{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:38:55Z","timestamp":1792132735951,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004734","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000}}],"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gates Foundation","award":["INV-039481"],"award-info":[{"award-number":["INV-039481"]}]},{"name":"Gates Foundation","award":["INV-046917"],"award-info":[{"award-number":["INV-046917"]}]},{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["K01TW010853"],"award-info":[{"award-number":["K01TW010853"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013589","name":"Research England","doi-asserted-by":"publisher","award":["ISPF 2023\/2024 Allocation"],"award-info":[{"award-number":["ISPF 2023\/2024 Allocation"]}],"id":[{"id":"10.13039\/501100013589","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec101\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rotavirus vaccine protects against severe rotavirus-related gastroenteritis. Its effectiveness is substantially lower in low- and middle-income countries (LMICs) compared to high-income settings, partly due to interference from maternally derived rotavirus-specific immunoglobulin G (IgG) resulting from high rotavirus burden. These antibodies wane over time, reducing their capacity to inhibit vaccine-induced immune responses, including immunoglobulin A (IgA). We aimed to estimate the optimal window for administering an additional rotavirus vaccine dose, beyond the routine doses given at 6 and 10 weeks of age, to maximise immunogenicity in an LMIC, high-disease-burdened setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec001\">\n                    <jats:title>Methods and Findings<\/jats:title>\n                    <jats:p>\n                      We collected longitudinal serum samples from 84 infants at five time points between January 2021 and October 2023, and cross-sectional serum samples from 798 healthy individuals aged 0\u201386 years between December 2022 and June 2024. For participants under 18 years of age, a written consent was obtained from parents or guardians, with assent from the child where appropriate, individuals aged 18 years and above provided written informed consent directly. Rotavirus-specific IgG and IgA concentrations were measured using a gold standard enzyme-linked immunosorbent assay (ELISA). Rotavirus gastroenteritis case data were extracted from ongoing surveillance during the same period. All participants were recruited from the Southern Region of Malawi, a rotavirus high-burden setting. We applied linear mixed-effects and generalised linear models with natural splines to assess age-dependent trends in antibody levels. Prior to scheduled Rotarix rotavirus vaccine dose 1, the median maternally derived rotavirus-specific IgG levels were significantly lower in infants who were seropositive following vaccination compared with those who remained seronegative (5,745.0 IU\/ml versus 9,689.8 IU\/ml; Wilcoxon-test,\n                      <jats:italic>\n                        <jats:italic>p<\/jats:italic>\n                      <\/jats:italic>\n                      \u2009=\u20090.015). Infants with the lowest maternal IgG levels were over five times more likely to seroconvert (odds ratio [OR] = 5.8, 95% confidence interval (CI): 1.6\u201324.2; Chi-square test,\n                      <jats:italic>\n                        <jats:italic>p<\/jats:italic>\n                      <\/jats:italic>\n                      \u2009=\u20090.012). An exponential decay model estimated that the median IgG concentration in non-seroconverters crossed the seroconversion-probability threshold at 6.2 months. Population-level analyses revealed IgG concentrations reached their nadir at 8.4 months, coinciding with a peak in severe rotavirus gastroenteritis cases at 9 months. Serum IgA levels peaked at 9 months and were associated with a decline in disease incidence between 9 and 17 months. Key limitations include the small number of non-seroconverting infants (n\u2009=\u200927) who were unexposed during follow-up and the observational study design. These factors may influence interpretation, but the findings nonetheless provide important insights into rotavirus antibody dynamics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that administering a booster dose between 6 and 8 months of age, when maternal antibody titer is low and severe rotavirus gastroenteritis risk is high, may enhance the immunogenicity and effectiveness of the rotavirus vaccine in LMICs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004734","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T17:54:51Z","timestamp":1757699691000},"page":"e1004734","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Maternal-infant rotavirus-specific antibody kinetics to inform timing of vaccine boosting in Malawi: An observational study"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0143-7469","authenticated-orcid":true,"given":"Jonathan","family":"Mandolo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Mulira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Moyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0066-6565","authenticated-orcid":true,"given":"Memory","family":"Mvula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Mtonga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1242-839X","authenticated-orcid":true,"given":"Marc Y. R.","family":"Henrion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willy","family":"Wotcheni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel A.","family":"Cunliffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8291-4388","authenticated-orcid":true,"given":"Kayla