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Messina NL, Zimmermann P, Curtis N. The impact of vaccines on heterologous adaptive immunity. Clin Microbiol Infect 2019; 25:1484-1493. [PMID: 30797062 DOI: 10.1016/j.cmi.2019.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaccines induce antigen-specific memory in adaptive immune cells that enables long-lived protection against the target pathogen. In addition to this, several vaccines have beneficial effects greater than protection against their target pathogen. These non-specific effects are proposed to be the result of vaccine-induced immunomodulation. In the case of bacille Calmette-Guérin (BCG) vaccine, this involves induction of innate immune memory, termed 'trained immunity', in monocytes and natural killer cells. OBJECTIVES This review discusses current evidence for vaccine-induced immunomodulation of adaptive immune cells and heterologous adaptive immune responses. CONTENT The three vaccines that have been associated with changes in all-cause infant mortality: BCG, diphtheria-tetanus-pertussis (DTP) and measles-containing vaccines (MCV) alter T-cell and B-cell immunity. The majority of studies that investigated non-specific effects of these vaccines on the adaptive immune system report changes in numbers or proportions of adaptive immune cell populations. However, there is also evidence for effects of these vaccines on adaptive immune cell function and responses to heterologous stimuli. There is some evidence that, in addition to BCG, DTP and MCV, other vaccines (that have not been associated with changes in all-cause mortality) may alter adaptive immune responses to unrelated stimuli. IMPLICATIONS This review concludes that vaccines alter adaptive immune cell populations and heterologous immune responses. The non-specific effects differ between various vaccines and their effects on heterologous adaptive immune responses may also involve bystander activation, cross-reactivity and other as yet undefined mechanisms. This has major implications for future vaccine design and vaccination scheduling.
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Affiliation(s)
- N L Messina
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
| | - P Zimmermann
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - N Curtis
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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Yelemkoure ET, Yonli AT, Montesano C, Ouattara AK, Diarra B, Zohoncon TM, Nadembega CWM, Ouedraogo P, Sombié C, Soubeiga ST, Tao I, Gansane A, Amicosante M, Djigma F, Obiri-Yeboah D, Pietra V, Simpore J, Colizzi V. Prevention of mother-to-child transmission of hepatitis B virus in Burkina Faso: Screening, vaccination and evaluation of post-vaccination antibodies against hepatitis B surface antigen in newborns. J Public Health Afr 2018; 9:816. [PMID: 30687485 PMCID: PMC6326159 DOI: 10.4081/jphia.2018.816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 08/09/2018] [Indexed: 01/06/2023] Open
Abstract
The low rate of screening for hepatitis B virus (HBV) in pregnant women is a highrisk factor for its vertical transmission. The objectives of this study were: i) to screen pregnant women for HBV infection; ii) vaccinate all children from birth against HBV regardless their mother HBV status; and iii) evaluate after 7 months of birth the level of their AbHBs among babies who received HBV vaccine at birth. Serological markers of HBV (HBsAg, HBeAg, AbHBs, AbHBe, and AbHBc) were determined on venous blood samples from 237 pregnant women and their children using the Abon Biopharm Kit. One hundred and two (102) children received the three doses of the EUVAX B® vaccine respectively at birth, two months and four months of life. Seven months after delivery, venous blood samples were collected from mothers and their children. Antibodies against hepatitis B surface antigen (AbHBs) were measured in vaccinated children using the ELISA Kit AbHBs Quantitative EIA. DNA extraction was performed on samples from HBV-seropositive mothers and their children using the Ribo Virus (HBV Real-TM Qual) Kit and for Real Time PCR, the HBV Real-TM Qual Kit was used. Serological diagnosis in pregnant women revealed 22 (9.28%) hepatitis B surface antigen (HBsAg) positive samples of which 21 were positive for viral DNA by real-time PCR. Among the 22 HBsAg+ women, five (05) transmitted the virus to their children with a vertical transmission rate of 22.73%. A transmission rate of 23.81% (5/21) was found with the PCR method. Analysis of AbHBs levels revealed that 98.31% of the children had an average concentration of 218.07 ± 74.66 IU/L, which is well above the minimum threshold for protection (11 IU/L). This study has confirmed that vertical transmission of HBV is a reality in Burkina Faso and that vaccination at birth would significantly reduce this transmission.
