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Knuf M, Charkaluk ML, The Nguyen PN, Salamanca de la Cueva I, Köbrunner P, Mason L, Duchenne M, Berlaimont V. Penta- and hexavalent vaccination of extremely and very-to-moderate preterm infants born at less than 34 weeks and/or under 1500 g: A systematic literature review. Hum Vaccin Immunother 2023; 19:2191575. [PMID: 37076111 PMCID: PMC10120554 DOI: 10.1080/21645515.2023.2191575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Debate regarding vaccinating high-risk infants with penta- and hexavalent vaccines persists, despite their good immunogenicity and acceptable safety profile in healthy full-term infants. We report the findings of a systematic literature search that aimed to present data on the immunogenicity, efficacy, effectiveness, safety, impact, compliance and completion of penta- and hexavalent vaccination in high-risk infants, including premature newborns. Data from the 14 studies included in the review showed that the immunogenicity and the safety profile of penta- and hexavalent vaccines in preterm infants was generally similar to those seen in full-term infants, with the exception of an increase in cardiorespiratory adverse events such as apnea, bradycardia and desaturation following vaccination in preterm infants. Despite recommendations of vaccinating preterm infants according to their actual age, and the relatively high completion rate of the primary immunization schedule, vaccination was often delayed, increasing the vulnerability of this high-risk population to vaccine-preventable diseases.
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Affiliation(s)
- Markus Knuf
- Department for Pediatric and Adolescent Medicine, Children's Hospital Worms, Worms, Germany
- Pediatric Infectious Diseases, University of Medicine, Mainz, Germany
| | - Marie-Laure Charkaluk
- Neonatology Department, Saint Vincent de Paul Hospital, GHICL, Lille, France
- Faculty of Medicine, Maieutics and Health Sciences, Université Catholique de Lille, Lille, France
- CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Université Paris Cité, Paris, France
| | | | | | - Petra Köbrunner
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | - Lauren Mason
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | - Maurine Duchenne
- GSK vaccine, GlaxoSmithKline Pharmaceuticals SA/NV, Wavre, Belgium
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Avulakunta I, Balasundaram P, Rechnitzer A, Morgan-Joseph T, Nafday S. A Improving Birth-dose Hepatitis-B Vaccination in a Tertiary Level IV Neonatal Intensive Care Unit. Pediatr Qual Saf 2023; 8:e693. [PMID: 37818203 PMCID: PMC10561802 DOI: 10.1097/pq9.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/07/2023] [Indexed: 10/12/2023] Open
Abstract
Background Perinatal hepatitis B is a global public health concern. To reduce perinatal hepatitis B and its complications, the Hepatitis B vaccine (HBV) is recommended by the New York State Department of Health and Advisory Committee on Immunization Practices within 24 hours of life for infants born with a birth weight ≥2000 g. Infants admitted to the neonatal intensive care unit (NICU) weighing over 2000 g missed their birth dose HBV frequently, which prompted the implementation of a quality improvement initiative to increase birth dose HBV immunization in a level IV NICU in New York. Methods May 2019 to April 2021 baseline data showed the birth dose HBV rate of infants born ≥2000 g at 24% and 31% within 12 and 24 hours, respectively. The multidisciplinary QI team identified barriers using an Ishikawa cause-and-effect diagram. Our interventions included multidisciplinary collaboration, electronic medical record reminders, education, posters, and improved communication between staff and parents. We aimed to achieve a 25% improvement from the baseline. Results After 19 months of QI interventions (four Plan-Do-Study-Act cycles), the rate of administering birth dose HBV within 12 hours of life increased from 24% to 56% and within 24 hours from 31% to 64%. Process measure compliance improved, exceeding the 25% target, and showed sustained improvement. Conclusion This QI initiative improved the rate of eligible infants receiving HBV within the first 24 hours of life in the NICU. This work can serve as a model for other healthcare institutions to improve HBV immunization rates in NICUs.
