human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the effect of an asymptomatic nonpolioviral infection on the immune response to poliovirus vaccines . DESIGN Open comparative trial . SETTING Well-child clinic at The Children 's Hospital of Buffalo , NY . PARTICIPANTS Twenty-seven healthy infants infected with nonpolioviruses and 27 healthy controls matched for age and vaccine group . INTERVENTIONS Trivalent oral attenuated poliovirus vaccine or enhanced potency inactivated vaccine administered at ages 4 and 12 months . MEASUREMENTS /MAIN RESULTS Neutralizing antibody to poliovirus serotypes 1 , 2 , and 3 were determined in the serum and nasopharyngeal secretion sample s obtained at ages 4 , 5 , 12 , and 13 months . The IgA antibody titers for polioviruses 1 , 2 , and 3 were measured in nasopharyngeal secretion sample s during the same periods . Antibody responses to poliovirus vaccines were similar in coinfected subjects and healthy controls at ages 5 and 13 months , except for serum neutralizing antibody that was significantly elevated in the controls compared with coinfected subjects ( geometric mean [ + /- SD ] antibody titers , 12.7 + /- 1.6 vs 11.5 + /- 1.7 ) . Concurrent viral infections affected the immune response in recipients of the oral poliovirus vaccine and the enhanced-potency inactivated poliovirus vaccine similarly . The immune response to polioviruses 1 and 3 were more adversely affected by coinfection than was the immune response to poliovirus 2 . CONCLUSION Concurrent asymptomatic viral infections minimally impaired the immune response to poliovirus vaccines . The adverse effects of coinfection were considered clinical ly insignificant BACKGROUND Rotavirus is the most common cause of severe gastroenteritis among young children worldwide . Data are needed to assess the efficacy of the rotavirus vaccine in African children . METHODS We conducted a r and omized , placebo-controlled , multicenter trial in South Africa ( 3166 infants ; 64.1 % of the total ) and Malawi ( 1773 infants ; 35.9 % of the total ) to evaluate the efficacy of a live , oral rotavirus vaccine in preventing severe rotavirus gastroenteritis . Healthy infants were r and omly assigned in a 1:1:1 ratio to receive two doses of vaccine ( in addition to one dose of placebo ) or three doses of vaccine - the pooled vaccine group - or three doses of placebo at 6 , 10 , and 14 weeks of age . Episodes of gastroenteritis caused by wild-type rotavirus during the first year of life were assessed through active follow-up surveillance and were grade d with the use of the Vesikari scale . RESULTS A total of 4939 infants were enrolled and r and omly assigned to one of the three groups ; 1647 infants received two doses of the vaccine , 1651 infants received three doses of the vaccine , and 1641 received placebo . Of the 4417 infants included in the per- protocol efficacy analysis , severe rotavirus gastroenteritis occurred in 4.9 % of the infants in the placebo group and in 1.9 % of those in the pooled vaccine group ( vaccine efficacy , 61.2 % ; 95 % confidence interval , 44.0 to 73.2 ) . Vaccine efficacy was lower in Malawi than in South Africa ( 49.4 % vs. 76.9 % ) ; however , the number of episodes of severe rotavirus gastroenteritis that were prevented was greater in Malawi than in South Africa ( 6.7 vs. 4.2 cases prevented per 100 infants vaccinated per year ) . Efficacy against all-cause severe gastroenteritis was 30.2 % . At least one serious adverse event was reported in 9.7 % of the infants in the pooled vaccine group and in 11.5 % of the infants in the placebo group . CONCLUSIONS Human rotavirus vaccine significantly reduced the incidence of severe rotavirus gastroenteritis among African infants during the first year of life . ( Clinical Trials.gov number , NCT00241644 . ) A comparison was made of the immunity conferred by injected formalin-killed poliomyelitis vaccine and orally administered attenuated poliomyelitis vaccine in Nigerian infants under tropical conditions where interfering enteroviruses have caused poor conversion rates with attenuated poliomyelitis vaccine . Two hundred and thirty infants completed the immunization schedules . The levels of antibodies to polioviruses were assessed before immunization and at periodic intervals during the trial . Seventy-four per cent , 72 % and 85 % of the children lacked antibodies to poliovirus types 1 , 2 and 3 respectively at 6 months if they received no vaccine , the comparative proportions respectively were 52 % , 8 % and 48 % if they had oral attenuated poliovaccine and 2 % , 4 % and 0 % if they had three doses of inactivated poliovaccine . It is suggested that killed poliovaccine incorporated in a quadruple vaccine may have a place in developing countries like Nigeria in the control of diphtheria , tetanus , whooping cough and poliomyelitis To assess factors that may influence the immunogenicity of oral poliovirus vaccine ( OPV ) , neutralizing antibody responses were measured in 1409 infants in Brazil and the Gambia who were r and omized to receive one of four different formulations of OPV at approximately birth and at 6 , 10 , and 14 weeks .  