SynthesisThe Lancet. Infectious diseases2019
Interventions to improve oral vaccine performance: a systematic review and meta-analysis.
Synthesis in The Lancet. Infectious diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
52 citing papers in PubMed, 72 citations in OpenAlex.
- Associations Between Histo-blood Group Antigen Status in Mother-Infant Dyads and Infant Oral Rotavirus Vaccine Immunogenicity in Rural Zimbabwe.The Journal of infectious diseases · 2025Trial
- Prenatal supplementation with multiple micronutrient supplements or medium-quantity lipid-based nutrient supplements has limited effects on child growth up to 24 months in rural Niger: a secondary analysis of a cluster randomized trial.The American journal of clinical nutrition · 2022Trial
- Impact of maternal antibodies and microbiota development on the immunogenicity of oral rotavirus vaccine in African, Indian, and European infants.Nature communications · 2021Trial
- The fecal microbiome and rotavirus vaccine immunogenicity in rural Zimbabwean infants.Vaccine · 2021Trial
- Immunogenicity of an oral rotavirus vaccine administered with prenatal nutritional support in Niger: A cluster randomized clinical trial.PLoS medicine · 2021Trial
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- Iron Deficiency Anemia at Time of Vaccination Predicts Decreased Vaccine Response and Iron Supplementation at Time of Vaccination Increases Humoral Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants.Frontiers in immunology · 2020Trial
- Enteropathogens and Rotavirus Vaccine Immunogenicity in a Cluster Randomized Trial of Improved Water, Sanitation and Hygiene in Rural Zimbabwe.The Pediatric infectious disease journal · 2019Trial
- Immune response to rotavirus vaccines in low- and middle-income countries: Challenges and perspectives.Human vaccines & immunotherapeutics · 2026Review
- Insights into Microbiota-Vaccine Crosstalk in Humans: Mechanisms, Modulators, and Translational Horizons.Vaccines · 2026Review
- Review
- Rotavirus mucosal immunology: insights and research priorities from an international convening in Liverpool, March 2024.NPJ vaccines · 2026Article
- Oral rotavirus vaccine effectiveness among malnourished children in 19 countries: Findings from the MNSSTER-V project.Journal of pediatric gastroenterology and nutrition · 2026Article
- The safety and immunogenicity of inactivated rotavirus vaccine delivered by a dissolving microneedle patch in rats.Human vaccines & immunotherapeutics · 2025Article
- Accounting for local incidence when estimating rotavirus vaccine efficacy among countries: a pooled analysis of monovalent rotavirus vaccine trials.American journal of epidemiology · 2025Article
- Mechanisms of maternal antibody interference with rotavirus vaccination.The EMBO journal · 2025Article
- Rotavirus Vaccine Effectiveness Stratified By National-Level Characteristics: An Introduction to the 24-Country MNSSTER-V Project, 2007-2023.The Journal of infectious diseases · 2025Article
- The role of the gut microbiota in regulating responses to vaccination: current knowledge and future directions.The FEBS journal · 2025Review
- Geographic disparities impacting oral vaccine performance: Observations and future directions.Clinical and experimental immunology · 2025Review
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Authors and funding
5 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundOral vaccines underperform in low-income and middle-income countries compared with in high-income countries. Whether interventions can improve oral vaccine performance is uncertain.
methodsWe 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).
findingsOf 2843 studies identified, 87 were eligible for qualitative synthesis and 66 for meta-analysis. 22 different interventions were assessed for oral poliovirus vaccine (OPV), oral rotavirus vaccine (RVV), oral cholera vaccine (OCV), and oral typhoid vaccines. There was generally high heterogeneity. Seroconversion to RVV was significantly increased by delaying the first RVV dose by 4 weeks (RR 1·37, 95% CI 1·16-1·62) and OPV seroconversion was increased with monovalent or bivalent OPV compared with trivalent OPV (RR 1·51, 95% CI 1·20-1·91). There was some evidence that separating RVV and OPV increased RVV seroconversion (RR 1·21, 95% CI 1·00-1·47) and that higher vaccine inoculum improved OCV seroconversion (RR 1·12, 95% CI 1·00-1·26). There was no evidence of effect for anthelmintics, antibiotics, probiotics, zinc, vitamin A, withholding breastfeeding, extra doses, or vaccine buffering.
interpretationMost 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.
fundingWellcome Trust, Bill & Melinda Gates Foundation, UK Medical Research Council, and WHO Polio Research Committee.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.