scholarly journals Impact of maternal antibodies and microbiota development on the immunogenicity of oral rotavirus vaccine in African, Indian, and European infants

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Edward P. K. Parker ◽  
Christina Bronowski ◽  
Kulandaipalayam Natarajan C. Sindhu ◽  
Sudhir Babji ◽  
Blossom Benny ◽  
...  
Keyword(s):  
Low Income ◽  
Early Life ◽  
Maternal Antibodies ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Specific Antibodies ◽  
Environmental Enteric Dysfunction ◽  
The Uk ◽  
Antibody Levels ◽  
Microbiota Diversity

AbstractIdentifying risk factors for impaired oral rotavirus vaccine (ORV) efficacy in low-income countries may lead to improvements in vaccine design and delivery. In this prospective cohort study, we measure maternal rotavirus antibodies, environmental enteric dysfunction (EED), and bacterial gut microbiota development among infants receiving two doses of Rotarix in India (n = 307), Malawi (n = 119), and the UK (n = 60), using standardised methods across cohorts. We observe ORV shedding and seroconversion rates to be significantly lower in Malawi and India than the UK. Maternal rotavirus-specific antibodies in serum and breastmilk are negatively correlated with ORV response in India and Malawi, mediated partly by a reduction in ORV shedding. In the UK, ORV shedding is not inhibited despite comparable maternal antibody levels to the other cohorts. In both India and Malawi, increased microbiota diversity is negatively correlated with ORV immunogenicity, suggesting that high early-life microbial exposure may contribute to impaired vaccine efficacy.

scholarly journals Impact of maternal antibodies and microbiota development on the immunogenicity of oral rotavirus vaccine in African, Indian, and European infants: a prospective cohort study

2020 ◽  
Author(s):  
Edward P. K. Parker ◽  
Christina Bronowski ◽  
Kulandaipalayam Natarajan C. Sindhu ◽  
Sudhir Babji ◽  
Blossom Benny ◽  
...  
Keyword(s):  
Low Income ◽  
Early Life ◽  
Maternal Antibodies ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Specific Antibodies ◽  
Environmental Enteric Dysfunction ◽  
The Uk ◽  
Antibody Levels ◽  
Microbiota Diversity

Identifying risk factors for impaired oral rotavirus vaccine (ORV) efficacy in low-income countries may lead to improvements in vaccine design and delivery. We measured maternal rotavirus antibodies, environmental enteric dysfunction (EED), and bacterial gut microbiota development among infants receiving two doses of Rotarix in India (n = 307), Malawi (n = 119), and the UK (n = 60), using standardised methods across cohorts. ORV shedding and seroconversion rates were significantly lower in Malawi and India than the UK. Maternal rotavirus-specific antibodies in serum and breastmilk were negatively correlated with ORV response in India and Malawi, and this was mediated partly by a reduction in ORV replication. In the UK, ORV replication was not inhibited despite comparable maternal antibody levels. In both India and Malawi, pre-vaccination microbiota diversity was negatively correlated with ORV immunogenicity, suggesting that high early-life microbial exposure may contribute to impaired vaccine efficacy.

scholarly journals The Rotavirus Vaccine Landscape, an Update

Pathogens ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 520
Author(s):  
Roberto Cárcamo-Calvo ◽  
Carlos Muñoz ◽  
Javier Buesa ◽  
Jesús Rodríguez-Díaz ◽  
Roberto Gozalbo-Rovira
Keyword(s):  
Developing Countries ◽  
Mortality Rate ◽  
Low Income ◽  
State Of The Art ◽  
The State ◽  
Cold Chain ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Oral Vaccines

