Impact of malaria and helminth infections on immunogenicity of the human papillomavirus-16/18 AS04-adjuvanted vaccine in Tanzania
University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States; University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA, United States; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania; National Institute for Medical Research, Isamilo, Mwanza, Tanzania; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Bugando Medical Centre, Mwanza, Tanzania
Background: Endemic malaria and helminth infections in sub-Saharan Africa can act as immunological modulators and impact responses to standard immunizations. We conducted a cohort study to measure the influence of malaria and helminth infections on the immunogenicity of the bivalent HPV-16/18 vaccine. Methods: We evaluated the association between malaria and helminth infections, and HPV-16/18 antibody responses among 298 Tanzanian females aged 10-25 years enrolled in a randomized controlled trial of the HPV-16/18 vaccine. Malaria parasitaemia was diagnosed by examination of blood smears, and helminth infections were diagnosed by examination of urine and stool samples, respectively. Geometric mean antibody titres (GMT) against HPV-16/18 antibodies were measured by enzyme-linked immunosorbent assay. Results: Parasitic infections were common; one-third (30.4%) of participants had a helminth infection and 10.2% had malaria parasitaemia. Overall, the vaccine induced high HPV-16/18 GMTs, and there was no evidence of a reduction in HPV-16 or HPV-18 GMT at Month 7 or Month 12 follow-up visits among participants with helminths or malaria. There was some evidence that participants with malaria had increased GMTs compared to those without malaria. Conclusions: The data show high HPV immunogenicity regardless of the presence of malaria and helminth infections. The mechanism and significance for the increase in GMT in those with malaria is unknown. © 2013 The Authors.
placebo; virus antibody; Wart virus vaccine; adolescent; adult; antibody response; antibody titer; article; blood smear; child; cohort analysis; controlled study; disease association; double blind procedure; drug safety; enzyme linked immunosorbent assay; feces analysis; female; follow up; helminthiasis; human; Human papillomavirus type 16; Human papillomavirus type 18; immunogenicity; major clinical study; malaria; parasitemia; phase 3 clinical trial; priority journal; randomized controlled trial; school child; Tanzania; urinalysis; young adult; Helminth; HPV; Human papillomavirus; Immunogenicity; Malaria; Parasitic infection; Sub-Saharan Africa; Tanzania; Vaccine; Adjuvants, Immunologic; Adolescent; Adult; Aluminum Hydroxide; Antibodies, Viral; Antibody Formation; Child; Double-Blind Method; Female; Helminthiasis; Human papillomavirus 16; Human papillomavirus 18; Humans; Lipid A; Malaria; Papillomavirus Infections; Papillomavirus Vaccines; Tanzania; Young Adult