Naturally Acquired Immunity Against Rotavirus Infection and Gastroenteritis in Children: Paired Reanalyses of Birth Cohort Studies. (5th July 2017)

• Record Type: Journal Article
• Authors: Lewnard, Joseph A; Lopman, Benjamin A; Parashar, Umesh D; Bar-Zeev, Naor; Samuel, Prasanna; Guerrero, M Lourdes; Ruiz-Palacios, Guillermo M; Kang, Gagandeep; Pitzer, Virginia E
• Is Part Of: Journal of infectious diseases. Volume 216:Number 3(2017:Aug. 01)
• Page Start: 317
• Page End: 326
• Publication Date: 2017-07-05
• Subjects: rotavirus -- gastroenteritis -- immunity -- natural infection -- birth cohort; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jix310
• Languages: English
• ISSNs: 0022-1899

Abstract

Summary: Antibody (immunoglobulins A and G) responses to rotavirus are associated with protection against reinfection, but do not predict whether rotavirus infections manifest as gastroenteritis. Risk for rotavirus infections to manifest as gastroenteritis declines with older age, independent of naturally acquired immunity. Abstract: Background: Observational studies in socioeconomically distinct populations have yielded conflicting conclusions about the strength of naturally acquired immunity against rotavirus gastroenteritis (RVGE), mirroring vaccine underperformance in low-income countries. We revisited birth cohort studies to understand naturally acquired protection against rotavirus infection and RVGE. Methods: We reanalyzed data from 200 Mexican and 373 Indian children followed from birth to 2 and 3 years of age, respectively. We reassessed protection against RVGE, decomposing the incidence rate into the rate of rotavirus infection and the risk of RVGE given infection, and tested for serum antibody correlates of protection using regression models. Results: Risk for primary, secondary, and subsequent infections to cause RVGE decreased per log-month of age by 28% (95% confidence interval [CI], 12%–41%), 69% (95% CI, 30%–86%), and 64% (95% CI, –186% to 95%), respectively, in Mexico City, and by 10% (95% CI, –1% to 19%), 51% (95% CI, 41%–59%) and 67% (95% CI, 57%–75%), respectively, in Vellore. Elevated serum immunoglobulin A and immunoglobulin G titers were associated with partial protection against rotavirus infection. Associations between older age and reduced risk for RVGE or moderate-to-severe RVGE given infection persisted after controlling for antibody levels. Conclusions: Dissimilar estimates of protection against RVGE may be due in part to age-related, antibody-independent risk for rotavirus infections to cause RVGE.