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Vittrup DM, Jensen A, Sørensen JK, Zimakoff AC, Malon M, Charabi S, Johansen MR, Simões EA, Kirkby NS, Buus S, Svensson J, Stensballe LG. Immunogenicity and reactogenicity following MMR vaccination in 5-7-month-old infants: a double-blind placebo-controlled randomized clinical trial in 6540 Danish infants. EClinicalMedicine 2024; 68:102421. [PMID: 38292039 PMCID: PMC10825632 DOI: 10.1016/j.eclinm.2023.102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Background Measles is a highly contagious viral disease. Vaccinated mothers transfer fewer antibodies during pregnancy, resulting in shortened infant immunity. Earlier primary vaccination might avert the gap in protection. Methods Healthy 5-7-month-old Danish infants were assigned in a 1:1 ratio to M-M-RVaxPro or placebo (solvent) in a double-blind, randomized trial between April 15, 2019 and November 1, 2021 (ClinicalTrials.govNCT03780179, EudraCT 2016-001901-18). Eligibility criteria were birth weight >1000 g and gestational age ≥32 weeks.Immunogenicity was measured by plaque reduction neutralization test (PRNT) and IgG ELISA before intervention, four weeks after intervention and routine MMR. Reactogenicity data were collected for six weeks and measured by hazard ratios (HR). Findings 647 and 6540 infants participated in the immunogenicity and reactogenicity study, respectively; 87% and 99% completed follow-up. After early MMR, seroprotection rates (SPRs) were 47% (13%) in measles PRNT; 28% (2%), 57% (8%) in mumps and rubella IgG (placebo). For measles PRNT, geometric mean ratio was 4.3 (95% CI: 3.4-5.3) between randomization groups after intervention and 1.5 (95% CI: 1.3-1.9) after routine MMR.Reactogenicity was independent of randomization (HR, 1.0; 95% CI: 0.9-1.1). Severe adverse events occurred in 25 infants (HR, 1.8; 95% CI: 0.8-4.0); none deemed vaccine related. Interpretation Early MMR elicited low SPRs but did not negatively impact short-term responses to a subsequent MMR. MMR at 5-7 months was safe and not associated with higher rates of reactogenicity than placebo. Funding Innovation Fund Denmark.
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Affiliation(s)
- Dorthe Maria Vittrup
- The Child and Adolescent Department, The University Hospital Herlev, Denmark
- The Child and Adolescent Clinic, The Juliane Marie Centre, The Danish National University Hospital “Rigshospitalet”, Denmark
| | - Andreas Jensen
- The Child and Adolescent Clinic, The Juliane Marie Centre, The Danish National University Hospital “Rigshospitalet”, Denmark
| | - Jesper Kiehn Sørensen
- The Child and Adolescent Clinic, The Juliane Marie Centre, The Danish National University Hospital “Rigshospitalet”, Denmark
| | - Anne Cathrine Zimakoff
- The Child and Adolescent Clinic, The Juliane Marie Centre, The Danish National University Hospital “Rigshospitalet”, Denmark
| | - Michelle Malon
- The Child and Adolescent Clinic, The Juliane Marie Centre, The Danish National University Hospital “Rigshospitalet”, Denmark
| | - Salma Charabi
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
| | | | - Eric A.F. Simões
- School of Medicine, and Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Nikolai Søren Kirkby
- Dept. of Microbiology, The Danish National University Hospital “Rigshospitalet”, Denmark
| | - Søren Buus
- Dept. of Immunology, University of Copenhagen, Denmark
| | - Jannet Svensson
- The Child and Adolescent Department, The University Hospital Herlev, Denmark
- Steno Diabetes Centre Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Lone Graff Stensballe
- The Child and Adolescent Clinic, The Juliane Marie Centre, The Danish National University Hospital “Rigshospitalet”, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
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Tamura K, Matsumura K, Tsuchida A, Yoshida T, Inadera H, Yamazakii S, Ohya Y, Kishi R, Yaegashi N, Hashimoto K, Mori C, Ito S, Yamagata Z, Nakayama T, Sobue T, Shima M, Nakamura H, Suganuma N, Kusuhara K, Katoh T. Prevalence of infectious diseases in preterm infants: a 2-year follow-up from the Japan Environment and Children's Study. Sci Rep 2022; 12:22488. [PMID: 36577762 PMCID: PMC9797578 DOI: 10.1038/s41598-022-26748-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Evidence regarding the long-term risk of infections in preterm infants is lacking. In this study, we examined whether preterm infants developed various common childhood infections more frequently than full-term infants by the age of 2 years by analyzing data from a questionnaire completed by 67,282 mother-toddler pairs in a nationwide birth cohort study. Of the target population, 2885 (4.3%) were born prematurely. After covariate adjustment for maternal and children factors, lower respiratory tract infections appeared more frequent in preterm than in full-term infants at both 1 and 2 years (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.05-1.41, and aOR 1.27, 95% CI 1.11-1.46, respectively). However, there was no significant difference in the frequencies of lower respiratory tract infection between preterm and full-term infants after Palivizumab administration. The risk of other common infections, such as in the upper respiratory tract infection, otitis media, urinary tract infection, gastroenteritis, herpangina, hand-foot-and-mouth disease, chickenpox, influenza virus, and adenovirus infections, was not higher in preterm than in full-term infants after covariates adjustment for maternal and children factors. These findings suggest Palivizumab prophylaxis could reduce the frequencies of lower respiratory tract infection in preterm to the same level as in full-term infants.
