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Kent A, Makwana A, Sheppard CL, Collins S, Fry NK, Heath PT, Ramsay M, Ladhani SN. Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post-13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now? Clin Infect Dis 2020; 69:84-90. [PMID: 30281069 DOI: 10.1093/cid/ciy842] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/28/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established. METHODS This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged <1 year diagnosed during 2013-2016. RESULTS There were 517 cases of IPD (incidence: 19/100000 infants). Incidence was significantly higher in premature infants compared with those born at term (49/100000 vs 17/100000; incidence rate ratio [IRR], 2.87; P < .001), with infants born before 28 weeks' gestation having the highest incidence (150/100000; IRR, 8.8; P < .001). Of the 454 IPD cases with serotyped isolates, most were caused by non-PCV13 serotypes (369 cases, 71.4%), with 85 cases (16.4%) due to PCV13 serotypes. There were 31 deaths (case fatality rate [CFR], 6.2% [95% confidence interval, 4.3%-8.6%]). Premature infants did not have a higher CFR than term infants (P = .62). CONCLUSIONS IPD incidence in infants remains lower than rates reported prior to PCV7 introduction in England. The risk of IPD remains significantly higher in premature infants compared to infants born at term, for both PCV13 and non-PCV13 serotypes. Any changes to the infant PCV13 immunization schedule may disproportionally affect premature infants.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St Georges, University of London
| | | | - Carmen L Sheppard
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England
| | - Sarah Collins
- Department of Immunisation, Hepatitis and Blood Safety
| | - Norman K Fry
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St Georges, University of London.,St George's University Hospitals National Health Service Trust, London, United Kingdom
| | - Mary Ramsay
- Department of Immunisation, Hepatitis and Blood Safety
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St Georges, University of London.,Department of Immunisation, Hepatitis and Blood Safety
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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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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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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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Circulating Antibody 1 and 2 Years After Vaccination With the 13-Valent Pneumococcal Conjugate Vaccine in Preterm Compared With Term Infants. Pediatr Infect Dis J 2017; 36:326-332. [PMID: 27902652 DOI: 10.1097/inf.0000000000001428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Premature infants have lower short-term immune responses to vaccination than term infants, but patterns of antibody persistence in preterm infants over longer periods are not well established. This study assessed the persistence of antibody response to the 13-valent pneumococcal conjugate vaccine (PCV13) in formerly preterm versus term infants. METHODS In total, 100 preterm and 100 term infants received PCV13 with routine vaccines at ages 2, 3, 4 and 12 months. Serotype-specific anticapsular immunoglobulin G (IgG)-binding antibodies and opsonophagocytic activity were determined 1 and 2 years after the last PCV13 dose. RESULTS At 1 and 2 years after the last vaccination (toddler dose), IgG geometric mean concentrations (GMCs) for all serotypes had declined from levels measured 1 month after the toddler dose but remained above pretoddler dose levels. IgG GMCs were significantly lower in preterm than term subjects for a majority of serotypes at both follow-up time points. IgG GMCs increased in both groups for some serotypes from the 1-year to 2-year follow-up, whereas others declined. Opsonophagocytic activity results supported the IgG results. CONCLUSIONS The routine (3 + 1) vaccination schedule is likely to offer long-term protection against invasive pneumococcal disease in preterm infants and should be initiated regardless of gestational age or weight at birth, without delay of the toddler dose.
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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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Kent A, Ladhani SN, Andrews NJ, Scorrer T, Pollard AJ, Clarke P, Hughes SM, Heal C, Menson E, Chang J, Satodia P, Collinson AC, Faust SN, Goldblatt D, Miller E, Heath PT. Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT. Pediatrics 2016; 138:peds.2015-3945. [PMID: 27503351 DOI: 10.1542/peds.2015-3945] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Premature infants have a higher risk of invasive pneumococcal disease and are more likely to have lower vaccine responses compared with term infants. Increasingly, immunization schedules are including a reduced, 2-dose, pneumococcal conjugate vaccine priming schedule. Our goal was to assess the immunogenicity of 3 commonly used 13-valent pneumococcal conjugate vaccine (PCV13) priming schedules in premature infants and their response to a 12-month booster dose. METHODS Premature infants (<35 weeks' gestation) were randomized to receive PCV13 at 2 and 4 months (reduced schedule); 2, 3, and 4 months (accelerated schedule); or 2, 4, and 6 months (extended schedule). All infants received a 12-month PCV13 booster. Serotype-specific pneumococcal immunoglobulin G (IgG) for PCV13 serotypes was measured by using enzyme-linked immunosorbent assay 1 month after the primary and booster vaccinations. RESULTS A total of 210 infants (median birth gestation, 29(+6) weeks; range, 23(+2)-34(+6) weeks) were included. After the primary vaccination, 75% (95% confidence interval [CI], 62-85), 88% (95% CI, 76-95), and 97% (95% CI, 87-99) of participants had protective antibody concentrations for at least one-half the PCV13 serotypes for the reduced, accelerated, and extended schedules, respectively. After the booster vaccination, participants receiving the extended schedule had significantly lower (P < .05) geometric mean concentrations compared with reduced (for 9 of 13 serotypes) and accelerated (for 4 of 13 serotypes) schedules, but nearly all participations, regardless of schedule or serotype, had seroprotective IgG concentrations. CONCLUSIONS A reduced priming schedule of PCV13 resulted in higher post-booster IgG concentrations but lower post-primary concentrations. The optimum vaccine schedule for preterm infants will therefore depend on when they are most at risk for invasive pneumococcal disease.
