Browsing by Author "Namujju Proscovia B."

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    Effect of Single-Dose Anthelmintic Treatment During Pregnancy on an Infant’s Response to Immunisation and on Susceptibility to Infectious Diseases in Infancy: a Randomised, Double-Blind, Placebo-Controlled Trial
    (2011) Ndibazza Juliet ; Maw Patrice A. ; Webb Emily L. ; Kizito Dennison ; Namatovu Alice ; Kyosiimire Lugemwa Jacqueline ; Nanteza Bridget ; Nampijja Margaret ; Muhangi Lawrence ; Woodburn Patrick W. ; Akurut Hellen ; Mpairwe Harriet ; Akello Miriam ; Lyadda Nancy ; Bukusuba Joseph ; Kihembo Macklyn ; Kizza Moses ; Kizindo Robert ; Nabulime Juliet ; Ameke Christine ; Namujju Proscovia B. ; Tweyongyere Robert ; Muwanga Moses ; Whitworth James A. G. ; Elliot Alison M.
    Helminth infections aff ect the human immune response. We investigated whether prenatal exposure to and treatment of maternal helminth infections aff ects development of an infant’s immune response toimmunisations and unrelated infections.Methods In this randomised, doubleblind, placebo-controlled trial, we enrolled 2507 women in the second or third trimester of pregnancy who were planning to deliver in Entebbe General Hospital, Entebbe, Uganda. With a computer-generated random number sequence in blocks of 100, we assigned patients to 440 mg albendazole and 40 mg/kg praziquantel (n=628), 440 mg albendazole and a praziquantel-matching placebo (n=625), 40 mg/kg praziquantel and an albendazole-matching placebo (n=626), or an albendazole-matching placebo and praziquantel-matching placebo (n=628). All participants and hospital staff were masked to allocation. Primary outcomes were immune response at age 1 year to BCG, tetanus, and measles immunisation; incidence of infectious diseases during infancy; and vertical HIV transmission. Analysis was by intention-to-treat. This trial is registered, number ISRCTN32849447.Findings Data were available at delivery for 2356 women, with 2345 livebirths; 2115 (90%) of liveborn infants remained in follow-up at 1 year of age. Neither albendazole nor praziquantel treatments aff ected infant response to BCG, tetanus, or measles immunisation. However, in infants of mothers with hookworm infection, albendazole treatment reduced interleukin-5 (geometric mean ratio 0·50, 95% CI 0·30–0·81, interaction p=0·02) and interleukin13 (0·52, 0·34–0·82, 0·0005) response to tetanus toxoid. The rate per 100 person-years of malaria was 40·9 (95% CI 38·3–43·7), of diarrhoea was 134·1 (129·2–139·2), and of pneumonia was 22·3 (20·4–24·4). We noted no eff ect on infectious disease incidence for albendazole treatment (malaria [hazard ratio 0·95, 95% CI 0·79–1.14], diarrhoea [1·06, 0·96–1·16], pneumonia [1·11, 0·90–1·38]) or praziquantel treatment (malaria [1·00, 0·84–1·20], diarrhoea [1·07, 0·98–1·18], pneumonia [1·00, 0·80–1·24]). In HIV-exposed infants, 39 (18%) were infected at 6 weeks; vertical transmission was not associated with albendazole (odds ratio 0·70, 95% CI 0·35–1·42) or praziquantel (0·60, 0·29–1·23) treatment.Interpretation These results do not accord with the recently advocated policy of routine antenatal anthelmintic treatment, and the value of such a policy may need to be reviewed.
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    Effects of Maternal and Infant Co-infections, and of Maternal Immunization, on the Infant Response to BCG and Tetanus Immunization
    (2012) Ndibazza Juliet; Muwanga Moses; Whitworth James A. G.; Elliotta Alison M.; Mawaa Patrice A.; Webb Emily L.; Nampijja Margaret; Lyadda Nancy; Bukusuba Joseph; Kizza Moses; Namujju Proscovia B.; Nabulime Juliet
    Some vaccines show poor efficacy in tropical countries. Within a birth cohort in Uganda, we investigatedfactors that might influence responses to BCG and tetanus immunisation. Whole blood assay responsesto crude culture filtrate proteins ofMycobacterium tuberculosis(cCFP)) and tetanus toxoid (TT) wereexamined among 1506 and 1433 one-year-olds, respectively. MaternalMansonella perstansinfection wasassociated with higher interleukin (IL)-10 responses to both immunogens but no reduction in gammainterferon (IFN-), IL-5 and IL-13 responses; other maternal helminth infections showed little effect.Tetanus immunisation during pregnancy was associated with higher infant responses to TT; maternalBCG scar (from past immunisation) with lower infant IL-5 and IL-13 responses to cCFP. IFN-, IL-5 andIL-13 to TT were reduced in HIVexposed-uninfected infants; infant malaria and HIV were associatedwith lower IFN-, IL-5 and IL13 responses to both immunogens. We conclude that maternal helminthinfections are unlikely to explain poor vaccine efficacy in the tropics. Effects of maternal immunisation oninfant responses to vaccines should be explored. Prevention of infant malaria and HIV could contributeto effectiveness of immunisation programmes.