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Recurrent apnoea post immunisation: Informing re-immunisation policy

Vanessa Clifford1, Nigel W Crawford, Jenny Royle

  • 1SAEFVIC, Murdoch Children's Research Institute, Melbourne, Australia. vanessa.clifford@rch.org.au

Vaccine
|June 23, 2011
PubMed

Insights

Preterm infants experiencing apnoea after immunisation have an 18% recurrence risk. Lower birth weight and prematurity complications are risk factors, but a third episode is unlikely. Monitoring is recommended.

Area of Science:

  • Neonatalogy
  • Pediatric Vaccinology
  • Public Health Surveillance

Background:

  • Routine immunizations are recommended based on chronological age, but concerns about adverse events following immunization (AEFI) in preterm infants often lead to delays.
  • Apnoea with or without bradycardia temporally associated with immunisation (AEFI) can occur in a small number of infants, with unknown risk factors and recurrence rates.
  • This uncertainty complicates immunization planning for vulnerable preterm infants.

Purpose of the Study:

  • To determine the recurrence rates of immunisation-associated apnoea in preterm and term infants.
  • To identify potential risk factors for recurrent apnoea in preterm infants following immunisation.

Main Methods:

  • A retrospective analysis of apnoea +/- bradycardia AEFIs reported to SAEFVIC in Victoria, Australia, from May 2007 to April 2010.
  • Included preterm and term infants; apnoea was defined as occurring up to 48 hours post-immunisation.

Main Results:

  • 18% (7/38) of preterm infants with initial apnoea experienced recurrence with subsequent immunisations.
  • Lower birth weight and ongoing hospitalisation for prematurity complications were identified as risk factors for recurrence (p=0.04 and p=0.01, respectively).
  • No preterm infant experienced a third episode; no term infants showed recurrence.

Conclusions:

  • A significant risk of recurrent apnoea exists in preterm infants following immunisation.
  • Preterm infants with post-immunisation apnoea should undergo cardio-respiratory monitoring for at least 24 hours after subsequent vaccinations.
Abstract

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