Between February 2008 and October 2009, 100 participants between the ages of 18 and 60 years were randomly allocated to receive one of the three vaccines: Rotarix (n = 24), ETEC (n = 21) or Vivotif (n = 81), or to act as controls who received no vaccine (n = 21). Forty-seven of these participants who were available were subsequently invited to participate on a second occasion, either as vaccinee or control, at time points separated by intervals of at least 1 year. No vaccinee received the same vaccine twice. Demographic

and clinical characteristics of the participants #inhibitors randurls[1|1|,|CHEM1|]# are shown in Table 2. Altogether, 34 HIV seropositive adults received 58 courses of live, attenuated vaccines orally at one time point or another. Vaccinees and controls were well matched for sex, age, body mass index, and (in the HIV seropositives) CD4 count ( Table 2). Diarrhoea was reported within 7 days of the last dose of vaccine by 6 participants, all of whom had received 3 doses of Vivotif and 5 of whom were HIV seropositive (OR for HIV seropositivity 6.3, 95% CI 0.67–303; P = 0.09). The intervals after which these were experienced were 3, 4, 4, 8, 10, and 13 days after the first dose. None of these had diarrhoea which they judged to have been serious enough to seek treatment but two had taken the day off work. The CD4 counts of those HIV seropositive participants

who experienced diarrhoea within 7 days of last vaccine administration were (in ascending order) 175, 179, 351, 670, and 845 cells/μl. If the period of attribution is extended to 28 days after the first dose of vaccine, 11 find more episodes

of diarrhoea were reported by 10 vaccinees. Of these, 3 were within 7 days, 5 between 8 and 14 days, 2 between 15 and 21 days, and 1 between 22 and 28 days. Of the 10 vaccinees who experienced diarrhoea, 8 were HIV seropositive (Table 3). The two HIV seronegative vaccinees reported diarrhoea 13 days after Vivotif and 21 days after ACAM2017. Including these later episodes of diarrhoea changes the Odds Ratio for HIV seropositivity too to 5.3 (95% CI 0.98–53; P = 0.04). Abdominal pain was reported by 3 vaccine recipients. In two of these instances, pain occurred during diarrhoeal illnesses, with onset 4 and 10 days after the first doses of Vivotif. One participant reported pain without diarrhoea 5 days after the first dose of Vivotif. Fever (subjective, not confirmed) was reported by one HIV negative man the day after rotavirus vaccination, and by two HIV positive men 13 and 16 days after ETEC vaccination, respectively. None of these participants sought medical care. Loss of appetite (scoring 1 on analogue scale of 1–10) was reported only by one HIV seronegative participant within 24 h of receiving ACAM2017. Three other HIV positive participants reported loss of appetite, but all over 3 weeks after the vaccine dose and designated not attributable. Only one HIV seronegative participant reported nausea or vomiting, and that was 12 days after a dose of Vivotif.