The challenge of assessing infant vaccine responses in resource-poor settings

Abstract

Newborns and infants are highly susceptible to infectious diseases, resulting in high mortality and morbidity, particularly in resource-poor settings. Many vaccines require several booster doses, resulting in an extensive vaccine schedule, and yet there is still inadequate protection from some of these diseases. This is partly due to the immaturity of the neonate and infant immune system. Little is known about the specific modifications to immunological assessment protocols in early life but increasing knowledge of infant immunology has helped provide better recommendations for assessing these responses. Since most new vaccines will eventually be deployed in low-income settings such as Africa, the logistics and resources of assessing immunity in such settings also need to be understood. In this article, we will review immunity to vaccines in early life, discuss the many challenges associated with assessing immunogenicity and provide practical tips.

Keywords::

• antibody
• B cell
• cord blood
• developing country
• immune response
• infant
• innate immunity
• neonate
• nonspecific effect
• T cell
• vaccine

Financial & competing interests disclosure

Katie L Flanagan and Sarah Burl are funded by the MRC (UK). Magdalena Plebanski is funded by The Australian National Health Medical Research Council (NHMRC). Barbara L Lohman-Payne is funded by NIH grants AI068431, HD023412 and HD054314; EDCTP grant CT.2006.33111.002; CDC/PEPFAR grant U62/CCU024512; and Elizabeth Glaser Pediatric AIDS Foundation grant MV-00-9-900-01872-0-00. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.