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Affiliation(s)
- Indirapriya Avulakunta
- From the Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Ark
| | - Palanikumar Balasundaram
- Division of Neonatology, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, N.Y
| | | | - Toshiba Morgan-Joseph
- Division of Neonatology, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, N.Y
| | - Suhas Nafday
- Division of Neonatology, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, N.Y
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Bohnhorst B, Weidlich C, Peter C, Böhne C, Kattner E, Pirr S. Cardiorespiratory Events Following the Second Routine Immunization in Preterm Infants: Risk Assessment and Monitoring Recommendations. Vaccines (Basel) 2021; 9:vaccines9080909. [PMID: 34452034 PMCID: PMC8402520 DOI: 10.3390/vaccines9080909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
Due to frequent cardiorespiratory events (CREs) in response to the first routine immunization (rIM), current guidelines recommend readmitting and monitoring extremely preterm infants after the second rIM, though evidence on CREs in response to the second rIM is weak. In a prospective observational study, preterm infants with an increase in CREs after the first rIM were monitored for CREs before and after the second rIM. Seventy-one infants with a median gestational age of 26.4 weeks and a median weight of 820 g at birth were investigated at a median postnatal age of 94 days. All but seven infants showed an increase in CREs after the second rIM. The frequency of hypoxemias (p < 0.0001), apneas (p = 0.0003) and cardiorespiratory events requiring tactile stimulation (CRE-ts) (p = 0.0034) increased significantly. The 25 infants (35%) presenting with CRE-ts were significantly more likely to have been continuously hospitalized since birth (p = 0.001) and to receive analeptic therapy at the first rIM (p = 0.002) or some kind of respiratory support at the first (p = 0.005) and second rIM (p < 0.0001). At a postmenstruational age of 43.5 weeks, CRE-ts ceased. Our data support the recommendation to monitor infants who fulfil the above-mentioned criteria during the second rIM up to a postmenstruational age of 44 weeks.
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Affiliation(s)
- Bettina Bohnhorst
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Cornelia Weidlich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Corinna Peter
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Carolin Böhne
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
| | - Evelyn Kattner
- Department of Neonatology, Children’s Hospital “Auf der Bult”, 30173 Hannover, Lower Saxony, Germany;
| | - Sabine Pirr
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany; (B.B.); (C.W.); (C.P.); (C.B.)
- Correspondence:
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Chiappini E, Petrolini C, Caffarelli C, Calvani M, Cardinale F, Duse M, Licari A, Manti S, Martelli A, Minasi D, Miraglia Del Giudice M, Pajno GB, Pietrasanta C, Pugni L, Tosca MA, Mosca F, Marseglia GL. Hexavalent vaccines in preterm infants: an update by Italian Society of Pediatric Allergy and Immunology jointly with the Italian Society of Neonatology. Ital J Pediatr 2019; 45:145. [PMID: 31744514 PMCID: PMC6862761 DOI: 10.1186/s13052-019-0742-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/23/2019] [Indexed: 03/16/2023] Open
Abstract
Hexavalent vaccines, protecting against six diseases (diphtheria, tetanus, pertussis [DTaP], poliovirus, hepatitis B virus [HBV], and Haemophilus influenzae type b [Hib], are routinely the standard of care in Europe. The use of combined vaccines allows the reduction of number of injections and side effects, the reduction of costs, and the increase in adherence of the family to the vaccination schedule both in terms of the number of doses and timing. The safety profile, efficacy and effectiveness of hexavalent vaccines have been extensively documented in infants and children born at term, and data are accumulating in preterm infants. Hexavalent vaccines are particularly important for preterm infants, who are at increased risk for severe forms of vaccine preventable diseases. However, immunization delay has been commonly reported in this age group. All the three hexavalent vaccines currently marketed in Italy can be used in preterm infants, and recent data confirm that hexavalent vaccines have a similar or lower incidence of adverse events in preterm compared to full-term infants; this is likely due to a weaker immune system response and reduced ability to induce an inflammatory response in preterm infants. Apnoea episodes are the adverse events that can occur in the most severe preterm infants and / or with history of respiratory distress. The risk of apnoea after vaccination seems to be related to a lower gestational age and a lower birth weight, supporting the hypothesis that it represents an unspecific response of the preterm infant to different procedures. High seroprotection rates have been reported in preterm infants vaccinated with hexavalent vaccine. However, a lower gestational age seems to be associated with lower antibody titres against some vaccine antigens (e.g. HBV, Hib, poliovirus serotype 1, and pertussis), regardless of the type of hexavalent vaccine used. Waiting for large effectiveness studies, hexavalent vaccines should be administered in preterm infants according to the same schedule recommended for infants born at term, considering their chronological age and providing an adequate monitoring for cardio-respiratory events in the 48–72 h after vaccination, especially for infants at risk of recurrence of apnoea.
