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Immunization of preterm infants: current evidence and future strategies to individualized approaches. Semin Immunopathol 2022; 44:767-784. [PMID: 35922638 PMCID: PMC9362650 DOI: 10.1007/s00281-022-00957-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Preterm infants are at particularly high risk for infectious diseases. As this vulnerability extends beyond the neonatal period into childhood and adolescence, preterm infants benefit greatly from infection-preventive measures such as immunizations. However, there is an ongoing discussion about vaccine safety and efficacy due to preterm infants' distinct immunological features. A significant proportion of infants remains un- or under-immunized when discharged from primary hospital stay. Educating health care professionals and parents, promoting maternal immunization and evaluating the potential of new vaccination tools are important means to reduce the overall burden from infectious diseases in preterm infants. In this narrative review, we summarize the current knowledge about vaccinations in premature infants. We discuss the specificities of early life immunity and memory function, including the role of polyreactive B cells, restricted B cell receptor diversity and heterologous immunity mediated by a cross-reactive T cell repertoire. Recently, mechanistic studies indicated that tissue-resident memory (Trm) cell populations including T cells, B cells and macrophages are already established in the fetus. Their role in human early life immunity, however, is not yet understood. Tissue-resident memory T cells, for example, are diminished in airway tissues in neonates as compared to older children or adults. Hence, the ability to make specific recall responses after secondary infectious stimulus is hampered, a phenomenon that is transcriptionally regulated by enhanced expression of T-bet. Furthermore, the microbiome establishment is a dominant factor to shape resident immunity at mucosal surfaces, but it is often disturbed in the context of preterm birth. The proposed function of Trm T cells to remember benign interactions with the microbiome might therefore be reduced which would contribute to an increased risk for sustained inflammation. An improved understanding of Trm interactions may determine novel targets of vaccination, e.g., modulation of T-bet responses and facilitate more individualized approaches to protect preterm babies in the future.
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Tooke L, Louw B. A successful preterm vaccination program in a neonatal unit in a developing country. Heliyon 2019; 5:e02857. [PMID: 31844744 PMCID: PMC6895665 DOI: 10.1016/j.heliyon.2019.e02857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/19/2019] [Accepted: 11/13/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although preterm infants are at a greater risk from vaccine preventable diseases, there are frequent delays in vaccine administration with great variability between units. There is little data from developing countries. Groote Schuur Hospital in Cape Town, South Africa starting vaccinating preterm infants from 2014. OBJECTIVES To determine whether vaccines were given at the correct chronological age and whether there were side effects or logistical problems. METHODS For a six month period, all infants who were still admitted at 6 weeks of age were included. Date of vaccination and side effects were recorded. RESULTS 60 infants were included. 57 (95%) received their 6 week vaccines. 68% received the vaccines on time, 10% early and 17% late. Reasons for delay included oxygen dependence and concerns about sepsis. There were no side effects. CONCLUSIONS It is possible to implement a successful vaccination program for preterm infants in a low resourced setting.
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Affiliation(s)
- Lloyd Tooke
- Neonatal Department, Groote Schuur Hospital, University of Cape Town
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López-Sanguos C, Rivero Calle I, Rodriguez Tenreiro C, Raguindin PF, Martinón-Torres F. Safety and immunogenicity of pneumococcal conjugate vaccines in preterm infants. Expert Opin Drug Saf 2019; 18:253-259. [PMID: 30907170 DOI: 10.1080/14740338.2019.1597849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The introduction of pneumococcal conjugate vaccines (PCVs) in the routine immunization program has resulted in a significant decline in invasive pneumococcal diseases (IPD) around the world. Preterm infants are a special group at a high risk of invasive infection by encapsulated bacteria. However, their slow growth accrual and prolonged hospital stay frequently lead to delays in immunization, which contributes to their risk for severe infections. Areas covered: Authors reviewed the published immunogenicity and safety of the use of PCVs in preterm infants. Expert opinion: PCVs are safe and effective for use in low birth weight and in-hospital preterm infants. Local and systemic reactions are similar for both term and preterm populations. Reports were inconsistent on the risk of apnea, therefore hospitalized extremely premature infants should be kept under observation for at least 48 h after immunization.