Overall seroconversion rates at the end of the trial were 85 % for poliovirus type 1 ( P1 ) , 94 % for type 2 ( P2 ) , and 68 % for type 3 ( P3 ) . Factors associated with vaccine failure included high levels of maternal antibody ( P1 , P2 , and P3 ) , vaccination during the rainy season ( P1 , P2 , and P3 ) , diarrhea at the time of vaccination ( P2 and P3 ) , household exposure to other OPV recipients ( P1 ) , and breast-feeding ( P3 ) ( P < .05 for each factor , logistic regression analysis ) . OPV containing twice the st and ard potency of Sabin type 1 virus increased seroconversion rates to P1 by 8 % in Brazil ( P < .05 ) and 15 % in the Gambia ( P < .001 ) . Suboptimal responses to OPV in developing countries are determined by a complex array of factors related to the vaccine , host , and environment Attenuated Vibrio cholerae oral vaccine CVD 103-HgR was well tolerated by 324 Thai soldiers and civilians . Most received a single 5 x 10(8 ) cfu dose , while 40 each received one or two 5 x 10(9 ) cfu doses . Vibriocidal antibody ( the best correlate of immunity ) seroconversion was lower in soldiers than civilians ( P less than .001 ) . Increasing the vaccine dose to 5 x 10(9 ) cfu raised the geometric mean titer ( P less than .001 ) . A second 5 x 10(9 ) cfu dose one week later did not notably increase seroconversions . Likelihood of seroconversion was inversely correlated with baseline vibriocidal titer ( P less than .001 ) . CVD 103-HgR caused seroconversion in most subjects with baseline titers less than or equal to 1:40 , including 100 % of civilians after one 5 x 10(8 ) cfu dose , 79 % of soldiers after one 5 x 10(9 ) cfu dose , and 45 % of soldiers after one 5 x 10(8 ) cfu dose . In persons with elevated baseline titers , vibriocidal antibody seroconversion is not a sensitive measure of whether vaccine has boosted intestinal immunity ; for such subjects , other measurements must be used . Study regimens in endemic areas should use a single 5 x 10(9 ) cfu dose The low efficiency of trivalent oral polio vaccine ( TOPV ) in inducing protective antibody titres to polio3 is a problem of great importance in many regions of the world . A prospect i ve study was conducted in 121 Tunisian infants aged 3 months during routine immunization with TOPV under carefully controlled conditions .  Seroconversion rates to  polio1 , polio2 and polio3  , one month after the third dose , were 94.7 , 100 and 89.5 % , respectively . The kinetics of the antibody response showed delayed and more difficult responses to polio3 compared to polio2 and polio1 . The following host related factors , previously suggested to interfere with the immune response , were assessed : maternal antibodies ; breast-feeding ; concurrent enteric infections ; and other illnesses . The main factor associated with the lack of seroconversion was concurrent infection with non-polio enteroviruses ( NPE ) which was found in 50 % of non-responders to polio1 and /or to polio3 during the vaccination protocol whereas no NPE was isolated in vaccine responders . The other studied factors seemed not to interfere in the infants according to the locally adopted vaccination schedule and to the specific socio-economic conditions Abstract Factors affecting immunogenicity of the first 2 doses of oral poliovirus vaccine ( OPV ) among unimmunized Mayan infants were prospect ively evaluated . The relative impact of multiple variables , including mass or routine vaccination , concurrent enteric bacterial ( salmonella , shigella , and campylobacter ) and viral ( adenovirus 40/41 , astrovirus , nonpolio enteroviruses , and rotavirus ) infections , interference among Sabin vaccine viruses , and preexisting poliovirus antibodies were studied . Sera were available from 181 infants after 2 OPV doses .  