Protection from natural immunity against enteric infections and etiology-specific diarrhea in a longitudinal birth cohort

Department of Public Health Sciences, University of Virginia, Charlottesville, Virgina, USA / Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina.
Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina.
Christian Medical College, Vellore, India.
Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina / Asociación Benéfica PRISMA, Iquitos, Peru.
Universidade Federal do Ceará. Fortaleza, CE, Brasil.
University of Venda. Thohoyandou, South Africa.
University of Venda. Thohoyandou, South Africa.
International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
Haydom Global Health Research Centre. Haydom, Tanzania.
Walter Reed/AFRIMS Research Unit. Kathmandu, Nepal.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Armed Forces Research Institute of Medical Sciences (AFRIMS). Bangkok, Thailand.
Aga Khan University. Karachi, Pakistan.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Kilimanjaro Clinical Research Institute. Moshi, Tanzania.
Department of Public Health Sciences, University of Virginia, Charlottesville, Virgina, USA / Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina.
International Centre for Diarrheal Disease Research. Dhaka, Bangladesh.
Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina.
Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina

Abstract

Background. The degree of protection conferred by natural immunity is unknown for many enteropathogens, but it is important to support the development of enteric vaccines. Methods. We used the Andersen-Gill extension of the Cox model to estimate the effects of previous infections on the incidence of subsequent subclinical infections and diarrhea in children under 2 using quantitative molecular diagnostics in the MAL-ED cohort. We used cross-pathogen negative control associations to correct bias due to confounding by unmeasured heterogeneity of exposure and susceptibility. Results. Prior rotavirus infection was associated with a 50% lower hazard (calibrated hazard ratio [cHR], 0.50; 95% confidence interval [CI], 0.41–0.62) of subsequent rotavirus diarrhea. Strong protection was evident against Cryptosporidium diarrhea (cHR, 0.32; 95% CI, 0.20–0.51). There was also protection due to prior infections for norovirus GII (cHR against diarrhea, 0.67; 95% CI, 0.49–0.91), astrovirus (cHR, 0.62; 95% CI, 0.48–0.81), and Shigella (cHR, 0.79; 95% CI, 0.65–0.95). Minimal protection was observed for other bacteria, adenovirus 40/41, and sapovirus. Conclusions. Natural immunity was generally stronger for the enteric viruses than bacteria, potentially due to less antigenic diversity. Vaccines against major causes of diarrhea may be feasible but likely need to be more immunogenic than natural infection.

Keywords in Portuguese

Análise de viés
Controle negativo
Diarréia
Infecções entéricas
Imunidade natural

Keywords

Bias analysis
Diarrhea
Enteric infections
Natural immunity
Negative control

Publisher

Oxford University Press

Citation

McQUADE, Elizabeth T. Rogawski et al. Protection From Natural Immunity Against Enteric Infections and Etiology-Specific Diarrhea in a Longitudinal Birth Cohort. The Journal of Infectious Diseases, v. XX, p. 1-11, 2020.

DOI

10.1093/infdis/jiaa031

ISSN

1413-8670

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/42623

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Copyright

Restricted access

Embargo date

2022-01-01

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