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Neonatology pp 1793-1802 | Cite as

Vaccinations and Neonatal Immunity

  • Alberto G. Ugazio
  • Alberto E. Tozzi
Reference work entry

Abstract

Immune responsiveness quickly matures in both term and preterm neonates after birth, rapidly reaching levels comparable with those observed in children and adults. The duration of this maturation process is variable and also depends on the type of antigen to which immunity is directed. Maternally acquired passive immunity keeps a major protective role during the first months of life, via transplacentally acquired IgG and maternal IgA acquired via breast milk. The safety profile and immunogenicity of routinely administered vaccines are similar in premature neonates to those measured in full-term infants. Preterm and low birth weight infants should be immunized according to their chronological age. Indeed, early and timely immunization of preterm and low birth weight infants is safe and essential for protecting them against diseases to which these infants are particularly susceptible and that may be even fatal. Besides traditional vaccination, maternal immunization during pregnancy is being tested and it is proving quite effective; new vaccines are therefore being studied in pregnant women. A potential cause of concern is whether vaccines administered to preterm infants induce a good immunological memory, because very preterm infants may develop a weaker immunological long-term response. Another critical aspect regarding neonatal vaccinations is the use of corticosteroids (often used in NICU) since they may decrease the response. In spite of that, their administration should not delay the vaccine schedule. The benefits of early and timely immunization of fragile children far exceed the risk of inducing suboptimal protection.