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Affiliation(s)
- Kentaro Tamura
- grid.452851.fDivision of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0194 Japan
| | - Kenta Matsumura
- grid.267346.20000 0001 2171 836XDepartment of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan ,grid.267346.20000 0001 2171 836XToyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Akiko Tsuchida
- grid.267346.20000 0001 2171 836XDepartment of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan ,grid.267346.20000 0001 2171 836XToyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Taketoshi Yoshida
- grid.452851.fDivision of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0194 Japan
| | - Hidekuni Inadera
- grid.267346.20000 0001 2171 836XDepartment of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan ,grid.267346.20000 0001 2171 836XToyama Regional Center for JECS, University of Toyama, Toyama, Japan
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Sioriki AA, Gkentzi D, Papadimitriou E, Dimitriou G, Karatza A. Vaccinations in Infants Born Preterm: An Update. Curr Pediatr Rev 2020; 16:148-155. [PMID: 31951184 DOI: 10.2174/1573396316666200116094459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/25/2019] [Accepted: 12/16/2019] [Indexed: 02/08/2023]
Abstract
Infants born prematurely (before completion of 37 weeks of gestation) are at increased risk of morbidity and mortality due to vaccine preventable diseases, mostly because of their immunological immaturity and failure of transfer of maternal protective antibodies. Despite their great need of being vaccinated, concerns on vaccine safety and efficacy, constitute the main reasons for which vaccinations are often delayed in this group. In this review we summarize the latest evidence on vaccine safety, efficacy and immunogenicity in preterm infants which is similar to full-term infants. Therefore there is no reason for delaying vaccination in this population.
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Affiliation(s)
| | - Despoina Gkentzi
- Department of Paediatrics, University Patras Medical School, Patras, Greece
| | | | - Gabriel Dimitriou
- Department of Paediatrics, University Patras Medical School, Patras, Greece
| | - Ageliki Karatza
- Department of Paediatrics, University Patras Medical School, Patras, Greece
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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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Bednarek A, Bartkowiak-Emeryk M, Klepacz R, Ślusarska B, Zarzycka D, Emeryk A. Persistence of Vaccine-Induced Immunity in Preschool Children: Effect of Gestational Age. Med Sci Monit 2018; 24:5110-5117. [PMID: 30033997 PMCID: PMC6067032 DOI: 10.12659/msm.908834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background A program of immunization that ensures optimal development of acquired immunity should be carried out in all healthy newborns. The aim of the present study was to verify, at 2.5–3 years after the last dose of basic vaccination, if preschool children who have been delivered preterm and at term differ in their levels of post-vaccination protective antibodies. Material/Methods Humoral response was assessed in 352 children (mean age: 5.22±0.34 years) who received a series of obligatory vaccinations in the period from birth to 2.5–3 years of age. Antibodies (in IgG class) against vaccine antigens – diphtheria (D), tetanus (T), pertussis (P), Haemophilus influenzae type b (Hib), poliomyelitis (IPV), measles, mumps, and rubella (MMR) – were measured using ELISA. The level of antibodies against hepatitis B (HBV) was assessed by chemiluminescence. Results All children had been immunized according to the Polish National Vaccination Program. The group of 352 children eligible for the study included 46 (13.1%) preschoolers delivered preterm (32–36 weeks of gestation), and 306 (86.9%) born at term (37–42 weeks of gestation). All children maintained seroprotective antibody levels against polioviruses type 1, 2, and 3 (>12 mIU/mL), and against measles antigens (>300 U/mL). No statistically significant differences were found in the proportions of preschoolers born preterm and at term who were seroprotected against other vaccine antigens. Conclusions Among preschool children who were immunized according to chronological age, those we were born late preterm do not seem to differ in vaccine-induced immunity from those who were born full-term.
