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Calvert A, Campbell H, Heath PT, Jones CE, Le Doare K, Mensah A, Ladhani S. Risk of Invasive Meningococcal Disease in Preterm Infants. Open Forum Infect Dis 2024; 11:ofae164. [PMID: 38665170 PMCID: PMC11045171 DOI: 10.1093/ofid/ofae164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Indexed: 04/28/2024] Open
Abstract
Background Invasive meningococcal disease (IMD) is most common in the first year of life. We hypothesized that preterm infants may have a higher risk of IMD and more severe disease than term infants. We compared the incidence, demographics, clinical presentation, and outcomes of IMD in preterm compared with term infants during the first 5 years after implementation of a national meningococcal group B vaccine (4CMenB) for infants in England. Methods The UK Health Security Agency conducts enhanced national IMD surveillance with detailed follow-up of all confirmed cases in England. Infants aged <1 year (uncorrected for gestational age) with IMD confirmed between 1 September 2015 and 31 August 2020 were included. Results There were 393 infant IMD cases (incidence, 12.4/100 000 live births). Among 363 (92.4%) of the infants with known gestational age, the IMD incidence was higher in preterm (<37 weeks' gestation) than in term infants (18.3/100 000 vs 10.9/100 000; incidence rate ratio [IRR], 1.68 [95% confidence interval, 1.23-2.29]; P = .001). The IMD incidence was highest in those born at <32 weeks' gestation (32.9/100 000; incidence rate ratio for <32 weeks' gestation vs term, 3.01 [95% confidence interval, 1.73-5.24]; P ≤ .001). There were no differences in demographics, clinical presentation, rate of intensive care admission, or case-fatality rate, but preterm infants were more likely than term infants to have ≥1 reported sequela (14 of 39 [35.9%] vs 51 of 268 [19.0%]; P = .02). Conclusions Preterm infants had a higher incidence of IMD than term infants and the IMD incidence was highest in infants born at <32 weeks' gestation. Preterm infants also had a higher risk of IMD sequelae.
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Affiliation(s)
- Anna Calvert
- Centre for Neonatal and Paediatric Infection and Vaccine Institute, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection and Vaccine Institute, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christine E Jones
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Experimental Sciences, University of Southampton, Southampton, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection and Vaccine Institute, St George's, University of London, London, UK
- Makerere University Johns Hopkins University, Kampala, Uganda
- Pathogen Immunology Group, UK Health Security Agency, Salisbury, UK
| | - Anna Mensah
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Shamez Ladhani
- Centre for Neonatal and Paediatric Infection and Vaccine Institute, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
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Chapman TJ, Patel SM, Flores SA, Xu S, Lupinacci R, Shi Y, Shekar T, Feemster K, Yi J, Tamms G, Kaminski J, Bickham K, Musey L, Buchwald UK, Banniettis N. Safety and Immunogenicity of V114 in Preterm Infants: A Pooled Analysis of Four Phase Three Studies. Pediatr Infect Dis J 2023; 42:1021-1028. [PMID: 37566897 PMCID: PMC10569678 DOI: 10.1097/inf.0000000000004069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Risk of invasive pneumococcal disease is 3-fold higher in preterm versus full-term infants. V114 is a 15-valent pneumococcal conjugate vaccine (PCV) containing the 13 serotypes in PCV13 plus 2 unique serotypes, 22F and 33F. A pooled subgroup analysis was performed in preterm infants (<37 weeks gestational age) enrolled in 4 pediatric phase 3 studies evaluating the safety and immunogenicity of different 4-dose regimens of V114 or PCV13. METHODS Healthy preterm infants were randomized 1:1 to receive V114/PCV13 in the 4 studies. Safety was evaluated as the proportion of participants with adverse events (AEs) following receipt of PCV. Serotype-specific antipneumococcal immunoglobulin G (IgG) geometric mean concentrations, IgG response rates and opsonophagocytic activity geometric mean titers were measured at 30 days postdose 3, pretoddler dose and 30 days postdose 4. RESULTS V114 and PCV13 were administered to 174 and 180 participants, respectively. Mean gestational age was 35.4 weeks (range: 27 - <37 weeks). Proportions of participants with AEs were comparable between vaccination groups; most AEs experienced were of short duration (≤3 days) and mild-to-moderate intensity. V114-elicited IgG geometric mean concentrations, IgG response rates and opsonophagocytic activity geometric mean titers were generally comparable to PCV13 for the 13 shared serotypes and higher for serotypes 22F and 33F at 30 days postdose 3 and postdose 4. CONCLUSIONS In preterm infants, V114 was well tolerated and induced comparable immune responses to PCV13 for the 13 shared serotypes and higher immune responses to serotypes 22F and 33F. Results support the use of V114 in preterm infants.