References

  1. Adenyi-Jones SC, Faden H, Ferdon MB et al (1992) Systemic and local immune responses to enhanced-potency inactivated poliovirus vaccine in premature and term infants. J Pediatr 120:686–689CrossRefGoogle Scholar
  2. American Academy of Pediatrics (2003) Hepatitis B. In: Pickering LK (ed) Red book: 2003 report of the committee on infectious diseases, 26th edn. American Academy of Pediatrics, Elk Grove Village, pp 318–336Google Scholar
  3. Basha S, Surendram N, Pichichero M (2014) Immune responses in neonates. Expert Rev Immunol 10(9):1171–1184CrossRefGoogle Scholar
  4. Berrington JE, Cant AJ, Matthews JN et al (2006) Haemophilus influenzae type b immunization in infants in the United Kingdom: effects of diphtheria/tetanus/acellular pertussis/Hib combination vaccine, significant prematurity, and a fourth dose. Pediatrics 117:e717–e724CrossRefGoogle Scholar
  5. Bonhoeffer J, Siegrist C-A, Heath PT (2006) Immunisation of premature infants. Arch Dis Child 91:929–935CrossRefGoogle Scholar
  6. Carbone T, McEntire B, Kissin D et al (2008) Absence of an increase in cardiorespiratory events after diphtheria-tetanus-acellular pertussis immunization in preterm infants: a randomized, multicenter study. Pediatrics 121:e1085–e1090CrossRefGoogle Scholar
  7. Centers for Disease Control and Prevention (1999) Thimerosal in vaccines: a joint statement of the American academy of pediatrics and the public health service. MMWR Morb Mortal Wkly Rep 48:563–565Google Scholar
  8. Chu HY, Englund JA (2014) Maternal immunization. Vaccine 59:560–568Google Scholar
  9. Clarke P, Powell PJ, Goldblatt D, Robinson MJ (2003) Effect of a fourth Haemophilus influenzae type b immunization in preterm infants who received dexamethasone for chronic lung disease. Arch Dis Child Fetal Neonatal Ed 88:F58–F61CrossRefGoogle Scholar
  10. Clarke P, Robinson MJ, Ahmad I et al (2006) Response of steroid treated former preterm infants to a single dose of meningococcal C conjugate vaccine. Vaccine 24:3273–3278CrossRefGoogle Scholar
  11. ClinicalTrials.gov (2015) A study to determine the safety and efficacy of the RSV F vaccine to protect infants via maternal immunization (NIH: https://clinicaltrials.gov/ct2/show/NCT02624947)
  12. Collins CL, Ruggeberg JU, Balfour G et al (2005) Immunogenicity and immunologic memory of meningococcal C conjugate vaccine in premature infants. Pediatr Infect Dis J 24:966–968CrossRefGoogle Scholar
  13. Conway S, James J, Balfour A, Smithells R (1994) Immunisation of the preterm baby. J Infect 28:143–150CrossRefGoogle Scholar
  14. D’Angio CT, Maniscalco WM, Pichichero ME (1995) Immunologic response of extremely premature infants to tetanus, Haemophilus influenzae, and polio immunizations. Pediatrics 96:18–22PubMedGoogle Scholar
  15. D’Angio CT, Boohene PA, Mowrer A et al (2007) Measles-mumps-rubella and varicella vaccine responses in extremely preterm infants. Pediatrics 119:e574–e579CrossRefGoogle Scholar
  16. Esposito S, Pugni L, Bosis S et al (2005) Immunogenicity, safety and tolerability of heptavalent pneumococcal conjugate vaccine administered at 3, 5 and 11 months post-natally to pre- and full-term infants. Vaccine 23:1703–1708CrossRefGoogle Scholar
  17. European Agency for the Evaluation of Medicinal Products (2009) EMEA public statement on thiomersal containing medicinal products, 8 July 1999. www.emea.europa.eu/pdfs/human/press/pus/2096299EN.pdf
  18. Faldella G, Galletti S, Corvaglia L et al (2007) Safety of DTaPIPV- HIb-HBV hexavalent vaccine in very premature infants. Vaccine 25:1036–1042CrossRefGoogle Scholar
  19. Flatz-Jequier A, Posfay-Barbe KM, Pfister RE, Siegrist CA (2008) Recurrence of cardiorespiratory events following repeat DTaPbased combined immunization in very low birth weight premature infants. J Pediatr 153:429–431CrossRefGoogle Scholar
  20. Forsyth K, Plotkin S, Tan T, Wirsing von König CH (2015) Strategies to decrease pertussis transmission to infants. Pediatrics 135(6):e1475–e1482CrossRefGoogle Scholar
  21. Gagneur A, Pinquier D, Quach C (2015) Immunization of preterm infants. Hum Vaccin Immunother 11(11):2556–2563CrossRefGoogle Scholar
  22. Gaudelus J, Lefèvre-Akriche S, Roumegoux C et al (2007) Immunization of the preterm infants. Arch Pediatr 14(Suppl 1):S24–S30CrossRefGoogle Scholar
  23. Groothuis JR, Levin MJ, Lehr MV et al (1992) Immune response to split-product influenza vaccine in preterm and full-term young children. Vaccine 10:221–225CrossRefGoogle Scholar