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Affiliation(s)
- Anna Bednarek
- Department of Pediatric Nursing, Medical University of Lublin, Lublin, Poland
| | | | - Robert Klepacz
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Barbara Ślusarska
- Department of Community Nursing, Medical University of Lublin, Lublin, Poland
| | - Danuta Zarzycka
- Department of Pediatric Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Andrzej Emeryk
- Department of Pulmonary Diseases and Children Rheumatology, Medical University of Lublin, Lublin, Poland
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Abstract
Preterm infants are at an increased risk of morbidity and mortality from vaccine-preventable diseases. Despite this, delays in routine immunization of preterm infants are common. Available guidelines clearly state that they should be immunized according to chronological age, irrespective of gestational age and birth weight or current weight. In this article, we try to assuage parental and provider doubts by reviewing data about immunogenicity, safety, and responses to routine immunizations in preterm infants with and without comorbidities. We also look at evidence for other strategies to help protect this fragile population. [Pediatr Ann. 2018;47(4):e147-e153.].
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Ferreira CSM, Perin MCAA, Moraes-Pinto MID, Simão-Gurge RM, Goulart AL, Weckx LY, dos Santos AMN. Humoral immune response to measles and varicella vaccination in former very low birth weight preterm infants. Braz J Infect Dis 2018; 22:41-46. [PMID: 29306654 PMCID: PMC9425665 DOI: 10.1016/j.bjid.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/19/2017] [Indexed: 11/01/2022] Open
Abstract
Introduction Objectives Methods Results Conclusions
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D'Angio CT, Wyman CP, Misra RS, Halliley JL, Wang H, Hunn JE, Fallone CM, Lee FEH. Plasma cell and serum antibody responses to influenza vaccine in preterm and full-term infants. Vaccine 2017; 35:5163-5171. [PMID: 28807607 DOI: 10.1016/j.vaccine.2017.07.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preterm (PT) infants are at greater risk for severe influenza infection and experience decrements in long-term antibody responses to vaccines. This may related to defects in antibody secreting cell (ASC) generation. OBJECTIVE To investigate the relationships among the frequencies of influenza-specific antibody secreting cells, ASC numbers and subsets, and antibody responses to influenza vaccines (IV) among PT and full-term (FT) infants. DESIGN/METHODS We enrolled 11 former PT (≤32weeks' gestation, ≤1500 g' birth weight) and 11FT infants, 6-17months of age, receiving their first influenza immunizations. Infants received two doses of inactivated trivalent (T)IV or quadrivalent (Q)IV during the 2012-2013 and 2013-2014 influenza seasons, respectively, at 0 and 28days, and blood was drawn at 0, 10, 35, and 56days and 9months. Vaccine-specific antibody was measured by hemagglutination inhibition (HAI) at 0 and 56days and 9months, vaccine-specific ASC numbers by enzyme linked immunospot (ELISPOT) at 10 and 35days, and ASC subsets by flow cytometry at 0, 10 and 35days. RESULTS PT infants had post-vaccine HAI titers to all 4 vaccine strains at least equal to FT infants at 56days and 9months after beginning immunization. Influenza-specific ASC ELISPOT responses at 35days were higher among PT than FT infants (median 100 v. 30 per 106 PBMC, p=0.04). ASC numbers at 35days were positively correlated with serum HAI titers at 56days (ρ=0.50-0.80). There were no statistical differences between PT and FT infants in the frequency of five ASC subsets and no specific ASC subset correlated with durability of serum antibody titers. CONCLUSIONS Influenza-specific ASC numbers in both FT and PT infants correlated with peak antibody titers, but ASC subsets did not correlate with durability of antibody response.
