Immunisation of premature infants

Abstract

Premature infants are at increased risk of vaccine preventable infections, but audits have shown that their vaccinations are often delayed. Early protection is desirable. While the evidence base for immunisation of preterm infants is limited, the available data support early immunisation without correction for gestational age. For a number of antigens the antibody response to initial doses may be lower than that of term infants, but protective concentrations are often achieved and memory successfully induced. A 2-3-4 month schedule may be preferable for immunisation of preterm infants in order to achieve protection as early as possible, but an additional dose may be required to achieve persistence of protection. This update focuses on the use of routine childhood vaccines in premature infants

The TLR-specific adjuvants R-848 and CpG-B endorse the immunological reaction of neonatal antigen-presenting cells

“…n eonatal infections are a major contributor to neonatal death and many of those are avoidable by vaccination (1). Extreme-and very-low-birth-weight infants are at higher risk of suffering from infections than term newborns (2), such as influenza (3) or pneumococcal diseases (4).…”

The Role of T Cells in the Enhancement of Respiratory Syncytial Virus Infection Severity during Adult Reinfection of Neonatally Sensitized Mice

“…Similarly, cytomegalovirus, Chlamydia spp., group B streptococci, and Haemophilus influenzae are important causes of neonatal pneumonia but do not normally cause pneumonia in adults. Despite the great need for vaccines that are effective in neonates, responses to vaccination are weak and usually ineffective in this age group (1,4).…”

Vaccination of Premature/Low-Birth-Weight Children

“…Unexpectedly, safety profile in terms of normal reactions to vaccines administered to premature and low-birth-weight children in comparison with term infants appeared different. The only possible exception is the increase in the rate of apnea (accompanied or not by bradicardia) and desaturation episodes, which is observed by most authors [12][13][14][15]. Observation of 473 premature infants of weight <1,500g (average weight -910g [375-1,495]), average GA of 27.6 (22.6-34.3) weeks and GA by the moment of vaccination of 37.4 (31.5-48.3) weeks showed that only 2.8% of children had generalized (fever) and local reactions; however, 10% of children had apneic episodes with/without bradicardia [16].…”