{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T02:00:04Z","timestamp":1783821604864,"version":"3.55.0"},"posted":{"date-parts":[[2026,5,20]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":39,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Malaria exposure has been hypothesized to alter immune responses to childhood vaccines, but evidence is inconsistent. We evaluated whether early-life malaria exposure and perennial malaria chemoprevention (PMC) modify antibody responses to the 10-valent pneumococcal conjugate vaccine (PCV-10) among infants in a high malaria transmission setting in eastern Uganda.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    This study was nested within the MIC-DroP trial (\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04978272\">NCT04978272<\/jats:ext-link>\n                    ) whereby 202 infants were selected for inclusion. Serotype-specific IgG concentrations were measured using an in-house multiplex seroassay from samples obtained at 8 and 24 weeks of age. Immunogenicity was quantified as the log\n                    <jats:sub>10<\/jats:sub>\n                    fold-change in IgG concentration between the 8 and 24-week timepoints, and seroconversion as \u22650.35 \u03bcg\/mL at week 24 (i.e., seropositive). Generalized estimating equation models were used to assess associations of PCV-10 immunogenicity and seroconversion with malaria exposure, malaria chemoprevention and birth outcomes.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the 195 of 202 infants who completed the three-dose PCV-10 series, neither infant PMC nor malaria exposure from study enrollment to 14 weeks were associated with PCV-10 immunogenicity or seroconversion. In contrast, low birthweight (&lt;2500g) was associated with lower immunogenicity (82% lower antibody fold-change, p=0.003) and reduced odds of seroconversion (OR=0.19, p=0.003); preterm birth (&lt;37 weeks) showed similar associations (79% lower antibody fold-change, p=0.018; OR=0.181, p=0.009).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In this malaria-endemic setting, early-life malaria exposure and chemoprevention did not measurably alter PCV-10 antibody responses. However, low birthweight and prematurity were associated with reduced vaccine immunogenicity.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.17.26353405","type":"posted-content","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T19:25:28Z","timestamp":1779305128000},"source":"Crossref","is-referenced-by-count":1,"title":["Low birthweight and prematurity, but not malaria chemoprevention, are associated with reduced pneumococcal vaccine immunogenicity in Ugandan infants"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6890-8988","authenticated-orcid":false,"given":"Kenneth","family":"Musinguzi","sequence":"first","affiliation":[{"name":"Infectious Diseases Research Collaboration, Uganda"},{"name":"School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7387-2729","authenticated-orcid":false,"given":"Alyssa N","family":"Sbarra","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0126-5516","authenticated-orcid":false,"given":"Florian","family":"Bach","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6011-9801","authenticated-orcid":false,"given":"Felistas","family":"Nankya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1877-4264","authenticated-orcid":false,"given":"Karen Bino","family":"Achom","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7127-2779","authenticated-orcid":false,"given":"Caroline","family":"Mwubaha","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8997-0376","authenticated-orcid":false,"given":"Patience","family":"Nayebare","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Nansubuga","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9941-1309","authenticated-orcid":false,"given":"Abel","family":"Kakuru","sequence":"additional","affiliation":[{"name":"Infectious Diseases 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