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Affiliation(s)
| | | | | | - Shengjie Xu
- From the Merck & Co., Inc., Rahway, New Jersey
| | | | - Yaru Shi
- From the Merck & Co., Inc., Rahway, New Jersey
| | | | | | - Jumi Yi
- From the Merck & Co., Inc., Rahway, New Jersey
| | | | | | | | - Luwy Musey
- From the Merck & Co., Inc., Rahway, New Jersey
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Sadeck LDSR, Kfouri RDÁ. An update on vaccination in preterm infants. J Pediatr (Rio J) 2023; 99 Suppl 1:S81-S86. [PMID: 36608935 PMCID: PMC10066441 DOI: 10.1016/j.jped.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The objective of this article is to review the most current literature on vaccines, focusing on their safety, immunogenicity, and efficacy in preterm newborns, aiming to improve vaccine coverage in this population. DATA SOURCE Most recent scientific publications addressing the immunization of preterm newborns. DATA SYNTHESIS Despite its immunological immaturity, vaccination is well tolerated by preterm infants, and protective immune responses are observed, but some studies have shown that preterm infants undergo unjustified delays in their vaccination schedule. CONCLUSIONS Despite being widely recommended, the routine immunization of preterm infants is often delayed, putting this vulnerable population at risk for several diseases, many of which are preventable by immunization. Every effort should be made to develop universal guidelines that define the immunization of preterm infants.
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Affiliation(s)
- Lilian Dos Santos Rodrigues Sadeck
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Centro Neonatal do Instituto da Criança e Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Departamento Científico de Neonatologia, Sociedade Brasileira de Pediatria (SBP), São Paulo, SP, Brazil
| | - Renato de Ávila Kfouri
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Maternidade Santa Joana, São Paulo, SP, Brazil; Departamento de Imunizações, Sociedade Brasileira de Pediatria (SBP), São Paulo, SP, Brazil.
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Chaudhari T. Vaccinations in the newborn. Best Pract Res Clin Obstet Gynaecol 2021; 76:66-82. [DOI: 10.1016/j.bpobgyn.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 02/07/2023]
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Emergence of Meningitis Caused by Nonvaccine Serotypes of Pneumococcus in Rural United States. Case Rep Pediatr 2020; 2020:2372843. [PMID: 33294245 PMCID: PMC7718068 DOI: 10.1155/2020/2372843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/26/2020] [Accepted: 11/21/2020] [Indexed: 11/24/2022] Open
Abstract
Pneumococcal conjugate vaccines have decreased the rates of invasive pneumococcal disease (IPD) in children. Since vaccine introduction, however, rates of infection due to nonvaccine Streptococcus pneumoniae serotypes have increased. We now describe 3 meningitis cases due to the nonvaccine serotypes 35B and 11A from rural United States.
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Vacunas e inmunizaciones en recién nacidos y recién nacidos prematuros. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Vaccine Prophylaxis of Pneumococcal Infections in Children under Conditions of Severe Flood in the Amur River Basin. Interdiscip Perspect Infect Dis 2019; 2019:5467275. [PMID: 30906320 PMCID: PMC6398015 DOI: 10.1155/2019/5467275] [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: 07/11/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 11/17/2022] Open
Abstract
Background Pneumococcal infection being one of the dominant causes of acute respiratory diseases and exacerbation of chronic ones is a serious problem for human health and society. The flood in the Amur river basin in the summer of 2013 created a special zone and risk conditions for the formation of respiratory pathology in the Far-Eastern region of Russia. We aimed to give clinical and epidemiological assessment of the effectiveness of vaccination programs of respiratory viral and pneumococcal infections and generalization of regional experience in the organization of a set of measures aimed at their prevention in the postflood period in the Far-Eastern region. Methods The monitoring program includes children aged 2 to 5 years in the amount of 4988 with risk factors for pneumococcal infection. The pneumococcal conjugate vaccine Prevenar-13 was used for immunization. Data on the incidence of ARVI and pneumonia in children in pre- and postvaccination periods were to be recorded. The indicators and special criteria were used to assess the effectiveness of vaccination. To study the circulation of serovariants of pneumococcus in inflammatory diseases of the respiratory tract and nasopharyngeal carrier, bacteriological and molecular genetic methods (RT-PCR in the mode of multiprime detection) were used. Results Differences in the frequency and range of serovariants of circulating isolates of pneumococcus in the postvaccinal period and in unvaccinated children, elimination of a number of serotypes, and appearance of circulation of nonvaccinated strains were revealed. The incidence of acute respiratory diseases and pneumonia among the vaccinated population for 2 years in the region decreased by 2.5 times. The coefficient of effectiveness of vaccination according to the indicator of morbidity of children with pneumonia reaches 75-100% with direct dependence on the age of children (r=0.98). Conclusion Comparative statistical analysis revealed a high degree of effectiveness of regional programs with the methods of immunoprophylaxis of pneumococcal infections.
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