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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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Kirui JC, Newberry DM, Harsh K. Strategies for Working With Parents With Vaccination Hesitancy. Neonatal Netw 2023; 42:254-263. [PMID: 37657807 DOI: 10.1891/nn-2022-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 09/03/2023]
Abstract
The purpose of this article is to provide an overview of effective strategies for working with parents' vaccination hesitancy or refusal. An overview of historical and current trends in vaccination hesitancy and factors that contribute to and strategies for addressing vaccine hesitancy are discussed. This includes an emphasis on the critical role played by health care providers, as trusted advisors and a primary source of health care information, in encouraging vaccine acceptance. Legal and ethical implications are also considered. Vaccination hesitancy strategies are most effective if they are timely, multifaceted, and collaborative.
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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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Safety of Vaccination within First Year of Life-The Experience of One General Medicine Center. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010104. [PMID: 36670654 PMCID: PMC9856298 DOI: 10.3390/children10010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
Vaccines represent an important preventive strategy in paediatric populations, but the rate of vaccination has been constantly declining in the last decade. Concerns about vaccines' safety represent one of the main causes of vaccine hesitancy among parents. The aim of this study was the analysis of the immediate adverse reactions induced by vaccines included in the national program of immunization for the first year of life. Method: Eighty-one children born between 1st of January 2018 and 31st of March 2019 were included. The vaccination refusal rate, and incidence and severity of adverse effects induced by three mandatory vaccines (Hexavalent, Prevenar 13 and MMR) were analyzed. The level of parents' education and the sources of information that were consulted in order to understand the adverse effects were also analyzed. Results and conclusions: The rate of adverse events was lower than 30% of the total number of doses, and most of them were mild. The incidence and severity of vaccine-induced adverse effects were correlated with prematurity. The vaccine hesitancy rate was lower than the national one, possibly due to a high level of education and good information provided by doctors that might have led to parents' concerns regarding vaccination being answered.
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Avila-Agüero ML, Ospina-Henao S, Mariño C, Vázquez-Rivera M, Torres JP, Estripeaut D, Ulloa-Gutierrez R, Gentile A. Vaccination against pertussis in Latin American preterm and low-birth weight infants: experts opinion position for a neglected childhood age group. Expert Rev Vaccines 2023; 22:1126-1135. [PMID: 37814599 DOI: 10.1080/14760584.2023.2268712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Pertussis remains as one of the oldest leading vaccine-preventable diseases of childhood, despite many decades of primary vaccine doses' and boosters' implementation. Although the epidemiology is well understood in infants and children, premature babies and low-birth weight infants remain a special group where the disease incidence is unknown, severity of the disease is considerable, and specific vaccination recommendations are scarce. RESEARCH DESIGN AND METHODS A retrospective review of the available evidence of pertussis vaccination in premature and low birth weight infants was analyzed from January 2000 to December 2022 in six selected countries: Argentina, Mexico, Colombia, Panamá, Costa Rica, and Chile. RESULTS Chile had reports of adverse effects associated with vaccination of premature infants with the pentavalent vaccine, and their rationale to switching to the hexavalent vaccine. Colombia had reports of the justification for the use of hexavalent vaccine in prematures in the Neonatal Units and Kangaroo Mother Programs throughout the country. Mexico had selected publications of the vaccination status in prematures and low-birth weight infants. CONCLUSION Despite its importance, increased morbidity, and highest risk of complications in premature babies, there is a paucity of information of vaccine recommendations and coverage rates among selected Latin American infants.
