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dc.contributor.authorCHURCH, JAen_US
dc.contributor.authorPRENDERGAST, Aen_US
dc.contributor.authorParker, EP
dc.contributor.authorKirkpatrick, BD
dc.contributor.authorGrassly, NC
dc.date.accessioned2019-01-08T11:59:18Z
dc.date.available2018-09-20en_US
dc.date.submitted2018-09-21T10:32:32.873Z
dc.identifier.urihttps://qmro.qmul.ac.uk/xmlui/handle/123456789/54185
dc.description.abstractBackground: Oral vaccines underperform in low-income and middle-income countries compared with in high-income countries. Whether interventions can improve oral vaccine performance is uncertain. Methods: We did a systematic review and meta-analysis of interventions designed to increase oral vaccine efficacy or immunogenicity. We searched Ovid-MEDLINE and Embase for trials published until Oct 23, 2017. Inclusion criteria for meta-analysis were two or more studies per intervention category and available seroconversion data. We did random-effects meta-analyses to produce summary relative risk (RR) estimates. This study is registered with PROSPERO (CRD42017060608). Findings: Of 2843 studies identified, 87 were eligible for qualitative synthesis and 66 for meta-analysis. 22 different interventions were assessed for oral poliovirus vaccine (OPV), oral rotavirus vaccine (RVV), oral cholera vaccine (OCV), and oral typhoid vaccines. There was generally high heterogeneity. Seroconversion to RVV was significantly increased by delaying the first RVV dose by 4 weeks (RR 1·37, 95% CI 1·16–1·62) and OPV seroconversion was increased with monovalent or bivalent OPV compared with trivalent OPV (RR 1·51, 95% CI 1·20–1·91). There was some evidence that separating RVV and OPV increased RVV seroconversion (RR 1·21, 95% CI 1·00–1·47) and that higher vaccine inoculum improved OCV seroconversion (RR 1·12, 95% CI 1·00–1·26). There was no evidence of effect for anthelmintics, antibiotics, probiotics, zinc, vitamin A, withholding breastfeeding, extra doses, or vaccine buffering. Interpretation: Most strategies did not improve oral vaccine performance. Delaying RVV and reducing OPV valence should be considered within immunisation programmes to reduce global enteric disease. New strategies to address the gap in oral vaccine efficacy are urgently required.en_US
dc.description.sponsorshipWellcome Trust (201293/Z/16/Z and 108065/Z/15/Z);en_US
dc.description.sponsorshipBill and Melinda Gates Foundationen_US
dc.description.sponsorshipMedical Research Councilen_US
dc.description.sponsorshipWHO Polio Research Committee.en_US
dc.format.extent203 - 214en_US
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.ispartofThe Lancet Infectious Diseasesen_US
dc.relation.replaces123456789/53263
dc.relation.replaceshttps://qmro.qmul.ac.uk/handle/123456789/53263
dc.relation.replaceshttps://qmro.qmul.ac.uk/xmlui/handle/123456789/53263
dc.rightsThis article is available under the terms of the Creative Commons Attribution License (CC BY).
dc.titleInterventions to improve oral vaccine performance in developing countries: a systematic review and meta-analysisen_US
dc.typeArticle
dc.rights.holder© 2019 The Author(s).
dc.identifier.doi10.1016/S1473-3099(18)30602-9en_US
pubs.issue2en_US
pubs.merge-from123456789/53263
pubs.merge-fromhttps://qmro.qmul.ac.uk/xmlui/handle/123456789/53263
pubs.notesNot knownen_US
pubs.organisational-group/Queen Mary University of London
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry/Blizard Institute
pubs.organisational-group/Queen Mary University of London/Faculty of Medicine & Dentistry/Blizard Institute/Genomics and Child Health
pubs.publication-statusAccepteden_US
pubs.volume19en_US
dcterms.dateAccepted2018-09-20en_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US
qmul.funderThe impact of the intestinal environment on the immunogenicity of oral vaccines in Zimbabwean infants::Wellcome Trusten_US


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