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Affiliation(s)
- E Chiappini
- SODc Malattie Infettive AOU Meyer, Dipartimento di Scienze della Salute, Università di Firenze, Firenze, Italy.
| | - C Petrolini
- Dipartimento di Scienze della Salute, Università di Firenze, Firenze, Italy
| | - C Caffarelli
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - M Calvani
- Dipartimento di Pediatria, Ospedale S. Camillo-Forlanini, Roma, Italy
| | - F Cardinale
- UOC Pediatria, Servizio di Allergologia e Pneumologia Pediatrica, Azienda Ospedaliera-Universitaria "Consorziale-Policlinico", Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - M Duse
- Dipartimento di Pediatria, Policlinico Umberto I, Università Sapienza di Roma, Roma, Italy
| | - A Licari
- Clinica Pediatrica, Fondazione IRCCS Policlinico "S. Matteo", Università di Pavia, Pavia, Italy
| | - S Manti
- Dipartimento di Medicina Clinica e Sperimentale, Unità di Broncopneumologia Pediatrica, Università di Catania, Catania, Italy
| | - A Martelli
- UOC Pediatria, Azienda Ospedaliera G. Salvini, Ospedali di Garbagnate Milanese e Bollate, Milano, Italy
| | - D Minasi
- Unità Pediatria, Ospedale di Polistena, Reggio Calabria, Italy
| | - M Miraglia Del Giudice
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - G B Pajno
- Dipartimento di Pediatria, Unità di Allergologia, Università di Messina, Messina, Italy
| | - C Pietrasanta
- Terapia intensiva neonatale, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico; Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italy
| | - L Pugni
- Terapia intensiva neonatale, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico; Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italy
| | - M A Tosca
- Allergologia Pediatrica, Istituto Giannina Gaslini, Genova, Italy
| | - F Mosca
- Terapia intensiva neonatale, Fondazione IRCCS "Ca' Granda", Ospedale Maggiore Policlinico; Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italy
| | - G L Marseglia
- Clinica Pediatrica, Fondazione IRCCS Policlinico "S. Matteo", Università di Pavia, Pavia, Italy
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Abstract
Developments in perinatal and neonatal care have increased the survival rate of high-risk newborns but led to a rise in chronic diseases seen in these infants. A significant number of them attend primary and secondary health care centers after discharge; however, there are very few standard protocols for the long-term follow-up of these babies. Therefore, we aimed to establish a follow-up guideline that emphasizes on universal screening schemes and takes into consideration national data. The guide presented here provides brief recommendations for physicians in light of evidence-based data for the follow-up of high-risk newborn infants. The steps taken to monitor and solve the problems of all high-risk infants may vary. We hope the use of such a standard approach in evaluating each infant in daily routine will improve the life quality of these high-risk infants.
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Affiliation(s)
- Betul Acunaş
- Division of Neonatology, Department of Pediatrics, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - Sinan Uslu
- Neonatology Clinic, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Yağmur Baş
- Division of Neonatology, Department of Pediatrics, Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
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Chiappini E, Petrolini C, Sandini E, Licari A, Pugni L, Mosca FA, Marseglia GL. Update on vaccination of preterm infants: a systematic review about safety and efficacy/effectiveness. Proposal for a position statement by Italian Society of Pediatric Allergology and Immunology jointly with the Italian Society of Neonatology. Expert Rev Vaccines 2019; 18:523-545. [PMID: 30952198 DOI: 10.1080/14760584.2019.1604230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Preterm infants (PIs) are at increased risk of vaccine-preventable diseases (VPDs). However, delayed vaccination start and low vaccine coverage are still reported. Areas covered: This systematic review includes 37 articles on preterm vaccination published in 2008-2018 in PubMed. Both live attenuated and inactivated vaccines are safe and well tolerated in PIs. Local reactions, apnea, and reactivity changes are the most frequently reported adverse events. Lower gestational age and birth weight, preimmunization apnea, longer use of continuous positive airway pressure (CPAP) are risk factors for apnea. The proportion of PIs who develop protective humoral and cellular immunity is generally similar to full terms although later gestational age is associated with increased antibody IgG concentrations (i.e. against certain pneumococcal serotypes, influenza, hepatitis B virus and poliovirus 1) and increased mononuclear cells proliferation (i.e. after inactivated poliovirus). Expert opinion: PIs can be safely and adequately protected by available vaccines with the same schedule used for full terms. Data at this regard have been retrieved by studies using a 3-dose primary series for pneumococcal and hexavalent vaccines. Further studies are needed regarding the 2 + 1 schedule. Apnea represents a nonspecific stress response in PIs, thus those hospitalized at 2 months should have cardio-respiratory monitoring after their first vaccination.
