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Qin W, Shao L, Wang J, Zhang H, Wang Y, Zhang X, Xie S, Pan F, Cheng K, Ma L, Chen Y, Song J, Gao D, Chen Z, Yang W, Zhu R, Su H. Persistence of antibodies 5 years after hepatitis B vaccination in preterm birth children: A retrospective cohort study using real-world data. J Viral Hepat 2024; 31:143-150. [PMID: 38235846 DOI: 10.1111/jvh.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024]
Abstract
Previous studies did not provide substantial evidence for long-term immune persistence after the hepatitis B vaccine (HepB) in preterm birth (PTB) children. Consequently, there is ongoing controversy surrounding the booster immunization strategy for these children. Therefore, we conducted a retrospective cohort study to evaluate the disparities in immune persistence between PTB children and full-term children. A total of 1027 participants were enrolled in this study, including 505 PTB children in the exposure group and 522 full-term children in the control group. The negative rate of hepatitis B surface antibody (HBsAb) in the PTB group was significantly lower than that in the control group (47.9% vs. 41.4%, p = .035). The risk of HBsAb-negative in the exposure group was 1.5 times higher than that in the control group (adjusted odds ratio [aOR] = 1.5, 95% confidence interval [CI]: 1.1-2.0). The geometric mean concentration (GMC) of HBsAb was much lower for participants in the exposure group compared to participants in the control group (9.3 vs. 12.4 mIU/mL, p = .029). Subgroup analysis showed that the very preterm infants (gestational age <32 weeks) and the preterm low birth weight infants (birth weight <2000 g) had relatively low GMC levels of 3.2 mIU/mL (95% CI: 0.9-11.1) and 7.9 mIU/mL (95% CI: 4.2-14.8), respectively. Our findings demonstrated that PTB had a significant impact on the long-term persistence of HBsAb after HepB vaccination. The very preterm infants (gestational age <32 weeks) and the preterm low birth weight infants (birth weight <2000 g) may be special populations that should be given priority for HepB booster vaccination.
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Affiliation(s)
- Wei Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Ling Shao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Blood Purification Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jun Wang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Huan Zhang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Yao Wang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Xiaqing Zhang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Shaoyu Xie
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Fan Pan
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Kai Cheng
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Liguo Ma
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Yafei Chen
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Dawei Gao
- Microbiology Laboratory, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Zhichao Chen
- Microbiology Laboratory, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Wei Yang
- Microbiology Laboratory, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Rui Zhu
- Microbiology Laboratory, Lu'an Municipal Center for Disease Control and Prevention, Lu'an, Anhui, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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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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Schepp RM, Kaczorowska J, van Gageldonk PGM, Rouers EDM, Sanders EAM, Bruijning-Verhagen PCJ, Berbers GAM. Effect of Palivizumab Prophylaxis on Respiratory Syncytial Virus Infection in Very Preterm Infants in the First Year of Life in The Netherlands. Vaccines (Basel) 2023; 11:1807. [PMID: 38140212 PMCID: PMC10747417 DOI: 10.3390/vaccines11121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Respiratory Syncytial Virus (RSV) poses a severe threat to infants, particularly preterm infants. Palivizumab, the standard preventive prophylaxis, is primarily utilized in high-risk newborns due to its cost. This study assessed palivizumab's effectiveness in preventing RSV infections in predominantly very preterm infants during their first year of life. Serum samples from a prospective multicentre cohort study in the Netherlands were analyzed to assess RSV infection rates by measuring IgG levels against three RSV proteins: nucleoprotein, pre-fusion, and post-fusion protein. Infants were stratified based on gestational age (GA), distinguishing very preterm (≤32 weeks GA) from moderate/late preterm (>32 to ≤36 weeks GA). In very preterm infants, palivizumab prophylaxis significantly reduced infection rates (18.9% vs. 48.3% in the prophylaxis vs. non-prophylaxis group. Accounting for GA, sex, birth season, and birth weight, the prophylaxis group showed significantly lower infection odds. In infants with >32 to ≤36 weeks GA, the non-prophylaxis group (55.4%) showed infection rates similar to the non-prophylaxis ≤32-week GA group, despite higher maternal antibody levels in the moderate/late preterm infants. In conclusion, palivizumab prophylaxis significantly reduces RSV infection rates in very premature infants. Future research should explore clinical implications and reasons for non-compliance, and compare palivizumab with emerging prophylactics like nirsevimab aiming to optimize RSV prophylaxis and improve preterm infant outcomes.