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Affiliation(s)
- Edwige T Yelemkoure
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Albert T Yonli
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Carla Montesano
- Department of Biology, Tor Vergata University of Rome, Italy
| | - Abdoul Karim Ouattara
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Birama Diarra
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Théodora M Zohoncon
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Christelle W M Nadembega
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso
| | - Paul Ouedraogo
- Saint Camille Hospital of Ouagadougou (HOSCO), Burkina Faso
| | - Charles Sombié
- Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Serge Theophile Soubeiga
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Issoufou Tao
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso
| | - Adama Gansane
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | - Florencia Djigma
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Ghana
| | - Virginio Pietra
- Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Laboratory of Molecular Biology and Genetics (LABIOGENE), UFR/SVT, University Ouaga, Ouagadougou, Burkina Faso.,Biomolecular Research Center Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso.,Department of Biology, Tor Vergata University of Rome, Italy
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Yang S, Ma X, Ni H, Zhou S, Hu D, Shi H, Chen X, Dong H, Xu G. Safety, immunization coverage and determinants of a new kind of Hepatitis B vaccine firstly applied in Ningbo, China. Hum Vaccin Immunother 2015. [PMID: 26211419 DOI: 10.1080/21645515.2015.1066946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Evaluate safety and immunization coverage of a new kind of recombinant Hepatitis B vaccine (HepB) in Ningbo city, China. Two groups were carried out in 2 of 11 randomly selected countries in Ningbo in 2009. All of the infants born from July 1 to December 31, 2009 were enrolled as subjects and received 3 doses of HepB at 0, 1, 6 month. Control group (N = 3452) received current HepB derived from Saccharomyces Cerevisiae Yeast (HepB made by recombinant DNA techniques in Saccharomyces Cerevisiae Yeast, HepB-SCY; 5 μg/0.5 ml per dose) and experimental group (N = 5104) received the new kind of HepB derived from Hansenula polymorpha Yeast (HepB made by recombinant DNA techniques in Hansenula polymorpha Yeast, HepB-HPY; 10 μg/0.5 ml per dose). 3-dose and timely birth dose (TBD) coverage were available and compared between 2 groups. Standard structured questionnaires were applied to record information from parents and hospitals for selecting determinants of coverage. The data were analyzed using stepwise multiple logistic regression models. After each dose, HepB-related adverse events (AEs) and recta-temperature were recorded for 7 days. 3-dose coverage in control group (89.98%) was higher than that in experimental group (χ2 = 575.1173, P < 0.0001). TBD coverage in control and experimental group were 98.41% and 98.53%, respectively. No statistically significant difference in TBD coverage was found between 2 groups (χ2 = 0.0623, P = 0.8029). A total of 9 local AEs were reported, 4 for control group and 5 for experimental group. The percentages of subjects reporting AEs were similar across the 2 vaccination groups. No serious or immediate reactions were found in this study. From logistic models, receiving 10 μg vaccine (odds ratio [OR]:0.38; 95% confidence interval [95%CI]: 0.34-0.44) and mother migrating from other cities (OR: 0.45; 95%CI: 0.42-0.47) were the determinants for non-acceptance of 3 doses of HepB; infants born from low grade hospitals and native mothers contributed to administrate the TBD.
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Affiliation(s)
- Sijia Yang
- a Ningbo Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Xiao Ma
- a Ningbo Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Hongxia Ni
- a Ningbo Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Shaoying Zhou
- a Ningbo Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Danbiao Hu
- b Ninghai Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Honghui Shi
- c Yuyao Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Xiaoying Chen
- a Ningbo Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Hongjun Dong
- a Ningbo Municipal Center for Disease Control and Prevention ; Zhejiang , China
| | - Guozhang Xu
- a Ningbo Municipal Center for Disease Control and Prevention ; Zhejiang , China
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Gasim GI, Bella A, Adam I. Immune response to hepatitis B vaccine among patients on hemodialysis. World J Hepatol 2015; 7:270-5. [PMID: 25729482 PMCID: PMC4342609 DOI: 10.4254/wjh.v7.i2.270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 11/08/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023] Open
Abstract
Infection with hepatitis B virus (HBV) poses a major health threat worldwide, where the magnitude and overburden of chronic carrier state approaches 150 million chronic carriers. The prevalence of HBV is greater among dialyzed patients compared to the general population owing to their increased vulnerability to blood and its products, along with hazards posed by contaminated hemodialysis tools and devices. An electronic systematic search of the published literature was carried and data on the immunological riposte to hepatitis B vaccination among hemodialysis patients was extracted from relevant studies. End stage renal disease patients on hemodialysis have a lower or an absolutely negative riposte to HBV vaccine. Several means have been tried to improve this response with some success, nevertheless none have been universally adopted. Genetic investigations are foreseen to make a break through concerning HBV vaccination.