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Affiliation(s)
- María L Avila-Agüero
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), Instituto de Investigación en Ciencias Médicas (IICIMED), San José, Costa Rica
- Sistema de Estudios de Posgrado, Universidad de Costa Rica (UCR), San José, Costa Rica
- Center for Infectious Disease Modelling and Analysis, Yale University, New Haven, TC, USA
| | - Sebastián Ospina-Henao
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), Instituto de Investigación en Ciencias Médicas (IICIMED), San José, Costa Rica
| | | | - Mirella Vázquez-Rivera
- Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Juan Pablo Torres
- Departamento de Pediatría, Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panamá
- Tecnología e Innovación, Sistema Nacional de Investigación (SIN) de la Secretaría Nacional de Ciencia, Tecnología e Innovación, Ciudad de Panamá, Panamá
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), Instituto de Investigación en Ciencias Médicas (IICIMED), San José, Costa Rica
- Sistema de Estudios de Posgrado, Universidad de Costa Rica (UCR), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Angela Gentile
- Departamento de Epidemiología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Costantino C, Cimino L, Bonaccorso N, Conforto A, Sciortino M, Blangiardi F, Bosco G, Canzoneri G, Casuccio N, Collura C, Cuccia M, Furnari R, Genovese P, Gucciardi G, Randazzo MA, Taranto GE, Palermo M, Vitale F. Real life hexavalent vaccination among children as a practical guide for public health professionals: Four years (from 2016 to 2019) of clinical practice in Sicily, Italy. Hum Vaccin Immunother 2022; 18:2141998. [PMID: 36330584 DOI: 10.1080/21645515.2022.2141998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hexavalent (HV) vaccination is a priority for newborn protection and in Italy is included in the National Immunization Plan with a three doses cycle at 61, 121 and 301 days of age. A retrospective clinical study has been conducted to evaluate real life clinical practice of HV vaccination in the fourth most populous Italian Region. Data on the completion of the HV cycle, on the interchangeability between the two HV adopted in 2016-2017 (DTaP3-IPV-HB/Hib) and 2018-2019 (DTaP5-IPV-HB-Hib) and on the use above the established age, were collected in five Sicilian Local Health Authorities. Data showed an average 91.5% completion of the vaccination cycle at 24 months of age. The average age of administration was significantly higher in children who switched between the two hexavalent vaccines compared to those who completed the vaccination cycle with the same product (p-value <.01). Interchangeability with one or two doses of HV was also documented in 17.8% (2018) and 16% (2019) of vaccinated infants. Co-administration with other vaccines included in the Sicilian Vaccination Schedule was 85% with anti-pneumococcal vaccination and 65% with anti-rotavirus vaccination. Children vaccinated above recommended age (from 15 to >36 months) significantly after the introduction of mandatory vaccination in Italy (p-value <.001). This retrospective analysis will contribute to manage potential disruptions due to missed routine immunization opportunities, as the pandemic has caused, with strategies such as catch up above recommended age as well as interchangeability. Data could also help to demonstrate the need to optimize vaccine sessions through co-administration, that strongly contribute to increase vaccination coverage rates and respect of timing of vaccination schedules.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialist Medicine, University of Palermo, Palermo, Italy
| | - Livia Cimino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialist Medicine, University of Palermo, Palermo, Italy
| | - Nicole Bonaccorso
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialist Medicine, University of Palermo, Palermo, Italy
| | - Arianna Conforto
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialist Medicine, University of Palermo, Palermo, Italy
| | - Martina Sciortino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialist Medicine, University of Palermo, Palermo, Italy
| | | | - Girolama Bosco
- Prevention and Epidemiology Unit, Agrigento Local Health Authority, Agrigento, Italy
| | - Gaspare Canzoneri
- Prevention and Epidemiology Unit, Trapani Local Health Authority, Trapani, Italy
| | - Nicolò Casuccio
- Prevention and Epidemiology Unit, Palermo Local Health Authority, Palermo, Italy
| | - Calogero Collura
- Prevention and Epidemiology Unit, Agrigento Local Health Authority, Agrigento, Italy
| | - Mario Cuccia
- Prevention and Epidemiology Unit, Ragusa Local Health Authority, Ragusa, Italy.,Prevention and Epidemiology Unit, Catania Local Health Authority, Catania, Italy
| | - Roberto Furnari
- Prevention and Epidemiology Unit, Ragusa Local Health Authority, Ragusa, Italy.,Prevention and Epidemiology Unit, Catania Local Health Authority, Catania, Italy
| | - Pietro Genovese
- Prevention and Epidemiology Unit, Trapani Local Health Authority, Trapani, Italy
| | - Giovanni Gucciardi
- Prevention and Epidemiology Unit, Trapani Local Health Authority, Trapani, Italy
| | | | - Gino Enzo Taranto
- Prevention and Epidemiology Unit, Ragusa Local Health Authority, Ragusa, Italy
| | - Mario Palermo
- Regional Epidemiological Observatory, Sicilian Health Department, Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialist Medicine, University of Palermo, Palermo, Italy
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Kandpal J, Priyadarshi M, Chaurasia S, Singh P, Basu S. Postvaccination Apnea in Extremely-Low-Birth-Weight Infants. Indian J Pediatr 2022; 89:736. [PMID: 35471477 DOI: 10.1007/s12098-022-04209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jyoti Kandpal
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249201, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249201, India.