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Affiliation(s)
- Alison Kent
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, United Kingdom;
| | | | - Nick J Andrews
- Statistics, Modelling and Economics Department, Public Health England, Colindale, London, United Kingdom
| | - Tim Scorrer
- Neonatal Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Paul Clarke
- Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Stephen M Hughes
- Department of Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Carrie Heal
- Neonatal Unit, Stepping Hill Hospital, Stockport, United Kingdom
| | - Esse Menson
- Department of Paediatric Infectious Diseases, Evelina London Children's Hospital, London, United Kingdom
| | - John Chang
- Neonatal Unit, Croydon University Hospital, London, United Kingdom
| | - Prakash Satodia
- Neonatal Unit, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | - Saul N Faust
- NIHR Welcome Trust Clinical Research Facility, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; and
| | | | | | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's, University of London, London, United Kingdom
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Hoshina T, Ohga S, Fujiyoshi J, Nanishi E, Takimoto T, Kanno S, Nishio H, Saito M, Akeda Y, Oishi K, Hara T. Memory B-Cell Pools Predict the Immune Response to Pneumococcal Conjugate Vaccine in Immunocompromised Children. J Infect Dis 2015; 213:848-55. [PMID: 26410591 DOI: 10.1093/infdis/jiv469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The immune responses to pneumococcal conjugate vaccine (PCV) are low in immunocompromised hosts. The effect of memory B cells on the immune response to PCV remains elusive. METHODS In this prospective study, 53 children who received 7-valent PCV were enrolled. Antipneumococcal immunoglobulin G (IgG) levels and opsonization index (OI) titers, along with lymphocyte subsets, were investigated in immunocompromised and immunocompetent hosts. Immunocompromised patients comprised 8 hematopoietic stem cell transplant recipients (group A) and 9 immunosuppressive therapy recipients (group B), and controls consisted of 14 children aged >1 year (group C) and 22 infants (group D). RESULTS Serotype-specific IgG concentrations and OIs in group A were lower than those in group C. These did not differ among groups B, C, and D. The rates of achieving immunity (defined as an IgG level of 1.0 µg/mL and an OI of 8) in group A were also lower than in group C. Despite the sustained numbers of total T cells and B cells, CD27(+) B-cell and CD4(+) T-cell counts in group A were lower than those in group C. In group B, the immunoglobulin D-expressing CD27(-) B-cell count was only lower than that in group C. CONCLUSIONS Circulating numbers of CD27(+) B cells, rather than CD4(+) T cells, may predict the effective PCV responses in immunocompromised children.