Rotavirus is the leading cause of severe acute childhood gastroenteritis, responsible for more than 128,500 deaths per year, mainly in low-income countries. Although the mortality rate has dropped significantly since the introduction of the first vaccines around 2006, an estimated 83,158 deaths are still preventable. The two main vaccines currently deployed, Rotarix and RotaTeq, both live oral vaccines, have been shown to be less effective in developing countries. In addition, they have been associated with a slight risk of intussusception, and the need for cold chain maintenance limits the accessibility of these vaccines to certain areas, leaving 65% of children worldwide unvaccinated and therefore unprotected. Against this backdrop, here we review the main vaccines under development and the state of the art on potential alternatives.

scholarly journals Evaluating strategies to improve rotavirus vaccine impact during the second year of life in Malawi

2019 ◽  
Vol 11 (505) ◽  
pp. eaav6419 ◽  
Author(s):  
Virginia E. Pitzer ◽  
Aisleen Bennett ◽  
Naor Bar-Zeev ◽  
Khuzwayo C. Jere ◽  
Benjamin A. Lopman ◽  
...  
Keyword(s):  
Low Income ◽  
Transmission Rate ◽  
Natural Infection ◽  
Vaccine Effectiveness ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Second Year Of Life ◽  
Vaccine Impact ◽  
Second Year ◽  
Induced Immunity

Rotavirus vaccination has substantially reduced the incidence of rotavirus-associated gastroenteritis (RVGE) in high-income countries, but vaccine impact and estimated effectiveness are lower in low-income countries for reasons that are poorly understood. We used mathematical modeling to quantify rotavirus vaccine impact and investigate reduced vaccine effectiveness, particularly during the second year of life, in Malawi, where vaccination was introduced in October 2012 with doses at 6 and 10 weeks. We fitted models to 12 years of prevaccination data and validated the models against postvaccination data to evaluate the magnitude and duration of vaccine protection. The observed rollout of vaccination in Malawi was predicted to lead to a 26 to 77% decrease in the overall incidence of moderate-to-severe RVGE in 2016, depending on assumptions about waning of vaccine-induced immunity and heterogeneity in vaccine response. Vaccine effectiveness estimates were predicted to be higher among 4- to 11-month-olds than 12- to 23-month-olds, even when vaccine-induced immunity did not wane, due to differences in the rate at which vaccinated and unvaccinated individuals acquire immunity from natural infection. We found that vaccine effectiveness during the first and second years of life could potentially be improved by increasing the proportion of infants who respond to vaccination or by lowering the rotavirus transmission rate. An additional dose of rotavirus vaccine at 9 months of age was predicted to lead to higher estimated vaccine effectiveness but to only modest (5 to 16%) reductions in RVGE incidence over the first 3 years after introduction, regardless of assumptions about waning of vaccine-induced immunity.

scholarly journals Understanding International Variation in Cancer-Specific 'Access to Diagnostics' Data and Steps Toward Cohesive Cancer Intelligence Frameworks: An International Cancer Benchmarking Partnership (ICBP) Study

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 68s-68s
Author(s):  
I. Reguilon ◽  
D. Robinson ◽  
J. Butler ◽  
S. Harrison ◽  
Keyword(s):  
Health Service ◽  
Low Income ◽  
Best Practice ◽  
Service Planning ◽  
Data Availability ◽  
Low Income Countries ◽  
Cancer Outcomes ◽  
Diagnostic Data ◽  
The Uk ◽  
Data Collections