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249201, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249201, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249201, India
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Napolitano F, Miraglia Del Giudice G, Pelullo CP, Di Giuseppe G, Pavia M. Do Pediatricians and Nurses Recommend Vaccines for Preterm Infants? A Survey in Italy. J Pediatr 2022; 246:64-70.e2. [PMID: 35452656 DOI: 10.1016/j.jpeds.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the level of knowledge, attitudes, and behaviors regarding vaccination in preterm infants among primary care pediatricians (PCPs) and health care workers (HCWs) in neonatal intensive care units (NICUs). STUDY DESIGN Data were collected from PCPs through a confidential questionnaire distributed by email, whereas the research team distributed a self-administered anonymous questionnaire to all HCWs working in the selected NICUs. RESULTS Overall, 64.1% of HCWs consider vaccines in preterm infants to be very safe. The majority of HCWs (69.8%) stated that they always recommend that preterm infants' parents vaccinate their children following the same schedule as for term infants. This behavior was significantly more likely among those who know that the vaccination schedule for preterm infants is the same as for term infants, who consider vaccines in preterm infants very effective, and who strongly agree that preterm infants should be vaccinated on the same schedule as term infants. Moreover, PCPs were more likely than NICU pediatricians to always recommend that preterm infants' parents vaccinate their children following the immunization schedule of term infants, whereas this behavior was significantly less frequent among NICU nurses. CONCLUSIONS There is a need for physicians and nurses in the NICU and in the community to counteract missed or delayed immunizations. Engagement of HCWs in healthcare quality improvement initiatives focused on the promotion of timely vaccinations in preterm infants should be encouraged.
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Affiliation(s)
- Francesco Napolitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Concetta Paola Pelullo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Maria Pavia
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy.
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Guarnieri V, Giovannini M, Lodi L, Astorino V, Pisano L, Di Cicco E, Canessa C, Citera F, Peroni D, Azzari C, Ricci S. Severe pertussis disease in a paediatric population: The role of age, vaccination status and prematurity. Acta Paediatr 2022; 111:1781-1787. [PMID: 35638439 DOI: 10.1111/apa.16436] [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: 05/01/2021] [Revised: 03/10/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
AIM To estimate hospitalisation rate and investigate the role of age, prematurity and vaccination status in severe pertussis cases. METHODS We retrospectively evaluated 200 children aged 0-14 years, admitted to the emergency rooms of Meyer Hospital of Florence and Pisa Hospital with a diagnosis of pertussis from 1 October 2010 to 31 January 2020. RESULTS Children younger than 12 months were 63.0%. Preterm infants were 6.5%. The rate of hospitalisation was 49.0%. Among hospitalised cases, 80.6% were younger than 5 months. Overall, 62.0% were unvaccinated; this percentage increased among hospitalised (73.5%) and preterm subsamples (76.9%). Delays in pertussis vaccination were found in 57.7% of term infants and in 80.0% of preterms. Multivariable analysis confirmed the age under 2 months as the variable at higher risk for hospitalisation (OR 4.49, 95% CI 1.85-10.96, p < 0.001). Being fully vaccinated represented a significant protective factor (OR 0.12, 95% CI 0.04-0.35, p < 0.001). CONCLUSION Older classes of age and a complete vaccination, in time with the recommended schedule, are both protective factors for hospitalisation in severe pertussis disease. The widespread vaccination delay frequently observed in preterm children may be the cause for their higher rate of hospitalisation.
