaccination on the immunogenicity of oral rotavirus vaccine--a randomized trial.
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DOI：
10.1371/journal.pone.0127622
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Zaidi AK
中科院分区：
文献类型：
--
作者：
Ali A;Kazi AM;Cortese MM;Fleming JA;Moon S;Parashar UD;Jiang B;McNeal MM;Steele D;Bhutta Z;Zaidi AK
母乳中含有抗轮状病毒IgA抗体和其他天然免疫因子，可在体外抑制轮状病毒的复制。这些因素可能会降低口服轮状病毒疫苗的免疫原性，特别是如果母乳喂养发生在接种疫苗的时间附近。2011年4月至2012年11月，我们进行了一项开放标签的随机试验，比较了在接种前一小时至接种后一小时内停止母乳喂养的婴儿与接种时母乳喂养的婴儿使用Rotarix(RV1)的免疫原性。这项试验是在巴基斯坦卡拉奇的易卜拉欣·海德里郊区进行的。两组在6、10和14周龄分别接种三剂RV1。分别于18周龄(主要目标)和14周龄(次要目标)检测接种3剂疫苗(6、10和14周)后的血清阳转率(抗轮状病毒Ig A抗体≥在6周龄时为阴性者)。400名符合条件的婴儿被随机分配到停止母乳喂养和立即母乳喂养的婴儿之间，比例为1：1。总体而言，353名婴儿(88.3%)按方案完成了研究；181名婴儿在停止母乳喂养组，172名婴儿在立即母乳喂养组。接种3剂RV1后，保留组抗轮状病毒IgA抗体阳转率为28.2%(95%CI：22.1；35.1)，立即哺乳组为37.8%(95%CI：30.9；45.2)(差值：-9.6%[95%CI：-19.2；0.2]p=0.07)。在两剂RV1注射后，保留臂的血清转阴率为16.6%(95%CI：11.9；22.7)，立即哺乳臂的血清转阴率为29.1%(95%CI：22.8，36.3)(差异：-12.5%[95%CI：-21.2，-3.8]p=0.005)。与接种RV1疫苗时母乳喂养相比，在接种RV1疫苗时停止母乳喂养并不会导致抗轮状病毒IgA血清转换率的增加。相反，立即母乳喂养的婴儿的IgA血清转换率往往高于不哺乳的婴儿。我们的发现表明，在接种轮状病毒疫苗的时候，应该继续即兴母乳喂养，而在那时停止母乳喂养不太可能提高疫苗的免疫原性。临床试验.gov NCT01199874
Breast milk contains anti-rotavirus IgA antibodies and other innate immune factors that inhibit rotavirus replication in vitro. These factors could diminish the immunogenicity of oral rotavirus vaccines, particularly if breastfeeding occurs close to the time of vaccine administration. Between April 2011 and November 2012, we conducted an open label, randomized trial to compare the immunogenicity of Rotarix (RV1) in infants whose breastfeeding was withheld one hour before through one hour after vaccination with that in infants breastfed at the time of vaccination. The trial was conducted in the peri-urban area of Ibrahim Hyderi in Karachi, Pakistan. Both groups received three doses of RV1 at 6, 10 and 14 weeks of age. Seroconversion (anti-rotavirus IgA antibodies ≥20 U/mL in subjects seronegative at 6 weeks of age) following three vaccine doses (6, 10 and 14 weeks) was determined at 18 weeks of age (primary objective) and seroconversion following two doses (6 and 10 weeks) was determined at 14 weeks of age (secondary objective). Four hundred eligible infants were randomly assigned in a 1:1 ratio between the withholding breastfeeding and immediate breastfeeding arms. Overall, 353 (88.3%) infants completed the study according to protocol; 181 in the withholding breastfeeding group and 172 in the immediate breastfeeding group. After three RV1 doses, anti-rotavirus IgA antibody seroconversion was 28.2% (95% CI: 22.1; 35.1) in the withholding arm and 37.8% (95% CI: 30.9; 45.2) in the immediate breastfeeding arm (difference: -9.6% [95% CI: -19.2; 0.2] p=0.07). After two doses of RV1, seroconversion was 16.6% (95% CI: 11.9; 22.7) in the withholding arm and 29.1% (95% CI: 22.8, 36.3) in the immediate breastfeeding arm (difference: -12.5% [95% CI: -21.2,-3.8] p=0.005). Withholding breastfeeding around the time of RV1 vaccine administration did not lead to increased anti-rotavirus IgA seroconversion compared with that seen with a breastfeed at the time of vaccination. On the contrary, IgA seroconversion in infants immediately breastfed tended to be higher than in those withheld from a feeding. Our findings suggest that breastfeeding should be continued adlib around the time of rotavirus vaccination and withholding breastfeeding at that time is unlikely to improve the vaccine immunogenicity. ClinicalTrials.gov NCT01199874
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影响因子：
6.4
作者：
Rennels, MB
通讯作者：
Rennels, MB
影响因子：
3.1
作者：
KNOWLTON, DR;SPECTOR, DM;WARD, RL
通讯作者：
WARD, RL
影响因子：
56.3
作者：
Tate, Jacqueline E.;Burton, Anthony H.;Parashar, Umesh D.
通讯作者：
Parashar, Umesh D.
影响因子：
11.1
作者：
Groome, Michelle J.;Moon, Sung-Sil;Madhi, Shabir A.
通讯作者：
Madhi, Shabir A.
DOI：
10.1097/inf.0b013e318290646d
发表时间：
2013-08
期刊：
The Pediatric infectious disease journal
影响因子：
--
作者：
Moon SS;Tate JE;Ray P;Dennehy PH;Archary D;Coutsoudis A;Bland R;Newell ML;Glass RI;Parashar U;Jiang B
通讯作者：
Jiang B