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Affiliation(s)
- Rutger M. Schepp
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (J.K.)
| | - Joanna Kaczorowska
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (J.K.)
| | - Pieter G. M. van Gageldonk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (J.K.)
| | - Elsbeth D. M. Rouers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (J.K.)
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Elisabeth A. M. Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (J.K.)
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital, 3508 AB Utrecht, The Netherlands
| | - Patricia C. J. Bruijning-Verhagen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (J.K.)
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Guy A. M. Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; (J.K.)
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Marques JG, Inácio Cunha FM, Bajanca-Lavado MP. Haemophilus influenzae Type b Vaccine Failure in Portugal: A Nationwide Multicenter Pediatric Survey. Pediatr Infect Dis J 2023; 42:824-828. [PMID: 37406244 DOI: 10.1097/inf.0000000000004011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Despite the high effectiveness of the Haemophilus influenzae type b (Hib) vaccine in preventing invasive disease (ID) in children, Hib vaccine failures (VFs) cases may still occur. This study aimed to characterize the Hib-VF cases in Portugal in a 12-year period and trying to identify the possible associated risk factors. METHODS Prospective descriptive nationwide surveillance study. Bacteriologic and molecular studies were performed at the same Reference Laboratory. Clinical data were collected by the referring pediatrician. RESULTS Hib was identified in 41 children with ID and 26 (63%) were considered VF. Nineteen (73%) cases occurred in children less than 5 years old; 12 (46%) occurred before the Hib vaccine booster dose at 18 months of age. Comparing the first and the last 6-year periods of the study, the incidence rate of Hib, VF and total H. influenzae (Hi) ID significantly raised ( P < 0.05). VF cases corresponded, respectively, to 13.5% (7/52) and 22% (19/88) of total Hi-ID cases ( P = 0.232). Two children died due to epiglottitis and 1 acquired sensorineural hearing loss. Only 1 child had an inborn error of immunity. The immunologic workup performed in 9 children revealed no significant abnormalities. All 25 Hib-VF strains analyzed belonged to the same clonal complex 6. CONCLUSIONS In Portugal, more than 95% of children are vaccinated against Hib, but severe Hib-ID cases still occur. No predisposing factors were clearly identified to justify the increased number of VF in recent years. Along with continued Hi-ID surveillance, Hib colonization and serologic studies should be implemented.
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Affiliation(s)
- José Gonçalo Marques
- From the Infectious Diseases and Immunodeficiency's Unit, Department of Pediatrics, Centro Hospitalar Universitário Lisboa Norte, Lisbon
- Department of Pediatrics, Faculdade de Medicina da Universidade de Lisboa, Lisboa
| | | | - Maria Paula Bajanca-Lavado
- Haemophilus influenzae Reference Laboratory, Department of Infectious Diseases, National Institute of Health, Lisboa, Portugal
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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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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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Pieren DKJ, Boer MC, de Wit J. The adaptive immune system in early life: The shift makes it count. Front Immunol 2022; 13:1031924. [PMID: 36466865 PMCID: PMC9712958 DOI: 10.3389/fimmu.2022.1031924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 10/13/2023] Open
Abstract
Respiratory infectious diseases encountered early in life may result in life-threatening disease in neonates, which is primarily explained by the relatively naive neonatal immune system. Whereas vaccines are not readily available for all infectious diseases, vaccinations have greatly reduced childhood mortality. However, repeated vaccinations are required to reach protective immunity in infants and not all vaccinations are effective at young age. Moreover, protective adaptive immunity elicited by vaccination wanes more rapidly at young age compared to adulthood. The infant adaptive immune system has previously been considered immature but this paradigm has changed during the past years. Recent evidence shows that the early life adaptive immune system is equipped with a strong innate-like effector function to eliminate acute pathogenic threats. These strong innate-like effector capacities are in turn kept in check by a tolerogenic counterpart of the adaptive system that may have evolved to maintain balance and to reduce collateral damage. In this review, we provide insight into these aspects of the early life's adaptive immune system by addressing recent literature. Moreover, we speculate that this shift from innate-like and tolerogenic adaptive immune features towards formation of immune memory may underlie different efficacy of infant vaccination in these different phases of immune development. Therefore, presence of innate-like and tolerogenic features of the adaptive immune system may be used as a biomarker to improve vaccination strategies against respiratory and other infections in early life.