Seroresponses were 86 % to Sabin type 1 , 97 % to Sabin type 2 , and 61 % to Sabin type 3 vaccines . Mass versus routine vaccination and preexisting poliovirus antibodies did not affect immunogenicity . By multiple logistic regression analysis , fecal shedding of homologous Sabin strains was associated with increased seroresponses to all Sabin types , especially to Sabin type 3 . Decreased  OPV immunogenicity was primarily attributable to interference of Sabin type 3 by Sabin type 2 . OPV formulations with higher doses of Sabin type 3 could improve immunogenicity among infants in developing countries BACKGROUND Diarrhoeal diseases cause illness and death among children younger than 5 years in low-income countries . We design ed the Global Enteric Multicenter Study ( GEMS ) to identify the aetiology and population -based burden of paediatric diarrhoeal disease in sub-Saharan Africa and south Asia . METHODS The GEMS is a 3-year , prospect i ve , age-stratified , matched case-control study of moderate-to-severe diarrhoea in children aged 0 - 59 months residing in censused population s at four sites in Africa and three in Asia . We recruited children with moderate-to-severe diarrhoea seeking care at health centres along with one to three r and omly selected matched community control children without diarrhoea . From patients with moderate-to-severe diarrhoea and controls , we obtained clinical and epidemiological data , anthropometric measurements , and a faecal sample to identify enteropathogens at enrolment ; one follow-up home visit was made about 60 days later to ascertain vital status , clinical outcome , and interval growth . FINDINGS We enrolled 9439 children with moderate-to-severe diarrhoea and 13,129 control children without diarrhoea . By analysing adjusted population attributable fractions , most attributable cases of moderate-to-severe diarrhoea were due to four pathogens : rotavirus , Cryptosporidium , enterotoxigenic Escherichia coli producing heat-stable toxin ( ST-ETEC ; with or without co-expression of heat-labile enterotoxin ) , and Shigella . Other pathogens were important in selected sites ( eg , Aeromonas , Vibrio cholerae O1 , Campylobacter jejuni ) . Odds of dying during follow-up were 8·5-fold higher in patients with moderate-to-severe diarrhoea than in controls ( odd ratio 8·5 , 95 % CI 5·8 - 12·5 , p<0·0001 ) ; most deaths ( 167 [ 87·9 % ] ) occurred during the first 2 years of life . Pathogens associated with increased risk of case death were ST-ETEC ( hazard ratio [ HR ] 1·9 ; 0·99 - 3·5 ) and typical enteropathogenic E coli ( HR 2·6 ; 1·6 - 4·1 ) in infants aged 0 - 11 months , and Cryptosporidium ( HR 2·3 ; 1·3 - 4·3 ) in toddlers aged 12 - 23 months . INTERPRETATION Interventions targeting five pathogens ( rotavirus , Shigella , ST-ETEC , C 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the effect of an asymptomatic nonpolioviral infection on the immune response to poliovirus vaccines . DESIGN Open comparative trial . SETTING Well-child clinic at The Children 's Hospital of Buffalo , NY . PARTICIPANTS Twenty-seven healthy infants infected with nonpolioviruses and 27 healthy controls matched for age and vaccine group . INTERVENTIONS Trivalent oral attenuated poliovirus vaccine or enhanced potency inactivated vaccine administered at ages 4 and 12 months . MEASUREMENTS /MAIN RESULTS Neutralizing antibody to poliovirus serotypes 1 , 2 , and 3 were determined in the serum and nasopharyngeal secretion sample s obtained at ages 4 , 5 , 12 , and 13 months . The IgA antibody titers for polioviruses 1 , 2 , and 3 were measured in nasopharyngeal secretion sample s during the same periods . Antibody responses to poliovirus vaccines were similar in coinfected subjects and healthy controls at ages 5 and 13 months , except for serum neutralizing antibody that was significantly elevated in the controls compared with coinfected subjects ( geometric mean [ + /- SD ] antibody titers , 12.7 + /- 1.6 vs 11.5 + /- 1.7 ) . Concurrent viral infections affected the immune response in recipients of the oral poliovirus vaccine and the enhanced-potency inactivated poliovirus vaccine similarly . The immune response to polioviruses 1 and 3 were more adversely affected by coinfection than was the immune response to poliovirus 2 . CONCLUSION Concurrent asymptomatic viral infections minimally impaired the immune response to poliovirus vaccines . The adverse effects of coinfection were considered clinical ly insignificant BACKGROUND Rotavirus is the most common cause of severe gastroenteritis among young children worldwide . Data are needed to assess the efficacy of the rotavirus vaccine in African children . METHODS We conducted a r and omized , placebo-controlled , multicenter trial in South Africa ( 3166 infants ; 64.1 % of the total ) and Malawi ( 1773 infants ; 35.9 % of the total ) to evaluate the efficacy of a live , oral rotavirus vaccine in preventing severe rotavirus gastroenteritis . Healthy infants were r and omly assigned in a 1:1:1 ratio to receive two doses of vaccine ( in addition to one dose of placebo ) or three doses of vaccine - the pooled vaccine group - or three doses