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Affiliation(s)
- Carolina López-Sanguos
- a Translational Paediatrics and Infectious Diseases, Department of Paediatrics , Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,b Genetics, Vaccines and Infections Research Group (GENVIP) , Instituto de Investigación Sanitaria de Santiago , Santiago de Compostela , Spain
| | - Irene Rivero Calle
- a Translational Paediatrics and Infectious Diseases, Department of Paediatrics , Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,b Genetics, Vaccines and Infections Research Group (GENVIP) , Instituto de Investigación Sanitaria de Santiago , Santiago de Compostela , Spain
| | - Carmen Rodriguez Tenreiro
- a Translational Paediatrics and Infectious Diseases, Department of Paediatrics , Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,b Genetics, Vaccines and Infections Research Group (GENVIP) , Instituto de Investigación Sanitaria de Santiago , Santiago de Compostela , Spain
| | - Peter Francis Raguindin
- b Genetics, Vaccines and Infections Research Group (GENVIP) , Instituto de Investigación Sanitaria de Santiago , Santiago de Compostela , Spain
| | - Federico Martinón-Torres
- a Translational Paediatrics and Infectious Diseases, Department of Paediatrics , Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,b Genetics, Vaccines and Infections Research Group (GENVIP) , Instituto de Investigación Sanitaria de Santiago , Santiago de Compostela , Spain
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Safety and Immunogenicity of Pneumococcal Conjugate Vaccine in Preterm Infants: A Meta-Analysis. Indian J Pediatr 2017; 84:101-110. [PMID: 27819116 DOI: 10.1007/s12098-016-2248-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the safety and immunogenicity of pneumococcal conjugate vaccine (PCVs) in preterm infants. METHODS In accordance with the PRISM (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement (as of May 2015), a meta-analysis was conducted to evaluate the safety and immunogenicity of PCVs in preterm infants. RESULTS Ten thousand nine hundred sixty full-term infants and 2131 preterm infants with 344 preterm infants of <2500 g birth weight [low-birth weight (LBW)] were included, and all the subjects were immunized with either PCV-7, PCV-10 or PCV-13 in this random-effects meta-analysis. For safety, the range of risk ratio (RRs) for local reaction was from 0.88 to 1.02 and from 0.94 to 1.24 for systematic reaction respectively. For immunogenicity, either post-primary or booster vaccination with PCV-7, PCV-10 or PCV-13, genomic mean concentration (GMC) of serotypes 4, 6B, 9 V, 19F and 23F was always less in preterm infants than in full-term infants, in which huge comparison of GMC was found in serotype 19F(SMD = -0.393, 95%CI:-0.612 ~ 0.175). After primary vaccination, the combined risk ratio (RRs) of immune response against seven common serotypes and additional serotype 1 was approximated to 1.00 with narrow 95 % confidence interval (CI) between preterm infants and full-term infants, and at least 91 % sero-conversion of two additional serotypes, 5 and 7F in two cohorts was observed. Furthermore, between very-low-birth-weight (VLBW) infants of <1500 g and 1501 ~ 2500 g, overall RRs of immune response to PCV-7 administration was 0.98 (95%CI: 0.96 ~ 1.00). CONCLUSIONS Preterm infants have a great tolerance to PCV-7, PCV-10 or PCV-13 vaccination. PCV-7 could elicit optimal immune response post vaccination in preterm infants, even in VLBW infants.