Background: Robust and accurate data underpins cancer research, planning, control and comparisons; it shapes the policies and structures of health systems internationally. Access to diagnostics is crucial for timely cancer diagnosis and treatment planning as previous evidence has shown that delays in diagnosis can impact cancer outcomes. It is possible that differences in cancer outcomes internationally are a consequence of differing levels of access to diagnostic tests. By better understanding variation in this access, this relationship can be further explored. However, diagnostic data availability is not currently well documented. Aim: The primary goal of this exercise was to identify already existing routine or national datasets exploring 'access' variables relating to diagnostics for imaging and endoscopy tests. These access variables included capacity, use, workforce, location and financial factors, and where possible specific to the cancer population. Secondly, to address what high-income countries need to improve to fulfill the existing criteria for 'cancer intelligence frameworks', such as those set out by the National Health Service in England. Methods: Mixed methods including online searches and discussion with local contacts were used to explore key diagnostic data variables across the seven participating countries of ICBP phase 2 (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK). Results: Gaps and inconsistencies in diagnostics data were identified in each country. These key issues make comparisons within and between countries challenging: inconsistent definitions, collection at different levels within a health system, and queries about the coverage, reliability, and linkage of data (especially for cancer) were raised. The usage and allocation of workforce is also poorly documented, and a lack of appropriate infrastructure raised as a key barrier to better collection of data. Currently, most countries do not have a centralised data collection organization, and there are no international or standardized definitions for the diagnostic data that should be collected and could be compared. Conclusion: Health data are disparately collected internationally, with little diagnostics data that can be linked to cancer populations. The data sources and gaps identified add weight to existing efforts to improve data collections and health service planning. International agreement on the key performance indicators, their definitions and how best to organize collected data are required to address gaps and enable robust comparisons. These definitions and an understanding of best practice will be useful for middle- and low-income countries who want to develop or start collecting cancer-specific data. Existing 'cancer intelligence' frameworks could be adapted for international use, but rely on the agreement and adoption of standardized definitions and metrics for the cancer population.

Medical electives in the UK for students from low income countries

BMJ ◽  
2013 ◽  
pp. f7135
Author(s):  
Beatrice Dyer ◽  
Louisa Pollock ◽  
Isaac Jabang ◽  
Beate Kampmann
Keyword(s):  
Low Income ◽  
Low Income Countries ◽  
The Uk

scholarly journals Understanding ‘The Essential Fact about Capitalism’: Markets, Competition and Creative Destruction

2001 ◽  
Vol 175 ◽  
pp. 67-84 ◽  
Author(s):  
Wendy Carlin ◽  
Jonathan Haskel ◽  
Paul Seabright
Keyword(s):  
Low Income ◽  
Productivity Growth ◽  
Selection Process ◽  
Low Income Countries ◽  
Poor Countries ◽  
Market Shares ◽  
Improved Performance ◽  
The Business Cycle ◽  
The Baltic ◽  
The Uk

This paper examines two ways in which competition works in modern capitalist economies to improve productivity. The first is through incentives: encouraging improvements in technology, organisation and effort on the part of existing establishments and firms. The second is through selection: replacing less-productive with more productive establishments and firms, whether smoothly via the transfer of market shares from less to more productive firms, or roughly through the exit of some firms and the entry of others. We report evidence from the UK suggesting that selection is responsible for a large proportion of aggregate productivity growth in manufacturing, and that much of this is due in turn to selection between plants belonging to multi-plant firms. We also investigate whether the nature of the selection process varies across the business cycle and report evidence suggesting that it is less effective in booms and recessions. Finally, although in principle productivity catch-up by low-income countries ought to be easier than innovation at the frontier, in the absence of a well functioning competitive infrastructure (a predicament that characterises many poor countries), selection may be associated with much more turbulence and a lower rate of productivity growth than in relatively prosperous societies. We report results of a survey of firms in transition economies suggesting that, particularly in the former Soviet states (excluding the Baltic states), poor output and productivity performance has not been due to an unwillingness on the part of firms to change and adapt. On the contrary, there has been a great deal of restructuring, much new entry and large reallocations of output between firms; but such activity has been much more weakly associated with improved performance than we would expect in established market economies.

scholarly journals Infrequent Transmission of Monovalent Human Rotavirus Vaccine Virus to Household Contacts of Vaccinated Infants in Malawi

2019 ◽  
Vol 219 (11) ◽  
pp. 1730-1734 ◽  
Author(s):  
Aisleen Bennett ◽  
Louisa Pollock ◽  
Khuzwayo C Jere ◽  
Virginia E Pitzer ◽  
Benjamin Lopman ◽  
...  
Keyword(s):  
Low Income ◽  
Indirect Effects ◽  
Horizontal Transmission ◽  
Vaccine Virus ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Fecal Shedding ◽  
Household Contacts ◽  
Human Rotavirus ◽  
Stool Samples