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Affiliation(s)
- Elena Chiappini
- a Pediatric Infectious Disease Unit, Department of Health Science, Anna Meyer Children's University Hospital , University of Florence , Florence , Italy
| | - Chiara Petrolini
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Elena Sandini
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Amelia Licari
- c Pediatric Clinic, IRCCS Policlinico "S. Matteo" Foundation , University of Pavia , Pavia , Italy
| | - Lorenza Pugni
- d Neonatal intensive care unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Fabio A Mosca
- d Neonatal intensive care unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy.,e Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy
| | - Gian Luigi Marseglia
- c Pediatric Clinic, IRCCS Policlinico "S. Matteo" Foundation , University of Pavia , Pavia , Italy
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7
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Gottlob S, Gille C, Poets CF. Randomized Controlled Trial on the Effects of Morning versus Evening Primary Vaccination on Episodes of Hypoxemia and Bradycardia in Very Preterm Infants. Neonatology 2019; 116:315-320. [PMID: 31394525 DOI: 10.1159/000501338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypoxemia and bradycardia occur frequently in preterm infants, but are incompletely understood. They are more prevalent during infections and following immunization. Data on adults suggested an increased immune response if subjects slept following vaccination, suggesting an interaction between circadian rhythm and the immune system. Whether this holds true for preterm infants with their less well-established circadian rhythm is unclear. OBJECTIVE Do infants born at 26-30 weeks' gestation and having received their first routine hexavalent vaccination in the morning have a lower cardiorespiratory event rate (CER) after vaccination than those receiving it in the evening? METHODS Twenty-six infants were randomized to an evening versus morning vaccination group in a pilot and main study with 10 and 16 participants, respectively. Pulse oximeter saturation, actigraphy, and rectal temperature were obtained for 24 h before and after vaccination. Blood samples for vaccination titers were taken before vaccination and during a follow-up examination in our outpatient clinic; another blood sample was taken 24 h after vaccination to determine inflammatory markers. RESULTS Vaccination led to an increase in CER in both groups, but there was no difference in CER between the morning and evening groups. Vaccination titers for Bordetella pertussis were increased in both groups, with no difference in inflammatory markers 24 h after vaccination. Body temperature increased in both groups after vaccination. Participants in the evening group slept longer after vaccination. CONCLUSIONS We did not identify a difference in CER between morning and evening vaccination but could confirm increased body temperatures and vaccination titers following vaccination.
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Affiliation(s)
- Stefan Gottlob
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
| | - Christian Gille
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital, Tübingen, Germany,
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Peña-Ortega F. Clinical and experimental aspects of breathing modulation by inflammation. Auton Neurosci 2018; 216:72-86. [PMID: 30503161 DOI: 10.1016/j.autneu.2018.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 12/19/2022]
Abstract
Neuroinflammation is produced by local or systemic alterations and mediated mainly by glia, affecting the activity of various neural circuits including those involved in breathing rhythm generation and control. Several pathological conditions, such as sudden infant death syndrome, obstructive sleep apnea and asthma exert an inflammatory influence on breathing-related circuits. Consequently breathing (both resting and ventilatory responses to physiological challenges), is affected; e.g., responses to hypoxia and hypercapnia are compromised. Moreover, inflammation can induce long-lasting changes in breathing and affect adaptive plasticity; e.g., hypoxic acclimatization or long-term facilitation. Mediators of the influences of inflammation on breathing are most likely proinflammatory molecules such as cytokines and prostaglandins. The focus of this review is to summarize the available information concerning the modulation of the breathing function by inflammation and the cellular and molecular aspects of this process. I will consider: 1) some clinical and experimental conditions in which inflammation influences breathing; 2) the variety of experimental approaches used to understand this inflammatory modulation; 3) the likely cellular and molecular mechanisms.
