Active Immunization of Premature and Low Birth-Weight Infants: A Review of Immunogenicity, Efficacy, and Tolerability

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http://www.ingentaconnect.com/content/adis/ped/2007/00000009/00000001/art00003

Active Immunization of Premature and Low Birth-Weight Infants: A Review of

Immunogenicity, Efficacy, and Tolerability

Author: D'Angio, Carl T.1

Source: Pediatric Drugs, Volume 9, Number 1, 2007 , pp. 17-32(16)

Publisher: Adis International

Abstract:

Preterm infants are at increased risk of disease and hospitalization from a

number of vaccine-preventable diseases. However, these same infants have

immunologic immaturities that may impact vaccine responses.

Larger premature infants mount immune responses to vaccines similar to

those of full-term infants, but very premature infants (<28-32 weeks'

gestation at birth) may have specific defects in vaccine responsiveness.

Although there are minor differences in immunogenicity, the immune

responses to diphtheria, tetanus, pertussis, and polio antigens are similar

enough between full-term and premature infants that clinical consequences

are unlikely to result. However, the immunogenicity of Haemophilus

influenzae type b conjugate vaccines varies widely among studies of

premature infants, and may be affected by the choice of conjugate protein,

inclusion in a combination vaccine, and by an infant's overall health.

Pneumococcal conjugate vaccine is efficacious in larger premature infants,

but little information is available about immunogenicity in smaller

premature infants. Meningococcal group C conjugate vaccine appears

immunogenic in even very premature infants, but the duration of immunity

may be limited. Hepatitis B vaccine given at birth appears poorly

immunogenic in infants with birth weights <1500-2000g, with delay in the

administration of the first dose yielding improved immunogenicity. Few data

on influenza vaccine in premature infants are available, but infants with

pulmonary disease may respond less robustly than others. Bacille Calmette

Guérin vaccine appears to be most immunogenic if delayed until at least

34-35 weeks' postmenstrual age in very premature infants, although there

may be non-specific advantages to its earlier administration. Premature

infants may have persistently lower antibody titers than full-term infants,

even years after initial immunization. Sick premature infants experience

increased episodes of apnea or cardiorespiratory compromise following

vaccine administration, necessitating careful monitoring.

Specific factors that impair immune response, quality of the immune

response, and safety and immunogenicity evaluation of new vaccines in

premature infants are topics needing further research. Premature infants

are at significant risk for decisions from healthcare providers that delay

beginning and completing their vaccine regimens. A major challenge facing

those who care for these infants is the provision of timely immunization.

Keywords: BCG vaccine; Diphtheria; Diphtheria tetanus and pertussis

vaccine; Haemophilus infections; Hepatitis B; Hepatitis B vaccine; Hib

vaccine; Immunisation; Infants; Influenza virus infections; Influenza virus

vaccine; Meningococcal infections; Meningococcal vaccine group C conjugate;

Pertussis; Pneumococcal infections; Poliovirus vaccine; Research and

development; Rotavirus infections; Rotavirus vaccine; Tetanus

Document Type: Review article

Affiliations: 1: Strong Children's Research Center, Department of

Pediatrics, University of Rochester School of Medicine and Dentistry,

Rochester, New York, USA

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Sheri Nakken, former R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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