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Affiliation(s)
| | | | - Jelle de Wit
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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Mode of delivery modulates the intestinal microbiota and impacts the response to vaccination. Nat Commun 2022; 13:6638. [PMID: 36380002 PMCID: PMC9666625 DOI: 10.1038/s41467-022-34155-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
The gut microbiota in early life, when critical immune maturation takes place, may influence the immunogenicity of childhood vaccinations. Here we assess the association between mode of delivery, gut microbiota development in the first year of life, and mucosal antigen-specific antibody responses against pneumococcal vaccination in 101 infants at age 12 months and against meningococcal vaccination in 66 infants at age 18 months. Birth by vaginal delivery is associated with higher antibody responses against both vaccines. Relative abundances of vaginal birth-associated Bifidobacterium and Escherichia coli in the first weeks of life are positively associated with anti-pneumococcal antibody responses, and relative abundance of E. coli in the same period is also positively associated with anti-meningococcal antibody responses. In this study, we show that mode of delivery-induced microbiota profiles of the gut are associated with subsequent antibody responses to routine childhood vaccines.
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Faingelernt Y, Dagan R, Givon-Lavi N, van der Beek BA, Ben-Shimol S, Shany E, Greenberg D. The impact of the pneumococcal conjugate vaccines on the incidence of community-acquired alveolar pneumonia in premature compared with in term-born infants. Vaccine 2022; 40:568-573. [PMID: 34973848 DOI: 10.1016/j.vaccine.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preterm-born children are prone to respiratory infections and complications during infancy and early childhood. In Israel, pneumococcal conjugated vaccines (PCVs) were introduced in 2009-2010, with high vaccination coverage. We assessed the impact of PCV implementation on community-acquired alveolar pneumonia (CAAP) in children < 2 years old born prematurely, in comparison with term born infants. METHODS We conducted a prospective, active, population-based surveillance of children < 2 years old with radiologically-proven CAAP, visiting the only regional medical center. CAAP incidence in the pre-PCV and post-PCV eras were compared in early premature (29-32 weeks gestational age [WGA]), late premature (33-36 WGA) and term-born infants (>36 WGA). RESULTS Of 214,947 births during the study period, 6'791 CAAP episodes were diagnosed; 211, 653 and 5,806 were in early premature, late premature and term infants, respectively. After PCV implementation, overall CAAP visits were reduced by 44% (95% CI 36-51): 60%, 21% and 45% among those born early preterm, late preterm and at term, respectively (statistically significant for children born early preterm and at term). For outpatients, the respective rate reductions were 79%, 40% and 65% (statistically significant for the children born at term). Importantly, the mean annual rates in the post-PCV period became similar in all 3 groups. The rate reductions among the hospitalized children were lower those that among the non-hospitalized children, with reductions of 56%, 16% and 33% for the three groups, respectively (statistically significant for early preterm and at term children). CONCLUSIONS CAAP reduction trends after PCV implementation for preterm-born infants were similar to those for term-born infants. Whether this was because of similar direct PCV- protection, because of indirect (herd) protection or both, is unclear. Post-PCV implementation, the gaps in CAAP rates between infants born prematurely and at term were reduced.
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Affiliation(s)
- Yaniv Faingelernt
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Noga Givon-Lavi
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Shalom Ben-Shimol
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Eilon Shany
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Neonatal department Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
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10
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Pertussis burden and acellular pertussis vaccine effectiveness in high risk children. Vaccine 2022; 40:1376-1382. [DOI: 10.1016/j.vaccine.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022]
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Immunization of preterm infants: current evidence and future strategies to individualized approaches. Semin Immunopathol 2022; 44:767-784. [PMID: 35922638 PMCID: PMC9362650 DOI: 10.1007/s00281-022-00957-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Preterm infants are at particularly high risk for infectious diseases. As this vulnerability extends beyond the neonatal period into childhood and adolescence, preterm infants benefit greatly from infection-preventive measures such as immunizations. However, there is an ongoing discussion about vaccine safety and efficacy due to preterm infants' distinct immunological features. A significant proportion of infants remains un- or under-immunized when discharged from primary hospital stay. Educating health care professionals and parents, promoting maternal immunization and evaluating the potential of new vaccination tools are important means to reduce the overall burden from infectious diseases in preterm infants. In this narrative review, we summarize the current knowledge about vaccinations in premature infants. We discuss the specificities of early life immunity and memory function, including the role of polyreactive B cells, restricted B cell receptor diversity and heterologous immunity mediated by a cross-reactive T cell repertoire. Recently, mechanistic studies indicated that tissue-resident memory (Trm) cell populations including T cells, B cells and macrophages are already established in the fetus. Their role in human early life immunity, however, is not yet understood. Tissue-resident memory T cells, for example, are diminished in airway tissues in neonates as compared to older children or adults. Hence, the ability to make specific recall responses after secondary infectious stimulus is hampered, a phenomenon that is transcriptionally regulated by enhanced expression of T-bet. Furthermore, the microbiome establishment is a dominant factor to shape resident immunity at mucosal surfaces, but it is often disturbed in the context of preterm birth. The proposed function of Trm T cells to remember benign interactions with the microbiome might therefore be reduced which would contribute to an increased risk for sustained inflammation. An improved understanding of Trm interactions may determine novel targets of vaccination, e.g., modulation of T-bet responses and facilitate more individualized approaches to protect preterm babies in the future.
