Socioeconomic and Environmental Exposures and Their Associations with Vaccine Response in Young Children in Northern Ecuador Open Access

Abstract

 

This study measured the association between socioeconomic and environmental exposures and vaccine response to nine childhood vaccines. The association was measured using birth cohort data from the ECUAVIDA (Ecuador Life) study conducted in Quinindé, Esmeraldas Province, Ecuador. 2,404 neonates and their mothers were recruited between 2006 and 2009. Criteria for inclusion in the analysis required having received the full vaccine series with respect to each vaccine, with the exception of the rotavirus vaccine. Data analysis used SAS version 9.4. Logistic regression was used to model the association between the exposures and the odds of meeting the achievement of a designated protective antibody threshold (seropositivity) for each vaccine. Linear regression was used to model the association between the exposures and the log-transformed antibody titers, resulting in a geometric mean antibody titer (GMT) ratio measurement. Socioeconomic status (SES) was found to be a significant predictor for the rotavirus GMT model (-0.16, 95% CI: -0.31, -0.01). A slightly protective association was found between low SES and increased rotavirus GMT ratio. Because antibodies generated from rotavirus vaccine and natural exposure cannot be distinguished from one another, it is possible that children who are lower SES could have more natural exposures, resulting in higher antibody titers being detected. Future research should focus on the biological mechanisms that broader societal factors, such as low SES, act through to impact vaccine response.

 

Table of Contents

 

Chapter One: Background/Literature Review ................................................................... 1

 

Vaccines in Developing Countries ......................................................................... 2

 

Malnutrition and Vaccine Response ...................................................................... 5

 

Environmental Microbial Burden .......................................................................... 7

 

Interactions with Maternal Antibodies ................................................................. 14

 

Conclusion ........................................................................................................... 19

 

Chapter Two: Manuscript ................................................................................................ 21

 

Introduction .......................................................................................................... 21

 

Methods ................................................................................................................ 22

 

Table 1 ................................................................................................................. 24

 

Figure 1 ................................................................................................................ 27

 

Results .................................................................................................................. 28

 

Table 2 ................................................................................................................. 31

 

Table 3 ..................................................................................................................33

 

Table 4 ................................................................................................................. 36

 

Table 5 ................................................................................................................. 39

 

Table 6 ................................................................................................................. 42

 

Table 7 ................................................................................................................. 43

 

Discussion ............................................................................................................ 44

 

Conclusion ........................................................................................................... 47

 

Chapter Three: Public Health Impact ...............................................................................48

 

References .........................................................................................................................50

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Immunology
Keyword	vaccine response oral vaccines socioeconomic status
Committee Chair / Thesis Advisor	Lopman, Ben, Emory University
Committee Members	Cooper, Philip, St. George's, University of London Baker, Julia, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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