  24. Heath PT, Booy R, McVernon J et al (2003) Hib vaccination in infants born prematurely. Arch Dis Child 88:206–210CrossRefGoogle Scholar
  25. Heyderman RS, Madhi SA, Neil F, Clare C, Bagrey N, Doris K, Robert M, Anthonet K, Lisa J, Morounfolu O, Frederik W, Karen S, Dull PM (2016) Group B streptococcus vaccination in pregnant women with or without HIV in AFRICA: a non-randomised phase 2, open-label, multicentre trial. Lancet 16:546–555CrossRefGoogle Scholar
  26. Huang FY, Lee PI, Lee CY et al (2007) Hepatitis B vaccination in preterm infants. Arch Dis Child Fetal Neonatal Ed 77:F135–F138CrossRefGoogle Scholar
  27. Kim SC, Chung EK, Hodinka RL et al (1997) Immunogenicity of hepatitis B vaccine in preterm infants. Pediatrics 99:534–536CrossRefGoogle Scholar
  28. Klein NP, Massolo ML, Greene J et al (2008) Vaccine safety datalink. Risk factors for developing apnea after immunization in the neonatal intensive care unit. Pediatrics 121:463–469CrossRefGoogle Scholar
  29. Klinman DM (2004) Immunotherapeutic uses of CpG oligodeoxynucleotides. Nat Rev Immunol 4:249–258CrossRefGoogle Scholar
  30. Koch CA, Platt JL (2007) T cell recognition and immunity in the fetus and mother. Cell Immunol 248:12–7CrossRefGoogle Scholar
  31. Kroger AT, Atkinson WL, Marcuse EK et al (2006) General recommendations on immunization recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 55:1–48PubMedGoogle Scholar
  32. Langkamp DL, Hoshaw-Woodard S, Boye ME, Lemeshow S (2001) Delays in receipt of immunizations in low-birth-weight children: a nationally representative sample. Arch Pediatr Adolesc Med 155:167–172CrossRefGoogle Scholar
  33. Lau YL, Tam AY, Ng KW et al (1992) Response of preterm infants to hepatitis B vaccine. J Pediatr 121:962–965CrossRefGoogle Scholar
  34. Lewis DB (2004) The physiologic immunodeficiency of immaturity. In: Stiehm ER, Ochs HD, Winkelstein JA (eds) Immunologic disorders in infants and children, 5th edn. Elsevier Saunders, Philadelphia, pp 687–760Google Scholar
  35. Linder N, Yaron M, Handsher R et al (1995) Early immunization with inactivated poliovirus vaccine in premature infants. J Pediatr 127:128–130CrossRefGoogle Scholar
  36. Madhi SA, Dangor Z, Heath PT, Schrag S, Izu A, Sobanjo-Ter Meulen A, Dull PM (2013) Considerations for a phase-III trial evaluate a group B Streptococcus polysaccharide-èrptein conjugate vaccine in pregnant women for the prevention of early- and late-onset invasive disease in young-infants. Vaccine 31(Suppl 4):D52–D57CrossRefGoogle Scholar
  37. Madhi SA, Cutland CL, Jose L, Koen A, Govender N, Wittke F, Olugbosi M, Meulen AS, Baker S, Dull PM, Narasimhan V, Slobod K (2016) Safety and immunogenicity of an investigational maternal trivalent group B Streptococcus vaccine in healthy women and their infants: a randomized phase 1b/2 trial. Lancet 1–12Google Scholar
  38. Martinón-Torres F, Czajka H, Center KJ, Wysocki J, Ewa M-S, Omeñaca F, Iturbe EB, Gamero DB, Concheiro-Guisán A, Gimenez-Sanchez F, Szenborn L, Giardina PC, Patterson S, Gruber WC, Scott DA, Gurtman A (2015) 13-valent pneumococcal conjugate vaccine (PCV13) in preterm versus term infants. Pediatrics 135:e877–e886CrossRefGoogle Scholar
  39. Mast EE, Margolis HS, Fiore AE et al (2005) A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the advisory committee on immunization practices (ACIP); part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep 54:1–31PubMedGoogle Scholar
  40. McCormick M, Bayer R, Berg A (2004) Report of the institute of medicine: immunization safety review–vaccines and autism. National Academy Press, Washington, DCGoogle Scholar
  41. Moyes C (1999) Immunisation of preterm babies. N Z Med J 112:263–264PubMedGoogle Scholar
  42. Negrete-Esqueda L, Vargas-Origel A (2007) Response to Bacillus Calmette-Guerìn vaccine in full term and pre term infants. Am J Perinatol 24:183–189CrossRefGoogle Scholar
  43. Okan F, Karagoz S, Nuhoglu A (2006) Bacillus Calmette-Guerìn vaccination in preterm infants. Int J Tuberc Lung Dis 10:1337–1341PubMedGoogle Scholar
  44. Omeñaca F, Garcia-Sicilia J, García-Corbeira P et al (2005) Response of preterm newborns to immunization with a hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio and Haemophilus influenzae type b vaccine: first experiences and solutions to a serious and sensitive issue. Pediatrics 116:1292–1298CrossRefGoogle Scholar