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Affiliation(s)
- Valentina Guarnieri
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
| | - Mattia Giovannini
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
- Allergy Unit, Department of Pediatrics Meyer Children's University Hospital Florence Italy
| | - Lorenzo Lodi
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
| | - Valeria Astorino
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
- Immunology and Molecular Microbiology Unit Meyer Children's Hospital Florence Italy
| | - Laura Pisano
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
- Immunology and Molecular Microbiology Unit Meyer Children's Hospital Florence Italy
| | - Elisa Di Cicco
- Pediatric Clinic, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Clementina Canessa
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
- Immunology and Molecular Microbiology Unit Meyer Children's Hospital Florence Italy
| | - Francesco Citera
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
- Immunology and Molecular Microbiology Unit Meyer Children's Hospital Florence Italy
| | - Diego Peroni
- Pediatric Clinic, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Chiara Azzari
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
- Immunology and Molecular Microbiology Unit Meyer Children's Hospital Florence Italy
| | - Silvia Ricci
- Department of Pediatrics, Department of Health Sciences University of Florence Florence Italy
- Immunology and Molecular Microbiology Unit Meyer Children's Hospital Florence Italy
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Cho HK, Park SE, Kim YJ, Jo DS, Kim YK, Eun BW, Lee TJ, Lee J, Lee H, Kim KH, Cho EY, Ahn JG, Choi EH. Recommendation for use of diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b conjugate, and hepatitis B vaccine in infants. Clin Exp Pediatr 2021; 64:602-607. [PMID: 34098627 PMCID: PMC8650817 DOI: 10.3345/cep.2021.00507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/14/2021] [Indexed: 11/27/2022] Open
Abstract
In April 2020, the Ministry of Food and Drug Safety licensed a hexavalent combined diphtheria and tetanus toxoids and acellular pertussis (DTaP), inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib) conjugated to tetanus protein, and hepatitis B (HepB) (recombinant DNA) vaccine, DTaP-IPV-Hib-HepB (Hexaxim, Sanofi Pasteur), for use as a 3-dose primary series in infants aged 2, 4, and 6 months. The DTaP-IPV-Hib-HepB vaccine is highly immunogenic and safe and provides a long-term immune response based on studies performed in a variety of settings in many countries, including Korea. This report summarizes the Committee on Infectious Diseases of the Korean Pediatric Society guidelines for the use of this newly introduced hexavalent combination vaccine.
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Affiliation(s)
- Hye-Kyung Cho
- Department of Pediatrics, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Su Eun Park
- Department of Pediatrics, School of Medicine, Pusan National University, Pusan, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Dae Sun Jo
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Byung-Wook Eun
- Department of Pediatrics, School of Medicine, Eulji University, Daejeon, Korea
| | - Taek-Jin Lee
- Department of Pediatrics, CHA University School of Medicine, Pocheon, Korea
| | - Jina Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Hwan Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Young Cho
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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11
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Fortunato F, Martinelli D, Lopalco PL, Prato R. Safety evaluation of the DTaP5-IPV-Hib-HepB vaccine: a review. Expert Opin Drug Saf 2021; 21:295-302. [PMID: 34787536 DOI: 10.1080/14740338.2022.2007882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The DTaP5-IPV-Hib-HepB vaccine is the most recently approved combination hexavalent vaccine. In Europe, it is licensed since 2016 for primary and booster vaccination in infants and toddlers above the age of 6 weeks to provide active immunization against diphtheria, tetanus, pertussis, poliomyelitis, invasive diseases caused by Haemophilus influenzae type b and hepatitis B. In the US, DTaP5-IPV-Hib-HepB is approved since 2018 in children 6 weeks through 4 years of age. Its safety profile has been extensively documented in infants and children born at term, and also data in preterm infants are made available. AREAS COVERED In this article, we conducted a safety evaluation of the DTaP5-IPV-Hib-HepB vaccine in infants and toddlers considering evidence from clinical trials and post-marketing use, also with regard to data on special populations e.g. preterm infants. EXPERT OPINION Based on the available data, the DTaP5-IPV-Hib-HepB vaccine has demonstrated a good safety profile, similar to that of other approved penta- and hexavalent vaccines. Rather, post-marketing data are limited and are frequently reported in combination with other hexavalent vaccines or are not adjusted for shares of vaccines use. Neither relevant interferences with other co-administered pediatric vaccines nor safety issues in premature infants have been shown.