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Affiliation(s)
- Fernando Peña-Ortega
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, QRO 76230, México.
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Tenenbaum T, Drechsel-Bäuerle U, Oberle D. Cardiorespiratory Events After Monoclonal Antibody Prophylaxis With Palivizumab. Pediatr Infect Dis J 2018; 37:e281-e282. [PMID: 30308606 DOI: 10.1097/inf.0000000000002017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tobias Tenenbaum
- Pediatric Infectious Diseases and Pulmonology, University Children's Hospital Mannheim, Heidelberg University, Mannheim, Germany Department Safety of Medicinal Products and Medical Devices, Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Institut, Langen, Germany
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Omeñaca F, Vázquez L, Garcia-Corbeira P, Mesaros N, Hanssens L, Dolhain J, Gómez IP, Liese J, Knuf M. Immunization of preterm infants with GSK's hexavalent combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine: A review of safety and immunogenicity. Vaccine 2018; 36:986-996. [PMID: 29336924 DOI: 10.1016/j.vaccine.2018.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/20/2017] [Accepted: 01/04/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infants with history of prematurity (<37 weeks gestation) and low birth weight (LBW, <2500 g) are at high risk of infection due to functional immaturity of normal physical and immunological defense mechanisms. Despite current recommendations that infants with history of prematurity/LBW should receive routine immunization according to the same schedule and chronological age as full-term infants, immunization is often delayed. METHODS Here we summarize 10 clinical studies and 15 years of post-marketing safety surveillance of GSK's hexavalent vaccine (DTPa-HBV-IPV/Hib), a combined diphtheria-tetanus-acellular-pertussis-hepatitis-B-inactivated-poliovirus-Haemophilus influenzae-type-b (Hib) conjugate vaccine, when administered alone, or co-administered with pneumococcal conjugate, rotavirus, and meningococcal vaccines and respiratory syncytial virus IgG to infants with history of prematurity/LBW in clinical trials. RESULTS At least 92.5% of infants with history of prematurity/LBW as young as 24 weeks gestation in clinical studies were seropositive to all vaccine antigens after 3-dose primary vaccination with GSK's hexavalent DTPa-HBV-IPV/Hib vaccine, with robust immune responses to booster vaccination. Seropositivity rates and antibody concentrations to hepatitis B and Hib appeared lower in infants with history of prematurity/LBW than term infants. Between 13-30% of medically stable infants with history of prematurity developed apnea after vaccination with GSK's hexavalent DTPa-HBV-IPV/Hib vaccine; usually after dose 1. The occurrence of post-immunization cardiorespiratory events appears to be influenced by the severity of any underlying neonatal condition. Most cardiorespiratory events resolve spontaneously or require minimal intervention. GSK's hexavalent DTPa-HBV-IPV/Hib vaccine was well tolerated in co-administration regimens. CONCLUSION GSK's hexavalent DTPa-HBV-IPV/Hib vaccine alone or co-administered with other pediatric vaccines has a clinically acceptable safety and immunogenicity profile when used in infants with history of prematurity/LBW for primary and booster vaccination. Additional studies are needed in very premature and very LBW infants. However, currently available data support using GSK's hexavalent DTPa-HBV-IPV/Hib vaccine to immunize infants with history of prematurity/LBW according to chronological age.
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Affiliation(s)
- Felix Omeñaca
- Hospital Infantil La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Liliana Vázquez
- Fundación Centro de Estudios Infectológicos, C1425AWK Buenos Aires, Argentina.
| | - Pilar Garcia-Corbeira
- GSK, Parque Tecnológico de Madrid, Calle de Severo Ochoa, 2, 28760 Tres Cantos, Madrid, Spain.
| | | | | | | | | | - Johannes Liese
- Department of Paediatrics, Paediatric Infectious Diseases and Immunology, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
| | - Markus Knuf
- HELIOS Dr. Horst Schmidt Kliniken, Children's Hospital, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany.