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Fletcher MA, Balmer P, Bonnet E, Dartois N. PCVs in individuals at increased risk of pneumococcal disease: a literature review. Expert Rev Vaccines 2015; 14:975-1030. [DOI: 10.1586/14760584.2015.1037743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ochoa TJ, Zea-Vera A, Bautista R, Davila C, Salazar JA, Bazán C, López L, Ecker L. Vaccine schedule compliance among very low birth weight infants in Lima, Peru. Vaccine 2014; 33:354-8. [PMID: 25448091 DOI: 10.1016/j.vaccine.2014.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 11/02/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE There is little information about vaccine schedule compliance in very-low-birth-weight infants in developing countries. The aim of the study was to describe the compliance with the vaccine schedule among this population in Lima, Peru. PATIENTS AND METHODS We conducted a prospective cohort study in four hospitals in Lima in infants with a birth-weight of less than 1500 g, followed from birth up to 12 months of age every 2 weeks. The date and age at administration of each vaccine was recorded RESULTS 222 infants were enrolled. The median birth-weight was 1250 g (range 550-1499 g) and the median gestational age was 30.0 weeks (range 23-37 weeks). The mean age for the first pentavalent (DPT, Hib, HepB) and oral polio vaccine administration was 4.3 ± 1.4 months in infants with a birth-weight of < 1000 g vs. 3.1 ± 1.0 in infants with a birth-weight 1000-1500 g (p < 0.001); 4.1 ± 0.9 vs. 3.3 ± 1.1 for rotavirus (p < 0.05); and 5.1 ± 2.1 vs. 4.3 ± 1.8 for the 7-valent pneumococcal conjugated vaccine. Only 35% had received the three doses of oral polio and pentavalent vaccine by seven months, although by nine months 81% had received these vaccines. CONCLUSIONS Vaccination of very-low-birth-weight infants in Peru is significantly delayed, especially in infants with a birth-weight of < 1000 g and lower gestational age. Urgent educational interventions targeting physicians and nurses should be implemented in order to improve vaccination rates and timing in these high risk populations.
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Affiliation(s)
- Theresa J Ochoa
- Universidad Peruana Cayetano Heredia, Lima, Lima, Peru; University of Texas School of Public Health, Houston, TX, United States.
| | | | | | - Carmen Davila
- Instituto de Nacional Materno Perinatal, Lima, Lima, Peru
| | | | - Carlos Bazán
- Hospital Nacional Madre Niño San Bartolome, Lima, Lima, Peru
| | - Luis López
- Instituto de Nacional Materno Perinatal, Lima, Lima, Peru
| | - Lucie Ecker
- Instituto de Investigación Nutricional, Lima, Lima, Peru
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Gaudelus J, Pinquier D, Romain O, Thiebault G, Vie le Sage F, Dommergues M, Hau I, Bakhache P, Virey B, Dufour V, Parez N, Guerin N, Aujard Y, Weil-Olivier C, Cohen R. Le nouveau calendrier vaccinal est-il adapté à l’ancien prématuré ? Arch Pediatr 2014; 21:1062-70. [DOI: 10.1016/j.arcped.2014.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Szynczewska E, Chlebna-Sokół D. Immunogenicity of heptavalent conjugate vaccine against Streptococcus pneumoniae in premature babies with low birth weight. Pediatr Neonatol 2014; 55:101-7. [PMID: 24129355 DOI: 10.1016/j.pedneo.2013.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are few studies about immunogenicity and safety of heptavalent pneumococcal-CRM197 conjugate vaccine (PCV7) in low birth weight infants. OBJECTIVE Assessment of immunogenicity following administration of PCV7 in low birth weight children. METHODS The PCV7 vaccine was administered to 60 infants divided into two groups: 23 children with birth weight <1000 g (Group I); and 37 children with birth weight ≥1000 g (Group II). Serum was collected four times. RESULTS Birth weight of children included in the study ranged from 480 g to 2450 g. The primary immunization caused an increase in the average concentration of antibodies for all serotypes in most of the participants, with no significant differences between the groups. However, there were some differences between various serotypes. Group serotypes 6B and 23F were the least immunogenic (≥0.35 μg/mL, Group I vs. Group II - 6B: 78.3% vs. 67,6% p = 0.371 and 23F: 87% vs. 83.8% p = 0.738). Prior to the administration of a booster dose, a significant decrease in antibody titer was observed in all children. The last vaccination resulted in an increased concentration of antibodies in all children in both groups, and the results were significantly higher compared to those measured following administration of three doses of the vaccine. CONCLUSION PCV7 is immunogenic in children with low, very low, and extremely low birth weight. Serotypes 6B and 23F were the least immunogenic, and serotype 14 proved to be the most immunogenic.