G.","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3195-2210","authenticated-orcid":true,"given":"Kondwani C.","family":"Jambo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3376-8529","authenticated-orcid":true,"given":"Khuzwayo C.","family":"Jere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"issue":"10","key":"pmed.1004734.ref001","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1001\/jamapediatrics.2018.1960","article-title":"Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years","volume":"172","author":"C Troeger","year":"2018","journal-title":"JAMA Pediatr"},{"issue":"2","key":"pmed.1004734.ref002","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/S1473-3099(11)70253-5","article-title":"2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis","volume":"12","author":"JE Tate","year":"2012","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pmed.1004734.ref003","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/S1473-3099(11)70253-5","article-title":"2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis","volume":"12","author":"JE Tate","year":"2012","journal-title":"Lancet Infect Dis"},{"issue":"4","key":"pmed.1004734.ref004","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/tmi.13040","article-title":"Impact of rotavirus vaccination on rotavirus hospitalisation rates among a resource-limited rural population in Mbita, Western Kenya","volume":"23","author":"EA Wandera","year":"2018","journal-title":"Trop Med Int Health"},{"key":"pmed.1004734.ref005","article-title":"Effect of human rotavirus vaccine on severe diarrhea in African infants","author":"SA Madhi","year":"2010","journal-title":"N Engl J Med"},{"key":"pmed.1004734.ref006","article-title":"Population impact and effectiveness of monovalent rotavirus vaccination in urban Malawian children 3 years after vaccine introduction: ecological and case-control analyses","author":"N Bar-Zeev","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"9","key":"pmed.1004734.ref007","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(18)30314-0","article-title":"Impact of monovalent rotavirus vaccine on diarrhoea-associated post-neonatal infant mortality in rural communities in Malawi: a population-based birth cohort study","volume":"6","author":"N Bar-Zeev","year":"2018","journal-title":"Lancet Glob Health"},{"key":"pmed.1004734.ref008","doi-asserted-by":"crossref","unstructured":"Mandolo JJ, Henrion MYR, Mhango C. 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Premkumar","year":"2014","journal-title":"Vaccine"},{"issue":"6","key":"pmed.1004734.ref017","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1038\/mi.2012.51","article-title":"IgA is important for clearance and critical for protection from rotavirus infection","volume":"5","author":"SE Blutt","year":"2012","journal-title":"Mucosal Immunol"},{"issue":"15","key":"pmed.1004734.ref018","doi-asserted-by":"crossref","first-page":"2718","DOI":"10.1016\/j.vaccine.2005.12.048","article-title":"Immunity and correlates of protection for rotavirus vaccines","volume":"24","author":"MA Franco","year":"2006","journal-title":"Vaccine"},{"key":"pmed.1004734.ref019","article-title":"Efficacy of human rotavirus vaccine against severe gastroenteritis in Malawian children in the first two years of life: a randomized, double-blind, placebo controlled trial","author":"NA Cunliffe","year":"2012","journal-title":"Vaccine"},{"key":"pmed.1004734.ref020","article-title":"Safety and immunogenicity of 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Protection of adults rechallenged with a human rotavirus. 1990. Available from: http:\/\/jid.oxfordjournals.org\/","DOI":"10.1093\/infdis\/161.3.440"},{"issue":"25","key":"pmed.1004734.ref026","doi-asserted-by":"crossref","first-page":"3094","DOI":"10.1016\/j.vaccine.2014.03.013","article-title":"Human and bovine rotavirus strain antigens for evaluation of immunogenicity in a randomized, double-blind, placebo-controlled trial of a single dose live attenuated tetravalent, bovine-human-reassortant, oral rotavirus vaccine in Indian adults","volume":"32","author":"A Paul","year":"2014","journal-title":"Vaccine"},{"issue":"1","key":"pmed.1004734.ref027","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/cid\/ciab895","article-title":"Plasma rotavirus-specific IgA and risk of rotavirus vaccine failure in infants in Malawi","volume":"75","author":"L Pollock","year":"2022","journal-title":"Clin Infect Dis"},{"key":"pmed.1004734.ref028","volume-title":"R: A language and environment for statistical computing","author":"Team R Core","year":"2003"},{"key":"pmed.1004734.ref029","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression modeling strategies with applications to linear models, logistic and ordinal regression, and survival analysis","author":"FE Harrell","year":"2015","edition":"2"},{"issue":"4","key":"pmed.1004734.ref030","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1093\/biomet\/26.4.404","article-title":"The use of confidence or fiducial limits illustrated in the case of the binomial","volume":"26","author":"CJ clopper","year":"1934","journal-title":"Biometrika"},{"issue":"2","key":"pmed.1004734.ref031","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s41096-024-00210-y","article-title":"Development and evaluation of EDM: an exponential decay model for probability estimation in random sampling with replacement","volume":"25","author":"S Godara","year":"2024","journal-title":"J Indian Soc Probab Stat"},{"key":"pmed.1004734.ref032","unstructured":"Langtangen HP, Board E, Barth TJ, Griebel M, Keyes DE, Nieminen RM, et al. Finite difference computing with exponential decay models. 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