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Affiliation(s)
- Francesca Fortunato
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Martinelli
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pier Luigi Lopalco
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Rosa Prato
- Policlinico Riuniti Foggia Hospital, Hygiene Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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12
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Di Mauro A, Di Mauro F, Greco C, Giannico OV, Grosso FM, Baldassarre ME, Capozza M, Schettini F, Stefanizzi P, Laforgia N. In-hospital and web-based intervention to counteract vaccine hesitancy in very preterm infants' families: a NICU experience. Ital J Pediatr 2021; 47:190. [PMID: 34530874 PMCID: PMC8447703 DOI: 10.1186/s13052-021-01129-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is a global problem, carrying significant health risks for extremely vulnerable population as that of preterm infants. Social media are emerging as significant tools for public health promotion. Our aim was to evaluate both the coverage and the timeliness of routine immunizations in a cohort of preterm infants (< 33 weeks of gestational age) at 24 months of age whose families have been subjected to in-hospital and web-based interventions to counteract vaccine hesitancy. METHODS For a period of 2 years parents of preterm infants were instructed during their follow up visits by a member of the NICU team to get correct informations about vaccines from a social network page. Vaccination rates of preterm infants were assessed at 24 months of chronological age with an electronic database and compared to both general population and historical cohort. RESULTS Coverage and timeliness of vaccinations at 24 months of age of 170 preterm infants were analyzed in December 2019. Gestational age and birth weight median (IQR) were, respectively, 31.0 (5.0) weeks and 1475.0 (843.8) g. Coverage rates were similar to those of the regional population (p > 0.05), while timeliness of administration was significantly delayed compared to the recommended schedule (p < 0.001). Age of administration was not correlated with either body weight and gestational age at birth (Spearman rank, p > 0.05). DTaP-IPV-HBV-Hib 2nd and 3rd doses, MMR and Varicella vaccines coverage data were higher compared to historical cohort (p < 0.05). CONCLUSION Increasing vaccine confidence through web-based interventions could have a positive impact on vaccination acceptance of parents of preterm infants, although timeliness results still delayed. There is a strong need to develop different and effective vaccination strategies to protect this very vulnerable population.
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Affiliation(s)
- Antonio Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Via Conversa 12, Margherita di Savoia, BAT, Italy.