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11
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Montague EC, Hilinski JA, Williams HO, McCracken CE, Giannopoulos HT, Piazza AJ. Respiratory Decompensation and Immunization of Preterm Infants. Pediatrics 2016; 137:peds.2015-4225. [PMID: 27244819 DOI: 10.1542/peds.2015-4225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Concern for respiratory decompensation after immunization in premature infants, particularly those with bronchopulmonary dysplasia (BPD), may lead to delayed and altered immunization schedules. METHODS A retrospective cohort of premature infants at <32 weeks' gestational age cared for in a tertiary level 4 NICU and immunized during their hospital stay were evaluated for respiratory decompensation within 72 hours of immunization. Respiratory measurements including change in respiratory support, mean fraction of inspired oxygen, and apnea, bradycardia, and desaturation events were compared between those infants with BPD and those without. The primary outcome was the difference in respiratory decompensation defined as a composite of increased respiratory support or increased fraction of inspired oxygen ≥10% within 72 hours of immunization. RESULTS Of 403 infants admitted to the NICU and immunized, 240 met the study criteria. Of those infants, 172 had a diagnosis of BPD. There was no difference in the primary outcome of respiratory decompensation after immunization between groups (P = .65). There was also no significant difference in apnea, bradycardia, and desaturation events between groups (P = .51). CONCLUSIONS In this cohort, respiratory decompensation requiring clinical intervention after immunization of preterm infants both with and without BPD was uncommon and not significantly different between groups. Consideration for immunization of this vulnerable population should not be delayed out of concern for clinical deterioration.
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Affiliation(s)
- Edwin Clark Montague
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and
| | - Joseph A Hilinski
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Helen O Williams
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Anthony J Piazza
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia; and Children's Healthcare of Atlanta, Atlanta, Georgia
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McArdle AJ, Mugisha G, Birahinduka D. QUESTION 2: Vaccinating preterm infants in resource-poor settings: what is the incidence of apnoea, bradycardia and need for respiratory support? Arch Dis Child 2016; 101:290-3. [PMID: 26893515 DOI: 10.1136/archdischild-2015-310273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Guy Mugisha
- Hôpital Militaire de Kamenge, Bujumbura, Burundi
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DeMeo SD, Raman SR, Hornik CP, Wilson CC, Clark R, Smith PB. Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants. JAMA Pediatr 2015; 169:740-5. [PMID: 26030302 PMCID: PMC4523398 DOI: 10.1001/jamapediatrics.2015.0418] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events, including fever and apnea or bradycardia, in the immediate postimmunization period. These adverse events present a diagnostic dilemma for physicians, leading to the potential for immunization delay and sepsis evaluations. OBJECTIVE To compare the incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death among immunized ELBW infants in the 3 days before and after immunization. DESIGN, SETTING, AND PARTICIPANTS In this multicenter retrospective cohort study, we studied 13,926 ELBW infants born at 28 weeks' gestation or less who were discharged from January 1, 2007, through December 31, 2012, from 348 NICUs managed by the Pediatrix Medical Group. EXPOSURES At least one immunization between the ages of 53 and 110 days. MAIN OUTCOMES AND MEASURES Incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death. RESULTS Most of the 13,926 infants (91.2%) received 3 or more immunizations. The incidence of sepsis evaluations increased from 5.4 per 1000 patient-days in the preimmunization period to 19.3 per 1000 patient-days in the postimmunization period (adjusted rate ratio [ARR], 3.7; 95% CI, 3.2-4.4). The need for increased respiratory support increased from 6.6 per 1000 patient-days in the preimmunization period to 14.0 per 1000 patient-days in the postimmunization period (ARR, 2.1; 95% CI, 1.9-2.5), and intubation increased from 2.0 per 1000 patient-days to 3.6 per 1000 patient-days (ARR, 1.7; 95% CI, 1.3-2.2). The postimmunization incidence of adverse events was similar across immunization types, including combination vaccines when compared with single-dose vaccines. Infants who were born at 23 to 24 weeks' gestation had a higher risk of sepsis evaluation and intubation after immunization. A prior history of sepsis was associated with higher risk of sepsis evaluation after immunization. CONCLUSIONS AND RELEVANCE All ELBW infants in the NICU had an increased incidence of sepsis evaluations and increased respiratory support and intubation after routine immunization. Our findings provide no evidence to suggest that physicians should not use combination vaccines in ELBW infants. Further studies are needed to determine whether timing or spacing of immunization administrations confers risk for the developing adverse events and whether a prior history of sepsis confers risk for an altered immune response in ELBW infants.