  45. Omeñaca F, Garcia-Sicilia J, García-Corbeira P et al (2007) Antipolyribosyl ribitol phosphate response of premature infants to primary and booster vaccination with a combined diphtheriatetanus- acellular pertussis-hepatitis B-inactivated polio virus/Haemophilus influenzae type b vaccine. Pediatrics 119:e179–e185CrossRefGoogle Scholar
  46. Pfister RE, Aeschbach V, Niksic-Stuber V et al (2004) Safety of DTaP-based combined immunization in very-low-birth-weight premature infants: frequent but mostly benign cardiorespiratory events. J Pediatr 145:58–66CrossRefGoogle Scholar
  47. Plotkin S (2005) Vaccines: past, present, and future. Nat Med 11:S5–S11CrossRefGoogle Scholar
  48. Pourcyrous M, Korones SB, Arheart KL, Bada HS (2007) Primary immunization of premature infants with gestational age <35 weeks: cardiorespiratory complications and c-reactive protein responses associated with administration of single and multiple separate vaccines simultaneously. J Pediatr 151:167–172CrossRefGoogle Scholar
  49. Robinson MJ, Heal C, Gardener E et al (2004) Antibody response to diphtheria-tetanus-pertussis immunization in preterm infants who receive dexamethasone for chronic lung disease. Pediatrics 113:733–737CrossRefGoogle Scholar
  50. Ruggeberg JU, Collins C, Clarke P et al (2007) Immunogenicity and induction of immunological memory of the heptavalent pneumococcal conjugate vaccine in preterm UK infants. Vaccine 25:264–271CrossRefGoogle Scholar
  51. Saari TN, Committee on Infectious Diseases (2003) Immunization of preterm and low birth weight infants. Pediatrics 112:193–198CrossRefGoogle Scholar
  52. Salious P, Aijan N, Guérin N (2002) Efficacy and tolerance of vaccinations in premature infants. Arch Pediatr 9:629–637CrossRefGoogle Scholar
  53. Schloesser RL, Fischer D, Otto W et al (1999) Safety and immunogenicity of an acellular pertussis vaccine in premature infants. Pediatrics 103:e60CrossRefGoogle Scholar
  54. Shinefield H, Black S, Ray P et al (2002) Efficacy, immunogenicity and safety of heptavalent pneumococcal conjugate vaccine in low birth weight and preterm infants. Pediatr Infect Dis J 21:182–186CrossRefGoogle Scholar
  55. Slack MH, Schapira D, Thwaites RJ et al (2001) Immune response of premature infants to meningococcal serogroup C and combined diphtheria-tetanus toxoids-acellular pertussis-Haemophilus influenzae type b conjugate vaccines. J Infect Dis 184:1617–1620CrossRefGoogle Scholar
  56. Slack MH, Cade S, Schapira D et al (2005) DT5aP-Hib-IPV and MCC vaccines: preterm infants’ response to accelerated immunisation. Arch Dis Child 90:338–341CrossRefGoogle Scholar
  57. Swamy GK, Heine RP (2015) Vaccinations for pregnant women. Clin Expert Ser 125(1):212–226Google Scholar
  58. Tozzi AE, Bisiacchi P, Tarantino V et al (2009) Neuropsychological performance 10 years after immunization in infancy with thimerosal-containing vaccines. Pediatrics 123:475–482CrossRefGoogle Scholar
  59. Tozzi AE, Piga S, Corchia C, Di Lallo D, Carnielli V, Chiandotto V, Fertz MC, Miniaci S, Rusconi F, Cuttini M (2014) Timeliness of routine immunization in a population-based Italian cohort of very preterm infants: results of the ACTION follow-up project. Vaccine 32(7):793–799CrossRefGoogle Scholar
  60. Vázquez L, Garcia F, Rüttimann R et al (2008) Immunogenicity and reactogenicity of DTPa-HBV-IPV/Hib vaccine as primary and booster vaccination in low-birth-weight premature infants. Acta Paediatr 97:1243–1249CrossRefGoogle Scholar
  61. Velasco C, Helene B, Bipin B, Fallon JT, Alexandra A, Paul G, Galarza JM (2016) A novel respiratory syncytial virus-like particle (VLP) vaccine composed of the postfusion and prefusion conformations of the F glycoprotein. Clin Vaccine Immunol 23:451–459CrossRefGoogle Scholar
  62. Vesikari T, Matson DO, Dennehy P et al (2006) Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med 354:23–33CrossRefGoogle Scholar
  63. Watson PS, Turner DP (2016) Clinical experience with the meningococcal B vaccine, Bexsero: prospects for reducing the burden of meningococcal serogroup B disease. Vaccine 34(7):875–880CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Child and Adolescent HealthBambino Gesù Children’s HospitalRomeItaly
  2. 2.Multifactorial and Complex Diseases Research AreaBambino Gesù Children’s HospitalRomeItaly

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