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Affiliation(s)
- Carl T D'Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Claire P Wyman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Ravi S Misra
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Jessica L Halliley
- Departments of Microbiology & Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Julianne E Hunn
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Caitlin M Fallone
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - F Eun-Hyung Lee
- Departments of Microbiology & Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA; Department of Medicine, Emory University School of Medicine, 1648 Pierce Drive NE, Atlanta, GA 30307, USA
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Rathore DK, Nair D, Raza S, Saini S, Singh R, Kumar A, Tripathi R, Ramji S, Batra A, Aggarwal KC, Chellani HK, Arya S, Bhatla N, Paul VK, Aggarwal R, Agarwal N, Mehta U, Sopory S, Natchu UCM, Bhatnagar S, Bal V, Rath S, Wadhwa N. Underweight full-term Indian neonates show differences in umbilical cord blood leukocyte phenotype: a cross-sectional study. PLoS One 2015; 10:e0123589. [PMID: 25898362 PMCID: PMC4405369 DOI: 10.1371/journal.pone.0123589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/19/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND While infections are a major cause of neonatal mortality in India even in full-term neonates, this is an especial problem in the large proportion (~20%) of neonates born underweight (or small-for-gestational-age; SGA). One potential contributory factor for this susceptibility is the possibility that immune system maturation may be affected along with intrauterine growth retardation. METHODS In order to examine the possibility that differences in immune status may underlie the susceptibility of SGA neonates to infections, we enumerated the frequencies and concentrations of 22 leukocyte subset populations as well as IgM and IgA levels in umbilical cord blood from full-term SGA neonates and compared them with values from normal-weight (or appropriate-for-gestational-age; AGA) full-term neonates. We eliminated most SGA-associated risk factors in the exclusion criteria so as to ensure that AGA-SGA differences, if any, would be more likely to be associated with the underweight status itself. RESULTS An analysis of 502 such samples, including 50 from SGA neonates, showed that SGA neonates have significantly fewer plasmacytoid dendritic cells (pDCs), a higher myeloid DC (mDC) to pDC ratio, more natural killer (NK) cells, and higher IgM levels in cord blood in comparison with AGA neonates. Other differences were also observed such as tendencies to lower CD4:CD8 ratios and greater prominence of inflammatory monocytes, mDCs and neutrophils, but while some of them had substantial differences, they did not quite reach the standard level of statistical significance. CONCLUSIONS These differences in cellular lineages of the immune system possibly reflect stress responses in utero associated with growth restriction. Increased susceptibility to infections may thus be linked to complex immune system dysregulation rather than simply retarded immune system maturation.
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Affiliation(s)
- Deepak K. Rathore
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Deepa Nair
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Saimah Raza
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Savita Saini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Singh
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Amit Kumar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Reva Tripathi
- Department of Obstetrics & Gynecology, Maulana Azad Medical College, New Delhi, India
| | - Siddarth Ramji
- Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | - Aruna Batra
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Kailash C. Aggarwal
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Harish K. Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K. Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Aggarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Agarwal
- Department of Obstetrics & Gynecology, General Hospital, Gurgaon, Haryana, India
| | - Umesh Mehta
- Department of Pediatrics, General Hospital, Gurgaon, Haryana, India
| | - Shailaja Sopory
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Uma Chandra Mouli Natchu
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Shinjini Bhatnagar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Vineeta Bal
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Satyajit Rath
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Nitya Wadhwa
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
- * E-mail:
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Macartney K, Heywood A, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database Syst Rev 2014; 2014:CD001833. [PMID: 24954057 PMCID: PMC7061782 DOI: 10.1002/14651858.cd001833.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevention of varicella (chickenpox) using live attenuated varicella vaccines has been demonstrated both in randomised controlled trials (RCTs) and in population-based immunisation programmes in countries such as the United States and Australia. Many countries do not routinely immunise children against varicella and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. The use of varicella vaccine in persons who have recently been exposed to the varicella zoster virus has been studied as a form of post-exposure prophylaxis (PEP). OBJECTIVES To assess the efficacy and safety of vaccines for use as PEP for the prevention of varicella in children and adults. SEARCH METHODS We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to March week 1, 2014), EMBASE (January 1990 to March 2014) and LILACS (1982 to March 2014). We searched for unpublished trials registered on the clinicaltrials.gov and WHO ICTRP websites. SELECTION CRITERIA RCTs and quasi-RCTs of varicella vaccine for PEP compared with placebo or no intervention. The outcome measures were efficacy in prevention of clinical cases and/or laboratory-confirmed clinical cases and adverse events following vaccination. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and analysed data using Review Manager software. MAIN RESULTS We identified three trials involving 110 healthy children who were siblings of household contacts. The included trials varied in study quality, vaccine used, length of follow-up and outcomes measured and, as such, were not suitable for meta-analysis. We identified high or unclear risk of bias in two of the three included studies. Overall, 13 out of 56 vaccine recipients (23%) developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients (78%). Of the vaccine recipients who developed varicella, the majority only had mild disease (with fewer than 50 skin lesions). In the three trials, most participants received PEP within three days following exposure; too few participants were vaccinated four to five days post-exposure to ascertain the efficacy of vaccine given more than three days after exposure. No included trial reported on adverse events following immunisation. AUTHORS' CONCLUSIONS These small trials suggest varicella vaccine administered within three days to children following household contact with a varicella case reduces infection rates and severity of cases. We identified no RCTs for adolescents or adults. Safety was not adequately addressed.
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Affiliation(s)
- Kristine Macartney
- Children's Hospital at Westmead and University of SydneyNational Centre for Immunisation Research and Surveillance of Vaccine Preventable DiseasesLocked Bag 4001WestmeadSydneyNSWAustralia2145
| | - Anita Heywood
- University of New South WalesSchool of Public Health and Community MedicineLevel 2, Samuels BuildingGate 11, Botany StreetKensingtonNSWAustralia2052
| | - Peter McIntyre
- Children's Hospital at Westmead and University of SydneyNational Centre for Immunisation Research and Surveillance of Vaccine Preventable DiseasesLocked Bag 4001WestmeadSydneyNSWAustralia2145
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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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Ichikawa T, Tsuji A, Fujino M, Kusano R, Sugiyama R, Oomori S, Mori K, Maeyama K, Nakayama T. Effect of early measles vaccination (AIK-C strain) for preterm infants. Pediatr Int 2013; 55:163-8. [PMID: 23379893 DOI: 10.1111/ped.12064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/22/2012] [Accepted: 11/06/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The level of maternal antibodies decreases more quickly in preterm than term infants, leaving them unprotected against measles. To protect premature infants from measles, an early vaccination trial was investigated. METHODS Changes in the serum measles neutralization test (NT) antibody titer were examined in 152 infants (average gestational period, 29 weeks; average birthweight, 1203 g). RESULTS The average antibody titer (2(n)) was 2(3.5) at birth and 2(2.2) at 1-3 months of age, and in all cases, NT antibody titer decreased to <1:4 (150 IU/mL). The AIK-C measles vaccine was given to 17 preterm infants at the age of 6 months, and induced sufficient serological responses without any serious adverse events. NT antibody level did not decay during 12 months after vaccination. CONCLUSION Early immunization at 6 months of age is effective to protect preterm infants in the outbreak setting.
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Affiliation(s)
- Tomonori Ichikawa
- Department of Pediatrics, Saitama Municipal Hospital Mother and Child Medical Center, Saitama, Japan
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Abstract
With few exceptions, it is currently recommended that all premature infants should receive routine childhood vaccines at the same chronologic age as term infants. Thus, neonatal nurses need to stay current on the recommendations for immunizations commonly used in the NICU setting. It is important for nurses to provide information that is reliable and verifiable with scientific evidence to the parents.