| | - Federica Di Mauro
- Department of Prevention, Local Health Authority of Bari, Bari, Italy
| | - Chiara Greco
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | | | - Francesca Maria Grosso
- Postgraduate School of Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Elisabetta Baldassarre
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Manuela Capozza
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Federico Schettini
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Nicola Laforgia
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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Kulkarni-Munje A, Malshe N, Palkar S, Amlekar A, Lalwani S, Mishra AC, Arankalle V. Immune Response of Indian Preterm Infants to Pentavalent Vaccine Varies With Component Antigens and Gestational Age. Front Immunol 2021; 12:592731. [PMID: 33968011 PMCID: PMC8102823 DOI: 10.3389/fimmu.2021.592731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/31/2021] [Indexed: 11/28/2022] Open
Abstract
Childhood vaccination plays critical role in protecting infants from several dreaded diseases. Of the global 15 million preterm (PT) infants with compromised immune system born annually, India contributes to >3.5 million. Generation of adequate vaccine-induced immune response needs to be ensured of their protection. Immune response of Indian PT (n = 113) and full-term (FT, n = 80) infants to pentavalent vaccine administered as per the national recommendation was studied. Antibody titers against component antigens of pentavalent vaccine, immune cells profiling (T and B cells, monocytes and dendritic cells) and plasma cytokines were determined pre- and post-vaccination. Additionally, cell-mediated recall immune responses to pentavalent antigens were evaluated after short time antigenic exposure to infant PBMCs. Irrespective of gestational age (GA), all the infants developed adequate antibody response against tetanus, diphtheria, and protective but lower antibody levels for Haemophilus influenzae type-b and hepatitis B in preterm infants. Lower (~74%) protective antibody response to pertussis was independent of gestational age. PT-infants exhibited lower frequencies of CD4 T cells/dendritic cells/monocytes, increased plasma IL-10 levels and lower proliferation of central and effector memory T cells than in term-infants. Proliferative central memory response of FT-infants without anti-pertussis antibodies suggests protection from subsequent infection. Responder/non-responder PT-infants lacked immunological memory and could be infected with Bordetella. For hepatitis B, the recall response was gestational age-dependent and antibody status-independent. Humoral/cellular immune responses of PT-infants were dependent on the type of the immunogen. Preterm infants born before 32 weeks of gestation may need an extra dose of pentavalent vaccine for long lived robust immune response.
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Affiliation(s)
- Archana Kulkarni-Munje
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
| | - Nandini Malshe
- Department of Paediatrics, Bharati Vidyapeeth (Deemed To Be University) University Medical College, Pune, India
| | - Sonali Palkar
- Department of Paediatrics, Bharati Vidyapeeth (Deemed To Be University) University Medical College, Pune, India
| | - Aniket Amlekar
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
| | - Sanjay Lalwani
- Department of Paediatrics, Bharati Vidyapeeth (Deemed To Be University) University Medical College, Pune, India
| | - Akhilesh Chandra Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
| | - Vidya Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University) University, Pune, India
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14
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Soans S, Mihalyi A, Berlaimont V, Kolhapure S, Dash R, Agrawal A. Vaccination in preterm and low birth weight infants in India. Hum Vaccin Immunother 2021; 18:1-12. [PMID: 33599562 PMCID: PMC8920132 DOI: 10.1080/21645515.2020.1866950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In India, the high neonatal and infant mortality rate is due in part to an increasing number of preterm and low birth weight (LBW) infants. Given the immaturity of immune system, these infants are at an increased risk of hospitalization and mortality from vaccine-preventable diseases (VPDs). In this narrative review, we screened the scientific literature for data on the risk of VPDs, vaccination delay and factors related to it in Indian preterm and LBW infants. Although routine childhood vaccinations are recommended regardless of gestational age or birth weight, vaccination is often delayed. It exposes these infants to a higher risk of infections, their associated complications, and death. After-birth complications, lack of awareness of recommendations, vaccine efficacy and effectiveness and concerns related to safety are some of the common barriers to vaccination. Awareness campaigns might help substantiate the need for (and value of) vaccination in preterm and LBW infants.
What is the context?
In India, the high neonatal mortality rate is due in part to an increasing number of pretern and low birth weight intants. Affected infants have a poorly developed inmune system and are more susceptible to contracting vaccine-preventable diseases. The Indian Academy of Pediatrics recommends vaccination according to the same schedule used for full term infants, following chronological (not gestational) age. Delays in vaccinations increase the risk of preventable infections.
What is new?
Our review of the scientific literature shows that, in India:infections have more serious conseuences in preterm and low birth weight infants delays to vaccinate affected infants are common, mostly due to safety and effectiveness concerns from parents and healthcare pracitionrs.
What is the impact?
Improving mternal nutritional status and immunization, and perinatal care could help reduce the number of preterm and low birth weight infants. Combining maternal immunization with vaccination of affected infants can confer safe and effective protection. Awareness campaigns for parents and healthcare practitioners could address the issue of vaccination delay in pretern and low birth weight infants in India.