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van Dongen JAP, Rouers EDM, Schuurman R, Band C, Watkins SM, van Houten MA, Bont LJ, Norbruis OF, Hemels MAC, van Well GTJ, Vlieger AM, van der Sluijs J, Stas HG, Tramper-Stranders G, Kleinlugtenbeld EA, van Kempen AAMW, Wessels M, van Rossem MC, Dassel CACM, Pajkrt D, Bonten MJM, Bruijning-Verhagen PCJ. Rotavirus Vaccine Safety and Effectiveness in Infants With High-Risk Medical Conditions. Pediatrics 2021; 148:183442. [PMID: 34814164 DOI: 10.1542/peds.2021-051901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Rotavirus vaccination has 87% to 100% effectiveness against severe rotavirus acute gastroenteritis (AGE) in healthy infants in high-income countries. Little is known whether infants with medical risk conditions (MRCs) are equally protected and if the vaccine is equally well tolerated. We conducted a quasi-experimental prospective multicenter before-after cohort study to assess the vaccine effectiveness (VE) and safety profile of the human rotavirus vaccine (HRV) among MRC infants that required prolonged or frequent postnatal care. METHODS The Netherlands has no national rotavirus immunization program, but HRV was implemented in routine care for MRC infants in 13 Dutch hospitals. Participants in the before and after cohort, HRV unvaccinated and vaccinated, respectively, were followed for occurrence of (rotavirus) AGE. VE of at least 1 dose was estimated by using time-to-event analysis for severe rotavirus AGE. Vaccine-related serious adverse event (AEs) after HRV were retrieved systematically from medical charts. Solicited AEs after vaccinations were prospectively collected and compared between vaccination time points with or without HRV. RESULTS In total, 1482 high-risk infants with MRC were enrolled, including 631 in the before and 851 in the after cohorts; 1302 infants were premature (88.3%), 447 were small for gestational age (30.2%), and 251 had at least 1 congenital disorder (17.0%). VE against severe rotavirus AGE was 30% (95% confidence interval [CI]: -36% to 65%). Overall, the observed number of rotavirus hospitalizations was low and not significantly different between the cohorts (2 and 2, respectively). The rate of vaccine-related serious AE was 0.24 per 100 vaccine doses. The adjusted risk ratio for any AE after HRV vaccination compared with other routine vaccinations was 1.09 (95% CI: 1.05 to 1.12) for concomitant administration and 0.91 (95% CI: 0.81 to 0.99) for single HRV administration. Gastrointestinal AEs were 10% more frequent after HRV. CONCLUSIONS In contrast to previous findings among healthy term infants, in routine use, HRV offered limited protection to vulnerable medical risk infants. HRV is generally well tolerated in this group in single administration, but when coadministered with routine vaccines, it is associated with higher risk of (mostly gastrointestinal) AE. Our study highlights the importance of studying vaccine performance in subgroups of medically vulnerable infants.
