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Immunologic response of extremely premature infants to tetanus, Haemophilus influenzae, and polio immunizations
C T D'Angio1, W M Maniscalco, M E Pichichero
1Department of Pediatrics, Strong Children's Medical Center, University of Rochester, NY, USA.
Insights
Extremely premature infants show adequate immune responses to tetanus and Haemophilus influenzae type b vaccines. However, their response to serotype 3 polio vaccine may be diminished compared to full-term infants.
Area of Science:
- Immunology
- Neonatal Medicine
- Vaccinology
Background:
- Extremely premature infants (< 29 weeks gestation) often have altered immune development.
- Assessing vaccine immunogenicity in this vulnerable population is crucial for public health.
Purpose of the Study:
- To compare the immunologic responses of extremely premature infants to standard infant vaccines with those of full-term infants.
- To evaluate antibody titers against tetanus toxoid, Haemophilus influenzae type b polysaccharide, and poliovirus.
Main Methods:
- A cohort of 16 extremely premature infants received diphtheria-tetanus-pertussis, Haemophilus influenzae type b oligosaccharide-CRM197-conjugated (HbOC), and polio vaccines.
- Serum antibody levels were measured before vaccination and 4-6 weeks after the primary series.
- Responses were compared to those of full-term infants immunized with the same vaccine lots.
Main Results:
- Preterm and full-term infants exhibited similar antibody titers for tetanus toxoid and HbOC antigens.
- Proportions of infants with protective antibody levels against tetanus, HbOC, and poliovirus serotypes 1 and 2 were comparable.
- Extremely premature infants showed significantly lower protective antibody levels against poliovirus serotype 3 compared to full-term infants.
Conclusions:
- Extremely premature infants mount adequate antibody responses to tetanus and HbOC vaccines.
- Responsiveness to serotype 3 poliovirus vaccine may be reduced in extremely premature infants, warranting further investigation.
Objective:
To determine whether extremely premature infants have immunologic responses to tetanus toxoid, Haemophilus influenzae type b polysaccharide and polio vaccines similar to those of full-term infants.
Infants And Methods:
Sixteen extremely premature (< 29 weeks, < 1000 g at birth) infants received separate diphtheria-tetanus-pertussis and H influenzae type b oligosaccharide-CRM197-conjugated (HbOC) vaccines at 2, 4 and 6 months of chronologic age, enhanced potency inactivated polio vaccine at 2 months, and oral polio vaccine at 4 months. Serum was obtained for anti-tetanus toxoid (TT), anti-Haemophilus b polysaccharide (HbPs) and polio neutralizing antibody assays before the 2-month vaccination and 4 to 6 weeks after the 6-month vaccination. Comparison sera were obtained from full-term infants immunized with the same lots of diphtheria-tetanus-pertussis (n = 46) and HbOC (n = 66) vaccines or the same sequence of polio vaccines (n = 10).
Results:
Preterm and full-term infants had similar geometric mean titers of anti-TT antibodies, anti-HbPs antibodies, and neutralizing antibodies to polio serotypes 1, 2, and 3 after the completion of the primary series of vaccines. After vaccination, similar proportions of preterm and full-term infants had protective levels of antibody to TT (preterm 100% vs full-term 100% with levels > 0.01 IU/mL), HbPS (82% vs 87%, > 1.0 microgram/mL), and polio serotypes 1 (85% vs 80%, > or = 1:8) and 2 (100% vs 100%, > or = 1:8). Preterm infants were less likely than full-term infants to have protective levels of neutralizing antibody to polio serotype 3 (31% vs 90%, > or = 1:8).
Conclusions:
Extremely premature infants have adequate antibody responses to tetanus and HbOC antigens but may have diminished responsiveness to serotype 3 polio vaccine.