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Affiliation(s)
- Stephen D. DeMeo
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Sudha R. Raman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Christoph P. Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Reese Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - P. Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Esposito S, Fumagalli M, Principi N. Immunogenicity, safety and tolerability of vaccinations in premature infants. Expert Rev Vaccines 2014; 11:1199-209. [DOI: 10.1586/erv.12.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Tozzi AE, Piga S, Corchia C, Di Lallo D, Carnielli V, Chiandotto V, Fertz MC, Miniaci S, Rusconi F, Cuttini M. Timeliness of routine immunization in a population-based Italian cohort of very preterm infants: results of the ACTION follow-up project. Vaccine 2014; 32:793-9. [PMID: 24397902 DOI: 10.1016/j.vaccine.2013.12.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/16/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although very preterm infants are recommended to receive immunizations, according to their chronological age, immunization start in these infants is often delayed. Aim To measure coverage and timeliness of routine immunizations in Italian very preterm infants and to assess determinants of delay. METHODS We followed up infants 22-31 completed weeks of gestational age discharged from intensive care. We measured the proportion of children with one dose of diphtheria-tetanus-pertussis-poliohepatitis, B-Hib vaccine (DTP-Pol-HBV-Hib), measles-mumps-rubella vaccine (MMR), conjugate pneumococcal vaccine (Pnc), conjugate meningococcal C vaccine (MenC), and varicella vaccine (Var) by 24 months. We used the Kaplan Meier method and Cox proportional hazard models to estimate the age, at immunization start and determinants of timeliness for each vaccine. RESULTS Data on 1102 (92.1%) children out of 1196 included in the cohort were analyzed. Immunization start by 24 months of age occurred in 95.9% of children for DTP-Pol-HBV-Hib; 84.0% for MMR; 49.7% for Pnc; 38.5% for MenC; and 4.1% for Var. Eighty-seven percent of participants received the first dose of DTP-Pol-HBV-Hib by 6 months of age, and 66.7% had their first MMR administered by 18 months. Hospitalization was associated with delay for all vaccines with the exception of MenC and Var. Maternal employment was associated with earlier immunization for MMR, Pnc, and MenC. DTP-Pol-HBV-Hib timeliness improved with increasing birthweight and paternal employment and decreased with a larger number of siblings in the household. MMR was delayed in children with cerebral palsy, and in those with a larger number of children in the household. Immunization for Pnc was delayed in children with larger number of siblings. CONCLUSIONS Immunization start for all vaccines was considerably delayed in many very preterm infants. Public health strategies taking into account determinants of delay should be implemented to improve coverage and timeliness of vaccination in this group of infants.
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Affiliation(s)
- Alberto E Tozzi
- Unit of Epidemiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Simone Piga
- Unit of Epidemiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Corchia
- International Centre on Birth Defects and Prematurity, Rome, Italy
| | | | - Virgilio Carnielli
- Maternal and Child Health Institute, Marche University and Salesi Hospital, Ancona, Italy
| | - Valeria Chiandotto
- Neonatal Intensive Care Unit, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Maria Cristina Fertz
- Neonatal Intensive Care Unit, Burlo Garofolo Maternal and Child Health Institute, IRCCS, Trieste, Italy
| | - Silvana Miniaci
- Neonatal Intensive Care Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's University Hospital and Regional Agency for Health of Tuscany, Florence, Italy
| | - Marina Cuttini
- Unit of Epidemiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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16
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Überwachung von Frühgeborenen im Rahmen der Grundimmunisierung. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Mialet-Marty T, Beuchée A, Ben Jmaa W, N'guyen N, Navarro X, Porée F, Nuyt AM, Pladys P. Possible predictors of cardiorespiratory events after immunization in preterm neonates. Neonatology 2013; 104:151-5. [PMID: 23887711 DOI: 10.1159/000351035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/21/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The influence of the first immunization on cardiorespiratory (CR) stability in very preterm infants is still a controversial subject. OBJECTIVES To describe the changes induced by immunization on heart and respiratory rate variability (HRV-RRV) and to test a potential association between preimmunization profiles and postimmunization CR events. METHODS Continuous 72-hour CR recordings and 2.5-hour polysomnographic recordings were performed on very preterm infants immunized after 7 weeks. The results are expressed as medians (interquartile ranges). RESULTS Immunization was performed on 31 very preterm infants [28 weeks' gestation (26.9-29), birth weight: 965 g (795-1,105)], and was associated with an increased incidence (p < 0.01) of events lasting more than 10 s: bradycardia <80 bpm [2.2 (1.1-7) vs. 1.8 (1-4)/12 h], desaturation [17.6 (9.4-36.4) vs. 13.9 (7.7-33.8)/12 h] and associated bradycardia-desaturation [IB+D, 4.1 (1.4-7.3) vs. 2.4 (1-4.6)/12 h], with mild changes in HRV and no change in RRV. The changes in IB+D frequency were correlated with preimmunization IB+D frequency (r = 0.44, p < 0.05), HRV spectral parameter low frequency/high frequency ratio (LF/HF, r = 0.55, p < 0.01) and approximate entropy of HRV (r = -0.39, p < 0.05). CONCLUSION The increase in CR events after the first immunization in very preterm infants was associated with: (1) sympathetic predominance in heart rate control (high LF/HF ratio), (2) abnormal oversimplification of HRV (low entropy) and (3) persistent respiratory rhythm control immaturity (high IB+D before vaccine).
