Interventions to improve oral vaccine performance: a systematic review and meta-analysis

Lancet Infectious Diseases
Feb 2019   Volume 19  Number 2  p113-216, e39-e62
http://www.thelancet.com/journals/laninf/issue/current

Interventions to improve oral vaccine performance: a systematic review and meta-analysis
James A Church, Edward P Parker, Beth D Kirkpatrick, Nicholas C Grassly, Andrew J Prendergast
Summary
Background
Oral vaccines underperform in low-income and middle-income countries compared with in high-income countries. Whether interventions can improve oral vaccine performance is uncertain.
Methods
We did a systematic review and meta-analysis of interventions designed to increase oral vaccine efficacy or immunogenicity. We searched Ovid-MEDLINE and Embase for trials published until Oct 23, 2017. Inclusion criteria for meta-analysis were two or more studies per intervention category and available seroconversion data. We did random-effects meta-analyses to produce summary relative risk (RR) estimates. This study is registered with PROSPERO (CRD42017060608)…
Interpretation
Most strategies did not improve oral vaccine performance. Delaying RVV and reducing OPV valence should be considered within immunisation programmes to reduce global enteric disease. New strategies to address the gap in oral vaccine efficacy are urgently required.
Funding
Wellcome Trust, Bill & Melinda Gates Foundation, UK Medical Research Council, and WHO Polio Research Committee.