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Affiliation(s)
- Gasim I Gasim
- Gasim I Gasim, Ishag Adam, Qassim College of Medicine, Qassim University, PO Box 15085 Buraydah, Saudi Arabia
| | - Abdelhaleem Bella
- Gasim I Gasim, Ishag Adam, Qassim College of Medicine, Qassim University, PO Box 15085 Buraydah, Saudi Arabia
| | - Ishag Adam
- Gasim I Gasim, Ishag Adam, Qassim College of Medicine, Qassim University, PO Box 15085 Buraydah, Saudi Arabia
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Ritz N, Mui M, Balloch A, Curtis N. Non-specific effect of Bacille Calmette-Guérin vaccine on the immune response to routine immunisations. Vaccine 2013; 31:3098-103. [DOI: 10.1016/j.vaccine.2013.03.059] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/17/2013] [Accepted: 03/28/2013] [Indexed: 11/27/2022]
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Carniel EDF, Antônio MÂRGM, Zanolli MDL, Vilela MMS. Estratégias de campo em ensaios clínicos com novas vacinas produzidas no Brasil. REVISTA PAULISTA DE PEDIATRIA 2012. [DOI: 10.1590/s0103-05822012000200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Relatar as estratégias de campo utilizadas em dois ensaios clínicos com vacinas desenvolvidas pelo Instituto Butantan, em 2004 e 2006. MÉTODOS: Estudo do tipo relato de experiência, em que se descreve o planejamento e a operacionalização dos ensaios clínicos, que avaliaram a imunogenicidade e a segurança da vacina BCG combinada com a vacina da hepatite B (VrHB-IB) e da tetravalente bacteriana modificada pela extração do lipopolissacarídeo (LPS) do componente pertussis (DTPm/Hib). RESULTADOS: As principais estratégias de campo utilizadas foram: a) Parceria entre os pesquisadores e os gestores da Secretaria Municipal de Saúde e b) Realização dos procedimentos da pesquisa nos domicílios ou nos Centros de Saúde frequentados pelos participantes. No primeiro estudo, foram vacinados 552 recém-nascidos na maternidade com a BCG/VrHB-IB (combinadas ou separadas) e nos domicílios, com as duas doses subsequentes de VrHB-IB. O segundo estudo incluiu 241 lactentes em Centros de Saúde da rede municipal, vacinados com tetravalente bacteriana (com componente pertussis total ou modificado). Em ambos os estudos, amostras de sangue foram colhidas nas residências. Não houve relatos de eventos adversos. A adesão foi de 90,2% para o primeiro estudo e 93,8%, para o segundo. As vacinas foram administradas nas datas preconizadas pelo Programa Nacional de Imunizações e as coletas de sangue, de acordo com o cronograma dos estudos. CONCLUSÕES: As estratégias utilizadas facilitaram o recrutamento das crianças e garantiram cumprir o protocolo da pesquisa com alta adesão, sem interferir no vínculo da família com o Serviço de Saúde, no calendário vacinal ou no seguimento pediátrico dos participantes.
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Economical value of vaccines for the developing countries--the case of Instituto Butantan, a public institution in Brazil. PLoS Negl Trop Dis 2011; 5:e1300. [PMID: 22140586 PMCID: PMC3226538 DOI: 10.1371/journal.pntd.0001300] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Impaired humoral response to vaccines among HIV-exposed uninfected infants. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1406-9. [PMID: 21775515 DOI: 10.1128/cvi.05065-11] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Little is known about the vaccine protective response for infants born from HIV-infected mothers. We evaluated the antibody response to hepatitis B, tetanus, and diphtheria vaccine in vertically HIV-exposed uninfected infants and compared them to those of control infants not exposed to the virus. The quantitative determination of specific neutralizing antibodies against hepatitis B, diphtheria, and tetanus were performed blindly on serum samples. The results showed that 6.7% of the HIV-exposed uninfected individuals were nonresponders to hepatitis B vaccine (anti-HBs titer, <10 mIU/ml), and 64.4% were very good responders (anti-HBs titer, ≥1,000 mIU/ml), whereas only 3.6% of the nonexposed infants were nonresponders (χ(2)=10.93; 1 df). The HIV-exposed uninfected infants showed protective titers for diphtheria and tetanus but lower geometric mean anti-tetanus titers compared to those of the HIV-unexposed infants. Our data point to the necessity of evaluating vaccine immune responses in these children and reinforced that alterations in lymphocyte numbers and functions reported for newborns from HIV-infected mothers interfere with the vaccine response.
