Influence of enteric infections on response to oral poliovirus vaccine: a systematic review and meta-analysis

J Infect Dis. 2014 Sep 15;210(6):853-64. doi: 10.1093/infdis/jiu182. Epub 2014 Mar 31.


Background: The impaired immunogenicity of oral poliovirus vaccine (OPV) in low-income countries has been apparent since the early field trials of this vaccine. Infection with enteropathogens at the time of vaccination may contribute to this phenomenon. However, the relative influence of these infections on OPV performance remains uncertain.

Methods: We conducted a systematic review to examine the impact of concurrent enteric infections on OPV response. Using random-effects models, we assessed the effects of nonpolio enteroviruses (NPEVs) and diarrhea on the odds of seroconversion and/or vaccine virus shedding.

Results: We identified 25 trials in which OPV outcomes were compared according to the presence or absence of enteric infections, the majority of which (n = 17) reported only on NPEVs. Concurrent NPEVs significantly reduced the odds of per-dose seroconversion for type 1 poliovirus (odds ratio [OR] 0.44, 95% confidence interval 0.23-0.84), but not type 2 (OR 0.53 [0.19-1.46]) or type 3 (OR 0.56 [0.27-1.12]). A similar reduction, significant for type 1 poliovirus (OR 0.50 [0.28-0.89]), was observed in the odds of vaccine virus shedding among NPEV-infected individuals. Concurrent diarrhea significantly inhibited per-dose seroconversion overall (OR 0.61 [0.38-0.87]).

Conclusions: Our findings are consistent with an inhibitory effect of concurrent enteric infections on OPV response.

Keywords: diarrhea; enterovirus; immunogenicity; interference; oral poliovirus vaccine.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Diarrhea / immunology
  • Enterovirus Infections / immunology*
  • Humans
  • Poliovirus / immunology
  • Poliovirus / physiology
  • Poliovirus Vaccine, Oral / immunology
  • Poliovirus Vaccine, Oral / pharmacology*
  • Virus Shedding / immunology


  • Poliovirus Vaccine, Oral