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Half-dose immunization for diphtheria, tetanus, pertussis: response of preterm infants
J Bernbaum1, A Daft, J Samuelson
1Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine 19104.
Insights
Full-dose diphtheria, tetanus, pertussis (DTP) vaccines are recommended for preterm infants. Half-dose DTP vaccines resulted in a significantly lower immune response to pertussis, underscoring the importance of full-dose immunizations for adequate protection.
Area of Science:
- Pediatrics
- Immunology
- Vaccinology
Background:
- The American Academy of Pediatrics recommends full-dose diphtheria, tetanus, pertussis (DTP) vaccines for preterm infants.
- Some physicians administer reduced-dose DTP vaccines to preterm infants, fearing increased side effects.
Purpose of the Study:
- To evaluate the immune response and side effects of half-dose DTP vaccine in preterm infants.
- To compare the efficacy of half-dose versus full-dose DTP vaccination in preterm infants.
Main Methods:
- A study involving 20 preterm infants receiving half-dose DTP vaccine.
- A control group of 25 preterm infants received full-dose DTP vaccine.
- Assessed serologic responses to diphtheria, tetanus, and pertussis, and monitored for side effects.
Main Results:
- Full-dose DTP achieved a 96% serologic response to pertussis after two doses.
- Half-dose DTP resulted in a 45% failure to mount a pertussis immune response after three doses, requiring a fourth full dose.
- Serologic responses to diphtheria and tetanus were comparable between groups.
- Side effect incidence was low in both full-dose and half-dose groups, and lower than in full-term infants.
Conclusions:
- Preterm infants require full-dose DTP vaccines for adequate pertussis protection.
- Adherence to the American Academy of Pediatrics' full-dose DTP vaccination schedule is crucial for preterm infants.
- Reduced-dose DTP vaccination is insufficient for ensuring adequate protection against pertussis in preterm infants.
Abstract:
The American Academy of Pediatrics currently recommends administering full-dose diphtheria, tetanus, pertussis, (DTP) vaccine to preterm infants, beginning at 2 months' chronologic age. Many physicians, however, continue to administer DTP vaccine at a reduced dosage in an attempt to lessen side effects. This study was designed to quantitate the immune response of 20 preterm infants immunized with half-dose DTP vaccine and to determine the nature and extent of side effects. Control subjects were 25 preterm infants immunized with full-dose vaccine. Although 96% of infants who received a full dose were able to mount a serologic response to pertussis after a second dose of DTP, 45% of infants who received a half dose were unable to mount a similar immune response to pertussis even after a third dose of DTP and required a full-dose (fourth dose of DTP) vaccine to better ensure protection. Serologic responses to diphtheria and tetanus were similar in the two groups. The incidence of side effects in preterm infants receiving both full-dose and half-dose DTP was less than that seen in a full-term population. Thus, the physician caring for the preterm infant should adhere to the American Academy of Pediatrics' recommendation for the immunization of preterm infants and offer full-dose DTP vaccine at the routine time intervals of 2, 4, 6, and 15 or 18 months' chronologic age to ensure adequate protection.