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Affiliation(s)
- Takayuki Hoshina
- Department of Pediatrics Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Shouichi Ohga
- Department of Pediatrics Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube
| | | | | | | | | | | | - Mitsumasa Saito
- Department of Bacteriology, Graduate School of Medical Sciences, Kyushu University
| | - Yukihiro Akeda
- International Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University
| | - Kazunori Oishi
- International Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
| | - Toshiro Hara
- Department of Pediatrics Fukuoka Children's Hospital for Medical Center
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Response on Pneumococcal Vaccine in Preterm Infants After Neutral and Acidic Oligosaccharides Supplementation. Pediatr Infect Dis J 2015; 34:976-82. [PMID: 26153784 DOI: 10.1097/inf.0000000000000766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Supplementation of oligosaccharides in premature infants was shown to influence the immune system. We determined the effect of combined short-chain galacto-oligosaccharides (scGOS), long-chain fructo-oligosaccharides (lcFOS) and pectin-derived acidic oligosaccharides (pAOS) on antibody concentrations after pneumococcal conjugate vaccination in very preterm infants. METHODS Very preterm infants with gestational age <32 weeks and/or birth weight <1500 g were randomized to receive enteral supplementation with scGOS/lcFOS/pAOS or placebo between days 3 and 30 of life. Blood samples were collected at birth, 5 and 12 months of age and compared with term samples from a Dutch cross-sectional population-based serosurveillance study. IgG antibody levels to pneumococcal capsular polysaccharides were determined by multiplex immunoassay. RESULTS In total, 113 preterm infants were included with similar baseline and nutritional characteristics in both groups. After 3 primary pneumococcal vaccinations, the scGOS/lcFOS/pAOS-group had lower GMC antibody concentrations (µg/mL; serotype 4: 1.53, 6B:0.25, 9V: 1.19, 14: 2.39, 18C: 1.88, 19F: 7.42, 23F: 0.72) than the placebo group (serotype 4: 3.29, 6B: 0.79, 9V:2.64, 14: 4.52, 18C: 3.13, 19F: 14.64, 23F: 1.88; all P < 0.05), but comparable with those in the term control group (serotype 4: 0.97, 6B: 0.32, 9V: 1.67, 14: 3.24, 18C: 2.03, 19F: 5.06, 23F: 0.59; all P > 0.05). After the booster vaccination at 11 months, antibody levels were no longer different between the two preterm groups. CONCLUSION Enteral supplementation of scGOS/lcFOS/pAOS has a regulatory effect on the response to conjugated polysaccharide pneumococcal vaccine with normalization of the enhanced responses in preterm infants toward levels similar to healthy term infants.
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Martinón-Torres F, Czajka H, Center KJ, Wysocki J, Majda-Stanislawska E, Omeñaca F, Bernaola Iturbe E, Blazquez Gamero D, Concheiro-Guisán A, Gimenez-Sanchez F, Szenborn L, Giardina PC, Patterson S, Gruber WC, Scott DA, Gurtman A. 13-valent pneumococcal conjugate vaccine (PCV13) in preterm versus term infants. Pediatrics 2015; 135:e876-86. [PMID: 25780077 DOI: 10.1542/peds.2014-2941] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study evaluated the immune response and safety profile of 13-valent pneumococcal conjugate vaccine (PCV13) in preterm infants compared with term infants. METHODS This Phase IV, open-label, 2-arm, multicenter, parallel-group study enrolled 200 healthy infants (preterm, n = 100; term, n = 100) aged 42 to 98 days. All subjects received PCV13 at ages 2, 3, 4 (infant series), and 12 (toddler dose [TD]) months, together with routine vaccines (diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b vaccine and meningococcal group C conjugate vaccine). RESULTS Most subjects achieved an anticapsular immunoglobulin G (IgG) antibody concentration ≥ 0.35 μg/mL for all serotypes: >85% after the infant series (except preterm infants for serotypes 5, 6A, and 6B) and >97% after TD (except for serotype 3). Preterm infants had overall lower IgG geometric mean concentrations compared with term infants; however, geometric mean fold increases after TD were similar for all serotypes. Opsonophagocytic activity results were consistent with IgG results and titers increased after TD in both groups for all serotypes, including serotype 3. PCV13 was generally well tolerated, with similar safety profiles in all preterm subgroups. CONCLUSIONS Immune responses were lower in preterm infants than in term infants. However, the majority of subjects in both groups achieved both pneumococcal serotype-specific IgG antibody levels after the infant series that exceeded the World Health Organization-established threshold of protection and functional antibody responses. Responses were uniformly higher after TD, reinforcing the importance of a timely booster dose. PCV13 was well tolerated regardless of gestational age.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela and Vaccine Research Unit, Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago, Santiago de Compostela, Spain;
| | - Hanna Czajka
- Wojewodzki Specjalistyczny Szpital Dzieciecy im. sw. Ludwika-Regional Infectious Diseases Outpatient Clinic, Krakow, Poland
| | | | - Jacek Wysocki
- Poznań University of Medical Sciences, Poznań, Poland
| | | | | | - Enrique Bernaola Iturbe
- Servicio de Pediatría y Unidad de Investigación en Vacunas Fundación Miguel Servet Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Daniel Blazquez Gamero
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Medical University, Wroclaw, Poland; and
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11
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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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12
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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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13
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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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14
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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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15
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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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