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Affiliation(s)
| | - Elsbeth D M Rouers
- Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases.,National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, Netherlands
| | | | - Caterina Band
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands
| | - Shannon M Watkins
- Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases
| | | | - Louis J Bont
- Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Obbe F Norbruis
- Department of Pediatrics, Isala Hospital, Zwolle, Netherlands
| | | | - Gijs T J van Well
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arine M Vlieger
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, Netherlands
| | | | - Helene G Stas
- Department of Pediatrics, Maasstad Hospital, Rotterdam, Netherlands
| | | | | | | | - Margreet Wessels
- Department of Pediatrics, Rijnstate Hospital, Arnhem, Netherlands
| | | | | | - Dasja Pajkrt
- Department of Pediatrics, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases.,Departments of Medical Microbiology.,National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, Netherlands
| | - Patricia C J Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases.,Departments of Medical Microbiology.,National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, Netherlands
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Exposure to perfluoroalkyl substances through human milk in preterm infants. Eur J Pediatr 2021; 180:3047-3051. [PMID: 33839913 DOI: 10.1007/s00431-021-04073-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 01/09/2023]
Abstract
Perfluoroalkyl substances (PFASs) are environmental contaminants that have been shown to exert toxic effects, which are dependent upon concentration, in animals and humans. No specific data on the exposure of preterm infants to PFASs are available. We aimed to quantify the potential exposure of preterm infants to PFASs through human milk (HM), to be compared to the exposure data recently reported for infants by EFSA. The amount of PFASs in ten preterm (PHM) and ten donor HM (DHM) samples was evaluated, and the expected daily intake (EDI) at full enteral feeding was calculated. This EDI was compared to the mean and the 95th centile dietary exposure ranges at the lower bound for infants issued by EFSA. The calculated median EDI for total PFASs was 20.72 ng/kg/day (range 10.72-107.84) for PHM and 17.92 ng/kg/day (range 6.4-28.96) for DHM, which were both higher than mean exposure ranges reported for infants (2.4-12.2 ng/kg/day). The calculated EDI for DHM was far more similar to the 95th centile (4.5-27.9 ng/kg/day) dietary exposure ranges. For PHM samples, higher EDI values were obtained, with 4 out of 10 samples exceeding the upper limit of the 95th centile range.Conclusion: The exposure of preterm infants to PFASs through HM feeding might exceed reference values reported for older and healthier infants. Given the immunological and developmental vulnerability of preterm infants, the risks related to their exposure to PFASs should be further investigated, also focusing on how maternal exposure and subsequent transfer through HM feeding can be reduced. What is Known: • Perfluoroalkyl substances (PFASs) are environmental contaminants that have been shown to exert toxic effects, which are dependent upon concentration, in animals and humans. The EFSA has recently issued reference values for PFASs exposure for different age groups. • Infants might be exposed to PFASs prenatally, as these substances can cross the placenta, and postnatally, through breastfeeding. No specific data about exposure of preterm infants through human milk (HM) feeding are currently available. What is New: • The exposure of preterm infants to PFASs through HM feeding might exceed reference values reported for older and healthier infants. • Given the immunological and developmental vulnerability of preterm infants, the risks related to their exposure to PFASs deserve further investigation. As HM represents the optimal feeding for preterm infants, it will be fundamental to focus on how maternal exposure and subsequent transfer through HM feeding can be reduced.
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Abstract
Severe Acute Respiratory Syndrome-Coronavirus-2 is responsible for the current pandemic that has led to more than 10 million confirmed cases of Coronavirus Disease-19 (COVID-19) and over 500,000 deaths worldwide (4 July 2020). Virus-mediated injury to multiple organs, mainly the respiratory tract, activation of immune response with the release of pro-inflammatory cytokines, and overactivation of the coagulation cascade and platelet aggregation leading to micro- and macrovascular thrombosis are the main pathological features of COVID-19. Empirical multidrug therapeutic approaches to treat COVID-19 are currently used with extremely uncertain outcomes, and many others are being tested in clinical trials. Acetylsalicylic acid (ASA) has both anti-inflammatory and antithrombotic effects. In addition, a significant ASA-mediated antiviral activity against DNA and RNA viruses, including different human coronaviruses, has been documented. The use of ASA in patients with different types of infections has been associated with reduced thrombo-inflammation and lower rates of clinical complications and in-hospital mortality. However, safety issues related both to the risk of bleeding and to that of developing rare but serious liver and brain damage mostly among children (i.e., Reye's syndrome) should be considered. Hence, whether ASA might be a safe and reasonable therapeutic candidate to be tested in clinical trials involving adults with COVID-19 deserves further attention. In this review we provide a critical appraisal of current evidence on the anti-inflammatory, antithrombotic, and antiviral effects of ASA, from both a pre-clinical and a clinical perspective. In addition, the potential benefits and risks of use of ASA have been put in the context of the adult-restricted COVID-19 population.
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COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection 2020; 48:681-686. [PMID: 32394344 PMCID: PMC7211976 DOI: 10.1007/s15010-020-01438-z] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 01/28/2023]
Abstract
Introduction Data on people living with human immunodeficiency virus (PLWH) in the current SARS-CoV-2 pandemic are still scarce. This case series of 33 PLWH patients with COVID-19 reveals symptoms and outcome in this special population. Methods Retrospective analysis of anonymized data including age, gender, HIV-associated parameters, symptoms, and outcome. Results Three out of 32 patients with documented outcomes died (9%). 91% of the patients recovered and 76% have been classified as mild cases. All patients were on antiretroviral treatment, of them 22 on tenofovir-containing regimen and 4 on the protease inhibitor darunavir. Conclusions This preliminary case series does not support excess morbidity and mortality among symptomatic COVID-19 PLWH and with viral suppression on ART. SARS-CoV-2 infections may occur during boosted darunavir-based and/or on tenofovir-containing ART.
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