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Affiliation(s)
- Ewa Szynczewska
- Department of Paediatric Propaedeutics and Metabolic Bone Diseases of Medical University of Lodz, Poland.
| | - Danuta Chlebna-Sokół
- Department of Paediatric Propaedeutics and Metabolic Bone Diseases of Medical University of Lodz, Poland
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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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Immunogenicity of Haemophilus influenzae type b protein conjugate vaccines in very low birth weight infants. Pediatr Infect Dis J 2013; 32:1400-2. [PMID: 24569312 PMCID: PMC3960569 DOI: 10.1097/01.inf.0000437263.04493.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wynn JL, Li L, Cotten CM, Phelps DL, Shankaran S, Goldberg RN, Carlo WA, Van Meurs K, Das A, Vohr BR, Higgins RD, Stoll BJ, D'Angio CT. Blood stream infection is associated with altered heptavalent pneumococcal conjugate vaccine immune responses in very low birth weight infants. J Perinatol 2013; 33:613-8. [PMID: 23370608 PMCID: PMC3722279 DOI: 10.1038/jp.2013.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/11/2012] [Accepted: 01/04/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Sepsis in older children and adults modifies immune system function. We compared serotype-specific antibody responses to heptavalent pneumococcal conjugate vaccine (PCV7) in very low birth weight infants (<1500 g,VLBWs) with and without blood stream infection (BSI) during their birth hospitalization. STUDY DESIGN Retrospective analysis of prospectively collected data for the Neonatal Research Network study of PCV7 responses among VLBWs. Infants received PCV7 at 2, 4 and 6 months after birth with blood drawn 4 to 6 weeks after third dose. Serotype antibodies were compared between infants with or without a history of BSI. Regression models were constructed with BW groups and other confounding factors identified in the primary study. RESULT In all, 244 infants completed the vaccine series and had serum antibody available; 82 had BSI. After adjustment, BSI was not associated with reduced odds of serum antibody 0.35 μg ml(-1). CONCLUSION BSI was not associated with reduced odds of World Health Organization-defined protective PCV7 responses in VLBWs.
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Affiliation(s)
- J L Wynn
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Pediatrics/Neonatology, Nashville, TN, USA.
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Szynczewska E, Chlebna-Sokół D. Immunogenicity and safety of heptavalent conjugate vaccine against Streptococcus pneumoniae in pre-term Polish infants. Vaccine 2011; 29:7107-13. [PMID: 21803093 DOI: 10.1016/j.vaccine.2011.06.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/21/2011] [Accepted: 06/27/2011] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to assess post-vaccination immune response and occurrence of adverse events in the group of prematurely born infants. The study included 40 pre-term infants. Each child was vaccined four times (2, 4, 6 and 16 months) with the heptavalent conjugated pneumococcal vaccine (PCV7). Assessing of the level of antibodies was performed before vaccination, 4 weeks after primary series, before and 4 weeks after the booster dose. The research participants were qualified into 2 groups: group I - 19 children born before 30th gestational week, group II - 21 children born between the 30th and 34th gestational week. After the basic vaccination, an increase in the average antibody concentration in the area of all serotypes in most of the children tested was registered, with no significant differences observed between the groups. However, differences between individual serotypes were observed. The lowest values were found for serotype 6B. Before administering the booster dose, a significant drop in antibody titre in all of the children tested was noted. The last vaccination caused another significant increase in antibody concentration in both groups and the results obtained were markedly higher than those obtained after administering three vaccine doses. The majority of the children tested (with the exception of three from group II) achieved the preventive antibody level ≥ 0.35 μg/ml. In all of the children, no serious adverse events were observed. Our research showed, that heptavalent pneumococcal conjugate vaccine is immunogenic in children born before the completion of the 34th week of pregnancy. A booster dose of vaccine must be given at the right time to optimal response to the vaccine for all serotypes. Finally, any serious adverse events were observed.