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Clifford V, Crawford NW, Royle J, Lazzaro T, Danchin M, Perrett KP, Lee KJ, Buttery JP. Recurrent apnoea post immunisation: Informing re-immunisation policy. Vaccine 2011; 29:5681-7. [DOI: 10.1016/j.vaccine.2011.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 05/16/2011] [Accepted: 06/06/2011] [Indexed: 11/26/2022]
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19
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Hospital initiation of a vaccinal schedule improves the long-term vaccinal coverage of ex-preterm children. Vaccine 2011; 29:382-6. [DOI: 10.1016/j.vaccine.2010.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 11/01/2010] [Accepted: 11/01/2010] [Indexed: 11/22/2022]
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20
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Bavaro SL, Kanduc D. Pentapeptide commonality between Corynebacterium diphtheriae toxin and the Homo sapiens proteome. Immunotherapy 2010; 3:49-58. [PMID: 21174557 DOI: 10.2217/imt.10.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cross-reactivity may affect diagnostic tests and cause harmful autoimmune reactions following immunotherapy. To predict potential cross-reactivity and search for safe immunotherapeutic approaches, we analyzed sequence identity between microbial antigens and the human proteome. Using diphtheria toxin (DT) as a model, we examined its patterns of identity with human proteins at the pentapeptide level. DT shares 503 pentapeptides with the human proteome, while only 31 pentapeptides are unique to the toxin. DT pentapeptide identity involves multiple/repeated matches in human proteins (a total of 4966 occurrences). Human proteins containing bacterial peptide matches include antigens linked to fundamental cellular functions, such as cell cycle control, proliferation, development and differentiation. The data presented in this article offer a rational basis for designing peptide-based vaccines that specifically target DT and thus eliminate the potential risk of cross-reactivity with human proteins. More generally, this study proposes a methodological approach for avoiding cross-reactivity in immune reactions.
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Affiliation(s)
- Simona Lucia Bavaro
- Department of Biochemistry & Molecular Biology, University of Bari, Bari 70126, Italy
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22
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Esposito S, Serra D, Gualtieri L, Cesati L, Principi N. Vaccines and preterm neonates: why, when, and with what. Early Hum Dev 2009; 85:S43-5. [PMID: 19775838 DOI: 10.1016/j.earlhumdev.2009.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review analyses what is known concerning the immune response of preterm (PTIs) and low birth weight infants (LBWIs) to widely used vaccines, the protection they receive from routine immunisation, and the safety and tolerability of the vaccines themselves. It shows why PTIs and LBWIs should be vaccinated using the same schedules as those usually recommended for full-term infants (FTIs), except in the case of hepatitis B vaccine, whose schedule should be repeated in infants who received the first dose during the first days of life when they weighed less than 2000 g because of their reduced immune response. Vaccines are immunogenic, safe and well tolerated in PTIs and LBWIs, in whom early active immunisation is particularly important because they are among the most vulnerable subjects for pediatric infectious diseases. It is therefore essential to make every effort to convince pediatricians and parents that compliance with these recommendations will not cause any clinical problems.
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Affiliation(s)
- Susanna Esposito
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
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23
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Impfungen von Frühgeborenen. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-1978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Überwachung der Atmung bei ehemaligen Frühgeborenen (<28 SSW) im Rahmen der Grundimmunisierung. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-008-1896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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