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[Efficacy and tolerance of vaccinations in premature infants]
1Aventis Pasteur, 2, avenue Pont-Pasteur, 69367 Lyon, France. pierre.saliou.aventis.com
Insights
Timely immunization is crucial for preventing infectious diseases in preterm infants. Key vaccines, like DTaP-IPV-Hib, should start at 2 months, with special monitoring for apnea in hospitalized infants.
Area of Science:
- Pediatrics
- Immunology
- Neonatology
Context:
- Preterm infants face unique challenges regarding immunization schedules and vaccine responses.
- Immune system maturation is primarily age-dependent, not solely based on gestational age.
Purpose:
- To review the effectiveness, safety, and duration of protection for immunizations in preterm infants.
- To provide evidence-based recommendations for optimizing vaccination strategies in this vulnerable population.
Summary:
- Immunization schedules should align with chronological age, initiating vaccines like diphtheria-tetanus-pertussis-poliomyelitis-Haemophilus influenzae b at 2 months.
- Preterm infants may require monitoring for apnea post-vaccination, particularly with the pertussis component.
- BCG vaccination is not recommended immediately after birth for infants under 33 weeks gestation, and Hepatitis B vaccination can be given at 2 months or at birth for high-risk newborns.
Impact:
- Ensures appropriate and timely protection against serious infectious diseases for preterm infants.
- Highlights the need for careful monitoring and tailored vaccination approaches in neonatal care.
- Confirms that prematurity does not alter the safety or duration of immunity for most standard vaccines.
Abstract:
Immunization may prevent an enhanced risk of infectious diseases, providing that it is completed on time. A review of the literature summarizes several studies on effectiveness, safety and duration of protection in preterm infants. Immune maturation depends on chronological age rather than gestational age. Then immunization against diphteria-tetanus-pertussis-poliomyelitis-Haemophilus influenzae b should be initiated at 2 months of age and completed prior than 6 months. The youngest preterm infants, still hospitalized at 8 weeks of age should be monitored following the first immunization as they may develop apnea episodes, probably linked with the pertussis component of the vaccine. In premature, BCG vaccination induces a delayed hypersensitivity to tuberculin less important than in full-term neonates, and should not be given right after birth in newborns less than 33 weeks of gestational age. Hepatitis B vaccination should be offered as soon as two months of age and even at birth to children born from HBs Ag carriers. Neither duration of immunity, nor safety are modified by prematurity.