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Affiliation(s)
- Ewa Szynczewska
- Department of Paediatric Propaedeutics and Metabolic Bone Diseases of Medical University of Lodz, Poland.
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Zangeneh TT, Baracco G, Al-Tawfiq JA. Impact of conjugate pneumococcal vaccines on the changing epidemiology of pneumococcal infections. Expert Rev Vaccines 2011; 10:345-53. [PMID: 21434802 DOI: 10.1586/erv.11.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae-related infections have a major global impact on healthcare, especially in the developing world, and are considered the number one vaccine-preventable cause of death in children. There are more than 90 pneumococcal serotypes and 46 serogroups. The first capsular polysaccharide pneumococcal vaccine was licensed in the USA in 1977 for individuals older than 2 years of age at high risk for pneumococcal disease. Two decades later, the first 7-valent pneumococcal polysaccharide-protein conjugate vaccine completed the required clinical trials and was introduced as part of the national immunization program of various countries. New-generation vaccines that include emerging serotypes, while maintaining protection against the 7-valent pneumococcal serotypes, have recently been approved. With the addition of these serotypes, the majority of potential pneumococcal serotypes causing invasive disease in most parts of the world could be covered.
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Affiliation(s)
- Tirdad T Zangeneh
- Division of Infectious Diseases, University of Miami Miller School of Medicine and the Miami Veterans Affairs Healthcare System, Miami, FL, USA
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Collaco JM. Environmental Modifiers of Chronic Lung Disease of Prematurity During Infancy. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:33-37. [PMID: 35927854 DOI: 10.1089/ped.2011.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Chronic lung disease is a common complication of prematurity with substantial mortality and morbidity. Although the variation seen in bronchopulmonary dysplasia has a strong genetic component, the limited environmental variation in neonatal intensive care units may lead to underestimates of the contribution of environmental factors to lung disease variation. Once discharged from the hospital, preterm infants are exposed to a variety of environmental factors that likely worsen their disease. Recognition of these factors may lead to improved outcomes in this vulnerable population through more effective guidelines and counseling. This review examines the role of selected outpatient environmental factors on respiratory outcomes during infancy in preterm infants with lung disease.
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Affiliation(s)
- Joseph Michael Collaco
- Eudowood Division of Pediatric Respiratory Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Ang JY, Lua JL, Asmar BI, Shankaran S, Heyne RJ, Schelonka RL, Das A, Li L, Jackson DM, Higgins RD, D'Angio CT. Nasopharyngeal carriage of Streptococcus pneumoniae in very low-birth-weight infants after administration of heptavalent pneumococcal conjugate vaccine. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164:1173-5. [PMID: 21135351 PMCID: PMC3266167 DOI: 10.1001/archpediatrics.2010.233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jocelyn Y Ang
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan, Wayne State University, Detroit, MI 48201, USA.
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Abstract
Polysaccharide-encapsulated organisms such as S. pneumoniae, H. influenzae type b and N. meningitidis are the leading causes of serious invasive bacterial diseases and pneumonia in children. The use of conjugate vaccines in developed countries has markedly decreased the burden of disease and mortality from these organisms through direct protection of the immunised and through herd immunity. Although conjugate vaccines are highly immunogenic, antibody levels after immunisation in early infancy wane, leading to the need for programmes which include booster doses. Understanding the generation of long-term immunity could lead to improvements in vaccine formulation and scheduling with the ultimate goal of providing more sustained protection. Prematurity is a risk factor for disease caused by polysaccharide-encapsulated bacteria and the available data indicate that preterm infants should be immunised according to their chronological age to provide early protection.
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Affiliation(s)
- Johannes Trück
- Department of Paediatrics, University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Headington, UK.
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