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Randomized study of intradermal compared to intramuscular hepatitis B vaccination in HIV-infected children without severe immunosuppression. Vaccine 2011; 29:2962-7. [PMID: 21329776 DOI: 10.1016/j.vaccine.2011.01.114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/27/2011] [Accepted: 01/31/2011] [Indexed: 02/08/2023]
Abstract
HIV infected individuals have poorer response to hepatitis B vaccine (HBV) compared to normal host. Intradermal administration (i.d.) facilitates the exposure of antigen to antigen-presenting cells compared to intramuscular administration (i.m.). HIV-infected children aged 1-18 years with CD4%≥15% or 200 cells/mm(3) who had negative HBs Ag, antiHBs, and antiHBc were randomized to receive 3-dose of HBV via i.d. (2 μg/dose) or i.m. (10 μg/dose) route at months 0, 2, and 6. AntiHBs titers were measured at months 2, 6 and 7 after first HBV. AntiHBs≥10 mIU/mL was considered protective and AntiHBs>100 mIU/mL was considered good response. Participants included 41 in i.d. and 39 in i.m. arms. 64% had completed 3-doses HBV during infancy. The mean (SD) of age, nadir CD4% and current CD4% were 12 (3.3) years, 10.6 (7.9)% and 28 (8.0)% respectively. 91% were on HAART and 84% had undetectable HIV-RNA. Proportion of children with protective antiHBs in i.d. vs. i.m. group were 19.5% vs. 25.6% at month 2, 56.1% vs. 76.9% at month 6, and 90.2% vs. 92.3% at month 7 (NS, all). The geometric mean (95% confidence interval) of antiHBs titer in i.d. vs. i.m. group were 112.5 (34.4-367.6) vs. 141.2 (49.4-404.1) mIU/mL at month 2 (p=0.74), 70.4 (39.8-124.4) vs. 132.1 (79.4-219.8) mIU/mL at month 6 (p=0.10), and 157.0 (103.0-239.3) vs. 458.9 (324.0-647.0) mIU/mL at month 7 (p<0.001). However, only 56.1% of the i.d. arm had good response to HBV compared to 82.1% in the i.m. arm (p=0.01). The predictors for being a good responder to HBV were i.m. administration [OR 4.0, 95%CI 1.4-11.8, p=0.012] and body weight <35 kg at baseline [OR 3.8, 95%CI 1.3-10.8, p=0.013]. No adverse events grade 3/4 occurred. In conclusion, HIV-infected children without severe immune suppression, both i.d. and i.m. routes of HBV resulted in similar rates of protective antibody titers. However, high antibody titers to HBV were more common with i.m.; therefore, i.m. administration is preferred.
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Borges-Almeida E, Milanez HMBPM, Vilela MMS, Cunha FGP, Abramczuk BM, Reis-Alves SC, Metze K, Lorand-Metze I. The impact of maternal HIV infection on cord blood lymphocyte subsets and cytokine profile in exposed non-infected newborns. BMC Infect Dis 2011; 11:38. [PMID: 21291536 PMCID: PMC3040712 DOI: 10.1186/1471-2334-11-38] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 02/03/2011] [Indexed: 02/08/2023] Open
Abstract
Background Children born to HIV+ mothers are exposed intra-utero to several drugs and cytokines that can modify the developing immune system, and influence the newborn's immune response to infections and vaccines. We analyzed the relation between the distribution of cord blood lymphocyte subsets and cytokine profile in term newborns of HIV+ mothers using HAART during pregnancy and compared them to normal newborns. Methods In a prospective, controlled study, 36 mother-child pairs from HIV+ mothers and 15 HIV-uninfected mothers were studied. Hematological features and cytokine profiles of mothers at 35 weeks of pregnancy were examined. Maternal and cord lymphocyte subsets as well as B-cell maturation in cord blood were analyzed by flow cytometry. The non-stimulated, as well as BCG- and PHA-stimulated production of IL2, IL4, IL7, IL10, IL12, IFN-γ and TNF-alpha in mononuclear cell cultures from mothers and infants were quantified using ELISA. Results After one year follow-up none of the exposed infants became seropositive for HIV. An increase in B lymphocytes, especially the CD19/CD5+ ones, was observed in cord blood of HIV-exposed newborns. Children of HIV+ hard drug using mothers had also an increase of immature B-cells. Cord blood mononuclear cells of HIV-exposed newborns produced less IL-4 and IL-7 and more IL-10 and IFN-γ in culture than those of uninfected mothers. Cytokine values in supernatants were similar in infants and their mothers except for IFN-γ and TNF-alpha that were higher in HIV+ mothers, especially in drug abusing ones. Cord blood CD19/CD5+ lymphocytes showed a positive correlation with cord IL-7 and IL-10. A higher maternal age and smoking was associated with a decrease of cord blood CD4+ cells. Conclusions in uninfected infants born to HIV+ women, several immunological abnormalities were found, related to the residual maternal immune changes induced by the HIV infection and those associated with antiretroviral treatment. Maternal smoking was associated to changes in cord CD3/CD4 lymphocytes and maternal hard drug abuse was associated with more pronounced changes in the cord B cell line.
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Affiliation(s)
- Eliane Borges-Almeida
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, 13083-887 - Campinas, Brazil
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Hu Y, Zhou YH. Concerns on Bacille Calmette-Guerin vaccination in infants born to mothers with hepatitis B virus infection. Vaccine 2009; 27:1987-8. [PMID: 19428825 DOI: 10.1016/j.vaccine.2009.01.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 01/22/2009] [Indexed: 11/28/2022]
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