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Breast-fed infants responded differently to rotavirus vaccine than formula-fed infants
Vesikari T. Pediatr Infect Dis J. 2012;doi:10.1097/INF.0b013e3182489cac.
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Infants who are breast-fed may mount less of an immune response against rotavirus after vaccination compared with infants who are exclusively formula-fed. However, the difference is small enough that breast-feeding should continue to be encouraged, according to a study from the Vaccine Research Center of the University of Tampere Medical School in Finland.
Timo Vesikari, MD, PhD, and colleagues examined data from 3,874 healthy European infants aged 6 to 14 weeks, 2,572 of whom were given two doses of rotavirus vaccine and 1,302 of whom received placebo. Researchers recorded whether the infants were breast- or formula-fed at each scheduled vaccination.
The investigators reported that during the first rotavirus season, vaccine efficacy was about the same, with the immunoglobulin A seroconversion rates in formula-fed infants only slightly edging out efficacy in breast-fed infants — 89.2% vs. 85.5%. However, during the second epidemic season, the disparity in efficacy among breast-fed and formula-fed infants continued to climb, with 2-year efficacy rates against any human rotavirus at 76.2% for breast-fed infants and 89.8% for infants exclusively fed formula. Against severe rotavirus gastroenteritis, efficacy was 88.4% in breast-fed infants and 98.1% in formula-fed infants.
Although the data indicate that breast-feeding slightly reduced efficacy in the second season, Vesikari and colleagues said the benefits of breast-feeding far outweigh the small suppression of immune response, adding that the blunted response may be because most women have antibody against the G1 type of rotavirus.
“The immune responses to the human rotavirus vaccine might be particularly suppressed due to the effect of maternal antibodies derived either transplacentally or that present in breast milk,” the study researchers wrote. “The human rotavirus vaccine is of G1 type, and most mothers have antibody against this common G-type rotavirus.”
Disclosure: A number of researchers reported financial ties to GlaxoSmithKline Biologicals, which partially funded the study.
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Vesikari and colleagues conducted a randomized, placebo-controlled, multi-country European trial to evaluate the efficacy and immunogenicity of live-attenuated human rotavirus vaccine in breast-fed and formula-fed infants. Healthy infants aged 6 to 14 weeks were enrolled to receive two doses of rotavirus vaccine or placebo concomitantly with the first two doses of the routine childhood immunizations. Previous immunogenicity studies performed in developing countries showed that the immune response induced by the rotavirus vaccine was lower compared with developed countries. In this European study, only 5% of the breast-fed infants showed rotavirus IgA seroconversion 1 to 2 months after second placebo dose, as compared with 11% in exclusively formula-fed infants; such seroconversion rates are likely to be due to natural wild-type rotavirus infection, so it seemed that breast-feeding provided partial protection against rotavirus infection during this period.
During the first year follow-up period, vaccine efficacy against rotavirus gastroenteritis of any severity in breast-fed infants was 86%, as compared with 91% in exclusively formula-fed infants; vaccine efficacy against severe rotavirus gastroenteritis was approximately 96% in both groups of infants. In the second season follow-up period, vaccine efficacy against rotavirus gastroenteritis of any severity was 68.5% in breast-fed infants and 88.5% in exclusively formula-fed infants; vaccine efficacy against severe rotavirus gastroenteritis was 82% and 100%, respectively.
I agree with the authors that the reduced vaccine efficacy in the second year might be a combined effect of higher attack rate of rotavirus in the second season, due to a only temporary protection during the first year of life induced by breast-feeding, and a lower immunogenicity in breast-fed infants post-vaccination. In light of the present study, I have no doubt that the benefits of both breast-feeding and rotavirus vaccines far outweigh the slight decrease in rotavirus vaccine effectiveness observed in breast-fed infants during the second season.
Carlos Rodrigo, MD, PhD
Head of the Department
of Pediatrics and Chief of the Pediatric Infectious Diseases
and Clinical
Immunology Unit
University Hospital Germans Trias i Pujol
Barcelona,
Spain
Disclosure: Dr. Rodrigo has been a consultant or member of advisory boards for GlaxoSmithKline, Sanofi-Pasteur-MSD, Wyeth, Pfizer, Novartis, MedImmune, AstraZeneca and Astellas, and he has participated as a researcher in clinical trials sponsored by Pfizer, Sanofi-Pasteur and GSK.
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