Sex-differential heterologous (non-specific) effects of vaccines: an emerging public health issue that needs to be understood and exploited

Introduction: Vaccines have heterologous effects on the immune system, leading to altered susceptibility to a range of pathogens, and possibly allergy and autoimmunity. Effects are often sex-differential. This review discusses the evidence, mechanisms and public health implications of the non-specific effects of vaccines (NSEs).Areas covered: This article firstly discusses the World Health Organization systematic review of the evidence for sex-differential heterologous effects of vaccines, and further PubMed indexed studies on NSEs on susceptibility to infectious diseases, allergy, autoimmunity and malignancy in animals and humans. Potential immunological mechanisms are evaluated, including sex-differential effects. Finally it describes how advances in systems biology might be applied to study such effects.Expert commentary: This section points out the need to understand immune mechanisms in order to exploit beneficial vaccine effects, and diminish deleterious ones. It suggests analysis of vaccine effects by sex is important, and discusses the future for personalised vaccines that take these effects into account.