Abstract Horizontal transmission of rotavirus vaccine virus may contribute to indirect effects of rotavirus vaccine, but data are lacking from low-income countries. Serial stool samples were obtained from Malawian infants who received 2 doses of monovalent human rotavirus vaccine (RV1) (days 4, 6, 8, and 10 after vaccination) and from their household contacts (8–10 days after vaccine). RV1 vaccine virus in stool was detected using semiquantitative real-time reverse-transcription polymerase chain reaction. RV1 fecal shedding was detected in 41 of 60 vaccinated infants (68%) and in 2 of 147 household contacts (1.4%). Horizontal transmission of vaccine virus within households is unlikely to make a major contribution to RV1 indirect effects in Malawi.

scholarly journals The Size and Growth Potential of the Digital Economy in ODA-eligible Countries

2021 ◽  
Author(s):  
George Herbert ◽  
Lucas Loudon
Keyword(s):  
Low Income ◽  
Grey Literature ◽  
Telecommunications Industry ◽  
Digital Economy ◽  
Growth Potential ◽  
Low Income Countries ◽  
Rapid Review ◽  
National Accounts ◽  
Business Interests ◽  
The Uk

This rapid review synthesises evidence on the current size of the digital market, the countries promoting development of digital business and their approach through Trade Policies or Incentive Frameworks, and the current and potential size of the market with the UK / China / US / other significant countries. It draws on a variety of sources, including reports by international organisations (such as the World Bank and OECD), grey literature produced by think tanks and the private sector, and peer reviewed academic papers. A high proportion of estimates of the size of the digital economy come from research conducted by or for corporations and industry bodies, such as Google and the GSMA (which represents the telecommunications industry). Their research may be influenced by their business interests, the methodologies and data sources they utilise are often opaque, and the information required to critically assess findings is sometimes missing. Given this, the estimates presented in this review are best seen as ballpark figures rather than precise measurements. A limitation of this rapid evidence review stems from the lack of consistent methodologies for estimating the size of the digital economy. The OECD is attempting to develop a standard approach to measuring the digital economy across the national accounts of the G20, but this has not yet been finalised. This makes comparing the results of different studies very challenging. The problem is particularly stark in low income countries, where there are frequently huge gaps in the relevant data.

scholarly journals Sex-Differential Impact of Human Cytomegalovirus Infection on In Vitro Reactivity to Toll-Like Receptor 2, 4 and 7/8 Stimulation in Gambian Infants

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 407
Author(s):  
Momodou Cox ◽  
Jane U. Adetifa ◽  
Fatou Noho-Konteh ◽  
Lady C. Sanyang ◽  
Abdoulie Drammeh ◽  
...  
Keyword(s):  
Sex Differences ◽  
Human Cytomegalovirus ◽  
Low Income ◽  
Early Life ◽  
Hcmv Infection ◽  
Vaccine Trial ◽  
Low Income Countries ◽  
Immune Reactivity ◽  
Toll Like Receptor ◽  
Males And Females

Human cytomegalovirus (HCMV) infection rates approach 100% by the first year of life in low-income countries. It is not known if this drives changes to innate immunity in early life and thereby altered immune reactivity to infections and vaccines. Given the panoply of sex differences in immunity, it is feasible that any immunological effects of HCMV would differ in males and females. We analysed ex vivo innate cytokine responses to a panel of toll-like receptor (TLR) ligands in 108 nine-month-old Gambian males and females participating in a vaccine trial. We found evidence that HCMV suppressed reactivity to TLR2 and TLR7/8 stimulation in females but not males. This is likely to contribute to sex differences in responses to infections and vaccines in early life and has implications for the development of TLR ligands as vaccine adjuvants. Development of an effective HCMV vaccine would be able to circumvent some of these potentially negative effects of HCMV infection in childhood.

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