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Affiliation(s)
- Santosh Soans
- Paediatrics, AJ Institute of Medical Sciences, Mangalore, India
| | - Attila Mihalyi
- Medical Affairs and Clinical R&D, GSK Vaccines Europe, Wavre, Belgium
| | | | | | - Resham Dash
- Medical Affairs Department, GSK, Bengaluru, India
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15
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Khatami M. Deceptology in cancer and vaccine sciences: Seeds of immune destruction-mini electric shocks in mitochondria: Neuroplasticity-electrobiology of response profiles and increased induced diseases in four generations - A hypothesis. Clin Transl Med 2020; 10:e215. [PMID: 33377661 PMCID: PMC7749544 DOI: 10.1002/ctm2.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022] Open
Abstract
From Rockefeller's support of patent medicine to Gates' patent vaccines, medical establishment invested a great deal in intellectual ignorance. Through the control over medical education and research it has created a public illusion to prop up corporate profit and encouraged the lust for money and power. An overview of data on cancer and vaccine sciences, the status of Americans' health, a survey of repeated failed projects, economic toxicity, and heavy drug consumption or addiction among young and old provide compelling evidence that in the twentieth century nearly all classic disease categories (congenital, inheritance, neonatal, or induced) shifted to increase induced diseases. Examples of this deceptology in ignoring or minimizing, and mocking fundamental discoveries and theories in cancer and vaccine sciences are attacks on research showing that (a), effective immunity is responsible for defending and killing pathogens and defective cancerous cells, correcting and repairing genetic mutations; (b) viruses cause cancer; and (c), abnormal gene mutations are often the consequences of (and secondary to) disturbances in effective immunity. The outcomes of cancer reductionist approaches to therapies reveal failure rates of 90% (+/-5) for solid tumors; loss of over 50 million lives and waste of $30-50 trillions on too many worthless, out-of-focus, and irresponsible projects. Current emphasis on vaccination of public with pathogen-specific vaccines and ingredients seems new terms for drugging young and old. Cumulative exposures to low level carcinogens and environmental hazards or high energy electronic devices (EMF; 5G) are additional triggers to vaccine toxicities (antigen-mitochondrial overload) or "seeds of immune destruction" that create mini electrical shocks (molecular sinks holes) in highly synchronized and regulated immune network that retard time-energy-dependent biorhythms in organs resulting in causes, exacerbations or consequences of mild, moderate or severe immune disorders. Four generations of drug-dependent Americans strongly suggest that medical establishment has practiced decades of intellectual deception through its claims on "war on cancer"; that cancer is 100, 200, or 1000 diseases; identification of "individual" genetic mutations to cure diseases; "vaccines are safe". Such immoral and unethical practices, along with intellectual harassment and bullying, censoring or silencing of independent and competent professionals ("Intellectual Me Too") present grave concerns, far greater compared with the sexual harassment of 'Me Too' movement that was recently spearheaded by NIH. The principal driving forces behind conducting deceptive and illogical medical/cancer and vaccine projects seem to be; (a) huge return of investment and corporate profit for selling drugs and vaccines; (b) maintenance of abusive power over public health; (c) global control of population growth via increased induction of diseases, infertility, decline in life-span, and death. An overview of accidental discoveries that we established and extended since 1980s, on models of acute and chronic ocular inflammatory diseases, provides series of the first evidence for a direct link between inflammation and multistep immune dysfunction in tumorigenesis and angiogenesis. Results are relevant to demonstrate that current emphasis on vaccinating the unborn, newborn, or infant would induce immediate or long-term immune disorders (eg, low birth weight, preterm birth, fatigue, autism, epilepsy/seizures, BBB leakage, autoimmune, neurodegenerative or digestive diseases, obesity, diabetes, cardiovascular problems, or cancers). Vaccination of the unborn is likely to disturb trophoblast-embryo-fetus-placenta biology and orderly growth of embryo-fetus, alter epithelial-mesenchymal transition or constituent-inducible receptors, damage mitochondria, and diverse function of histamine-histidine pathways. Significant increased in childhood illnesses are likely due to toxicities of vaccine and incipient (eg, metals [Al, Hg], detergents, fetal tissue, DNA/RNA) that retard bioenergetics of mitochondria, alter polarization-depolarization balance of tumoricidal (Yin) and tumorigenic (Yang) properties of immunity. Captivated by complex electobiology of immunity, this multidisciplinary perspective is an attempt to initiate identifying bases for increased induction of immune disorders in three to four generations in America. We hypothesize that (a) gene-environment-immune biorhythms parallel neuronal function (brain neuroplasticity) with super-packages of inducible (adaptive or horizontal) electronic signals and (b) autonomic sympathetic and parasympathetic circuitry that shape immunity (Yin-Yang) cannot be explained by limited genomics (innate, perpendicular) that conventionally explain certain inherited diseases (eg, sickle cell anemia, progeria). Future studies should focus on deep learning of complex electrobiology of immunity that requires differential bioenergetics from mitochondria and cytoplasm. Approaches to limit or control excessive activation of gene-environment-immunity are keys to assess accurate disease risk formulations, prevent inducible diseases, and develop universal safe vaccines that promote health, the most basic human right.