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Impfungen von Frühgeborenen. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-1978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Perella D, Fiks AG, Jumaan A, Robinson D, Gargiullo P, Pletcher J, Forke CM, Schmid DS, Renwick M, Mankodi F, Watson B, Spain CV. Validity of reported varicella history as a marker for varicella zoster virus immunity among unvaccinated children, adolescents, and young adults in the post-vaccine licensure era. Pediatrics 2009; 123:e820-8. [PMID: 19403475 DOI: 10.1542/peds.2008-3310] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We assessed the validity of reported varicella history as a marker for varicella zoster virus immunity among unvaccinated persons 1 to 29 years of age, and we examined varicella disease characteristics associated with varicella zoster virus immunity among those reporting positive histories. METHODS We conducted a cross-sectional study at 7 community-based sites in Philadelphia, Pennsylvania, between June 2004 and May 2006 and recruited 1476 participants 1 to 29 years of age who had not been vaccinated against varicella. Sensitivity, specificity, and positive predictive value were determined by comparing self-reported or parent-reported varicella histories from a standardized study interview with varicella zoster virus immunoglobulin G serological results for each participant. We performed multivariate logistic regression analyses to determine which disease characteristics best predicted seropositivity. RESULTS The sensitivity of reported varicella history was highest (81%-89%) among participants > or =10 years of age, whereas specificity was highest among participants 1 to 4 years of age (99%) and > or =20 years (88%). Reported varicella history was highly predictive of seropositivity (>95%) only among participants > or =15 years of age. For participants 10 to 14 years of age, parental reports of a generalized itchy rash with 1 of the following were highly predictive of seropositivity: varicella transmission to another household member or being raised in a household with no other children. Among participants < or =9 years of age, no combination of disease characteristics was both highly predictive of seropositivity and common. CONCLUSIONS The validity of reported varicella history varies according to age, and a reported history is no longer highly predictive of seropositivity among cohorts born since 1994 (participants < or =9 years of age). Universal varicella vaccination, regardless of history, for these children should be considered, as should simplified criteria for varicella zoster virus immunity among unvaccinated persons born before 1994.
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Affiliation(s)
- Dana Perella
- Varicella Active Surveillance Project, Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA 19146, USA.
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Wu JF, Ni YH, Chen HL, Hsu HY, Lai HS, Chang MH. Humoral immunogenicity to measles, rubella, and varicella-zoster vaccines in biliary atresia children. Vaccine 2009; 27:2812-5. [DOI: 10.1016/j.vaccine.2009.02.094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 02/13/2009] [Accepted: 02/25/2009] [Indexed: 11/25/2022]
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Macartney K, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database Syst Rev 2008:CD001833. [PMID: 18646079 DOI: 10.1002/14651858.cd001833.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Live attenuated varicella vaccines for the prevention of varicella (chickenpox) has been demonstrated both in randomised controlled trials (RCTs) and in population-based immunisation programmes in countries such as the United States. However, many countries do not routinely immunise children against varicella, and exposures continue to occur. Although the disease is often mild, complications such as secondary bacterial infection, pneumonitis and encephalitis occur in about 1% of cases, usually leading to hospitalisation. The use of varicella vaccine in persons who have recently been exposed to the varicella zoster virus has been studied as a form of post-exposure prophylaxis (PEP). OBJECTIVES To assess the efficacy and safety of vaccines for use as PEP for the prevention of varicella in children and adults. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, Issue 1); MEDLINE (1966 to February 2008); and EMBASE (January 1990 to February 2008). SELECTION CRITERIA RCTs and quasi-RCTs of varicella vaccine for PEP compared with placebo or no intervention. The outcome measures were efficacy in prevention of clinical cases and/or laboratory-confirmed clinical cases and adverse effects following vaccination. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and analysed data using Review Manager software. MAIN RESULTS Three studies involving 110 healthy children who were siblings of household contacts were identified as suitable for inclusion. The studies varied in quality, study design, vaccine used, and outcomes measured and, as such, were not suitable for meta-analysis. Overall, 13 out of 56 vaccine recipients (18%) developed varicella compared with 42 out of 54 placebo (or no vaccine) recipients (78%). Of the vaccine recipients who developed varicella, the majority only had mild disease (with less than 50 skin lesions). In the three studies, most subjects received PEP within three days following exposure; too few subjects were vaccinated four to five days post exposure to ascertain the efficacy of vaccine given more than three days after exposure. No included studies reported on adverse events following immunisation. AUTHORS' CONCLUSIONS These small trials suggest varicella vaccine administered within three days to children following household contact with a varicella case reduces infection rates and severity of cases. No RCTs for adolescents or adults were identified. However safety was not adequately addressed.
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Affiliation(s)
- Kristine Macartney
- National Centre for Immunisation Research (NCIRS), Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, Australia, 2145.
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