of placebo at 6 , 10 , and 14 weeks of age . Episodes of gastroenteritis caused by wild-type rotavirus during the first year of life were assessed through active follow-up surveillance and were grade d with the use of the Vesikari scale . RESULTS A total of 4939 infants were enrolled and r and omly assigned to one of the three groups ; 1647 infants received two doses of the vaccine , 1651 infants received three doses of the vaccine , and 1641 received placebo . Of the 4417 infants included in the per- protocol efficacy analysis , severe rotavirus gastroenteritis occurred in 4.9 % of the infants in the placebo group and in 1.9 % of those in the pooled vaccine group ( vaccine efficacy , 61.2 % ; 95 % confidence interval , 44.0 to 73.2 ) . Vaccine efficacy was lower in Malawi than in South Africa ( 49.4 % vs. 76.9 % ) ; however , the number of episodes of severe rotavirus gastroenteritis that were prevented was greater in Malawi than in South Africa ( 6.7 vs. 4.2 cases prevented per 100 infants vaccinated per year ) . Efficacy against all-cause severe gastroenteritis was 30.2 % . At least one serious adverse event was reported in 9.7 % of the infants in the pooled vaccine group and in 11.5 % of the infants in the placebo group . CONCLUSIONS Human rotavirus vaccine significantly reduced the incidence of severe rotavirus gastroenteritis among African infants during the first year of life . ( Clinical Trials.gov number , NCT00241644 . ) A comparison was made of the immunity conferred by injected formalin-killed poliomyelitis vaccine and orally administered attenuated poliomyelitis vaccine in Nigerian infants under tropical conditions where interfering enteroviruses have caused poor conversion rates with attenuated poliomyelitis vaccine . Two hundred and thirty infants completed the immunization schedules . The levels of antibodies to polioviruses were assessed before immunization and at periodic intervals during the trial . Seventy-four per cent , 72 % and 85 % of the children lacked antibodies to poliovirus types 1 , 2 and 3 respectively at 6 months if they received no vaccine , the comparative proportions respectively were 52 % , 8 % and 48 % if they had oral attenuated poliovaccine and 2 % , 4 % and 0 % if they had three doses of inactivated poliovaccine . It is suggested that killed poliovaccine incorporated in a quadruple vaccine may have a place in developing countries like Nigeria in the control of diphtheria , tetanus , whooping cough and poliomyelitis To assess factors that may influence the immunogenicity of oral poliovirus vaccine ( OPV ) , neutralizing antibody responses were measured in 1409 infants in Brazil and the Gambia who were r and omized to receive one of four different formulations of OPV at approximately birth and at 6 , 10 , and 14 weeks .  Overall seroconversion rates at the end of the trial were 85 % for poliovirus type 1 ( P1 ) , 94 % for type 2 ( P2 ) , and 68 % for type 3 ( P3 ) . Factors associated with vaccine failure included high levels of maternal antibody ( P1 , P2 , and P3 ) , vaccination during the rainy season ( P1 , P2 , and P3 ) , diarrhea at the time of vaccination ( P2 and P3 ) , household exposure to other OPV recipients ( P1 ) , and breast-feeding ( P3 ) ( P < .05 for each factor , logistic regression analysis ) . OPV containing twice the st and ard potency of Sabin type 1 virus increased seroconversion rates to P1 by 8 % in Brazil ( P < .05 ) and 15 % in the Gambia ( P < .001 ) . Suboptimal responses to OPV in developing countries are determined by a complex array of factors related to the vaccine , host , and environment Attenuated Vibrio cholerae oral vaccine CVD 103-HgR was well tolerated by 324 Thai soldiers and civilians . Most received a single 5 x 10(8 ) cfu dose , while 40 each received one or two 5 x 10(9 ) cfu doses . Vibriocidal antibody ( the best correlate of immunity ) seroconversion was lower in soldiers than civilians ( P less than .001 ) . Increasing the vaccine dose to 5 x 10(9 ) cfu raised the geometric mean titer ( P less than .001 ) . A second 5 x 10(9 ) cfu dose one week later did not notably increase seroconversions . Likelihood of seroconversion was inversely correlated with baseline vibriocidal titer ( P less than .001 ) . CVD 103-HgR caused seroconversion in most subjects with baseline titers less than or equal to 1:40 , including 100 % of civilians after one 5 x 10(8 ) cfu dose , 79 % of soldiers after one 5 x 10(9 ) cfu dose , and 45 % of soldiers after one 5 x 10(8 ) cfu dose . In persons with elevated baseline titers , vibriocidal antibody seroconversion is not a sensitive measure of whether vaccine has boosted intestinal immunity ; for such subjects , other measurements must be used . Study regimens in endemic areas should use a single 5 x 10(9 ) cfu dose The low efficiency of trivalent oral polio vaccine ( TOPV ) in inducing protective antibody titres to polio3 is a problem of great importance in many regions of the world . A prospect i ve study was conducted in 121 Tunisian infants aged 3 months during routine immunization with TOPV under carefully controlled conditions .  