# Helminth driven gut inflammation and microbial translocation associate with altered vaccine responses in rural Uganda

## TL;DR

In rural Uganda, gut inflammation and microbial translocation linked to helminth infections are associated with weaker vaccine responses, and treating these infections can reverse some of these effects.

## Contribution

This study identifies helminth-driven gut inflammation and microbial translocation as factors affecting vaccine responses in a low-income setting.

## Key findings

- Helminth infections are associated with increased gut inflammation markers like fecal calprotectin and occult blood.
- Praziquantel treatment reduces gut inflammation and microbial translocation markers, suggesting reversibility.
- Gut inflammation and microbial translocation are inversely associated with vaccine-specific immune responses.

## Abstract

Vaccine responses are sometimes impaired in rural, low-income settings. Helminth-associated gut barrier dysfunction and microbial translocation (MT) may be implicated. We used samples from a trial of praziquantel treatment-effects on vaccine responses in Schistosoma mansoni (Sm)-endemic Ugandan islands, measuring intestinal fatty acid-binding protein 2 (I-FABP2), lipopolysaccharide-binding protein, anti-endotoxin core antibodies (EndoCab), soluble CD14 (sCD14) in plasma, and faecal lipocalin-2, occult blood (FOB), and calprotectin (fCAL), and evaluating their associations with baseline helminth infection, praziquantel treatment, and responses to BCG, yellow fever, typhoid, HPV, and tetanus-diphtheria vaccines. Sm associated positively with fCAL and FOB, hookworm with I-FABP2, and any helminth with EndoCab IgM, fCAL and FOB. Sm associated inversely with sCD14. Praziquantel treatment reduced all marker concentrations, significantly fCAL and FOB, implying that Sm-associated gut inflammation and MT is reversible. Associations of assessed markers with vaccine-specific responses were predominantly inverse. Interventions to improve gut barrier function may enhance vaccine responsiveness.