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Affiliation(s)
- Mahin Khatami
- Inflammation, Aging and Cancer, National Cancer Institute (NCI)the National Institutes of Health (NIH) (Retired)BethesdaMarylandUSA
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16
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Caffarelli C, Santamaria F, Santoro A, Procaccianti M, Castellano F, Nastro FF, Villani A, Bernasconi S, Corsello G. Best practices, challenges and innovations in pediatrics in 2019. Ital J Pediatr 2020; 46:176. [PMID: 33256810 PMCID: PMC7703504 DOI: 10.1186/s13052-020-00941-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 12/22/2022] Open
Abstract
This paper runs through key progresses in epidemiology, pathomechanisms and therapy of various diseases in children that were issued in the Italian Journal of Pediatrics at the end of last year. Novel research and documents that explore areas such as allergy, critical care, endocrinology, gastroenterology, infectious diseases, neonatology, neurology, nutrition, and respiratory tract illnesses in children have been reported. These observations will help to control childhood illnesses.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Michela Procaccianti
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Fabio Castellano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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17
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Manti S, Parisi GF, Leonardi S. Nonresponse to intramuscular vaccination: An unmet need in hepatitis B vaccination. Saudi J Gastroenterol 2020; 26:298613. [PMID: 33078721 PMCID: PMC8019139 DOI: 10.4103/sjg.sjg_472_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 08/24/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sara Manti
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giuseppe F. Parisi
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, Pediatric Respiratory Unit, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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18
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Saso A, Kampmann B. Maternal Immunization: Nature Meets Nurture. Front Microbiol 2020; 11:1499. [PMID: 32849319 PMCID: PMC7396522 DOI: 10.3389/fmicb.2020.01499] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
Vaccinating women in pregnancy (i.e., maternal immunization) has emerged as a promising tool to tackle infant morbidity and mortality worldwide. This approach nurtures a 'gift of nature,' whereby antibody is transferred from mother to fetus transplacentally during pregnancy, or postnatally in breast milk, thereby providing passive, antigen-specific protection against infections in the first few months of life, a period of increased immune vulnerability for the infant. In this review, we briefly summarize the rationale for maternal immunization programs and the landscape of vaccines currently in use or in the pipeline. We then direct the focus to the underlying biological phenomena, including the main mechanisms by which maternally derived antibody is transferred efficiently to the infant, at the placental interface or in breast milk; important research models and methodological approaches to interrogate these processes, particularly in the context of recent advances in systems vaccinology; the potential biological and clinical impact of high maternal antibody titres on neonatal ontogeny and subsequent infant vaccine responses; and key vaccine- and host-related factors influencing the maternal-infant dyad across different environments. Finally, we outline important gaps in knowledge and suggest future avenues of research on this topic, proposing potential strategies to ensure optimal testing, delivery and implementation of maternal vaccination programs worldwide.
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Affiliation(s)
- Anja Saso
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Banjul, Gambia
| | - Beate Kampmann
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Banjul, Gambia
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19
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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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