Seroconversion rates to  polio1 , polio2 and polio3  , one month after the third dose , were 94.7 , 100 and 89.5 % , respectively . The kinetics of the antibody response showed delayed and more difficult responses to polio3 compared to polio2 and polio1 . The following host related factors , previously suggested to interfere with the immune response , were assessed : maternal antibodies ; breast-feeding ; concurrent enteric infections ; and other illnesses . The main factor associated with the lack of seroconversion was concurrent infection with non-polio enteroviruses ( NPE ) which was found in 50 % of non-responders to polio1 and /or to polio3 during the vaccination protocol whereas no NPE was isolated in vaccine responders . The other studied factors seemed not to interfere in the infants according to the locally adopted vaccination schedule and to the specific socio-economic conditions Abstract Factors affecting immunogenicity of the first 2 doses of oral poliovirus vaccine ( OPV ) among unimmunized Mayan infants were prospect ively evaluated . The relative impact of multiple variables , including mass or routine vaccination , concurrent enteric bacterial ( salmonella , shigella , and campylobacter ) and viral ( adenovirus 40/41 , astrovirus , nonpolio enteroviruses , and rotavirus ) infections , interference among Sabin vaccine viruses , and preexisting poliovirus antibodies were studied . Sera were available from 181 infants after 2 OPV doses .  Seroresponses were 86 % to Sabin type 1 , 97 % to Sabin type 2 , and 61 % to Sabin type 3 vaccines . Mass versus routine vaccination and preexisting poliovirus antibodies did not affect immunogenicity . By multiple logistic regression analysis , fecal shedding of homologous Sabin strains was associated with increased seroresponses to all Sabin types , especially to Sabin type 3 . Decreased  OPV immunogenicity was primarily attributable to interference of Sabin type 3 by Sabin type 2 . OPV formulations with higher doses of Sabin type 3 could improve immunogenicity among infants in developing countries BACKGROUND Diarrhoeal diseases cause illness and death among children younger than 5 years in low-income countries . We design ed the Global Enteric Multicenter Study ( GEMS ) to identify the aetiology and population -based burden of paediatric diarrhoeal disease in sub-Saharan Africa and south Asia . METHODS The GEMS is a 3-year , prospect i ve , age-stratified , matched case-control study of moderate-to-severe diarrhoea in children aged 0 - 59 months residing in censused population s at four sites in Africa and three in Asia . We recruited children with moderate-to-severe diarrhoea seeking care at health centres along with one to three r and omly selected matched community control children without diarrhoea . From patients with moderate-to-severe diarrhoea and controls , we obtained clinical and epidemiological data , anthropometric measurements , and a faecal sample to identify enteropathogens at enrolment ; one follow-up home visit was made about 60 days later to ascertain vital status , clinical outcome , and interval growth . FINDINGS We enrolled 9439 children with moderate-to-severe diarrhoea and 13,129 control children without diarrhoea . By analysing adjusted population attributable fractions , most attributable cases of moderate-to-severe diarrhoea were due to four pathogens : rotavirus , Cryptosporidium , enterotoxigenic Escherichia coli producing heat-stable toxin ( ST-ETEC ; with or without co-expression of heat-labile enterotoxin ) , and Shigella . Other pathogens were important in selected sites ( eg , Aeromonas , Vibrio cholerae O1 , Campylobacter jejuni ) . Odds of dying during follow-up were 8·5-fold higher in patients with moderate-to-severe diarrhoea than in controls ( odd ratio 8·5 , 95 % CI 5·8 - 12·5 , p<0·0001 ) ; most deaths ( 167 [ 87·9 % ] ) occurred during the first 2 years of life . Pathogens associated with increased risk of case death were ST-ETEC ( hazard ratio [ HR ] 1·9 ; 0·99 - 3·5 ) and typical enteropathogenic E coli ( HR 2·6 ; 1·6 - 4·1 ) in infants aged 0 - 11 months , and Cryptosporidium ( HR 2·3 ; 1·3 - 4·3 ) in toddlers aged 12 - 23 months . INTERPRETATION Interventions targeting five pathogens ( rotavirus , Shigella , ST-ETEC , C 
    Output:
    