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Abstract

Background
Invasive meningococcal disease (IMD) causes significant morbidity and mortality. Preterm infants may be at greater risk of IMD and may have reduced responses to the current 2+1 4CMenB vaccine schedule. Serum bactericidal antibody assays, using adult complement with infant serum, may not accurately assess infant immunity against N. meningitidis.

Methods
The literature was systematically reviewed for outcomes of immunogenicity, efficacy, effectiveness, reactogenicity and safety of routine vaccines in preterm infants. An epidemiological study compared incidence of IMD in preterm and term infants. A clinical trial compared the immunogenicity of 4CMenB vaccine when given to preterm infants according to a 2+1 and 3+1 schedule. Cord blood samples were collected and pooled to create a neonatal complement source for SBA assays to allow comparison of titres between assays using adult and neonatal complement.

Results
Although antibody and cellular responses were reduced following some vaccines, where a protective threshold exists preterm infants usually achieved this, and vaccine effectiveness and efficacy is similar between term and preterm infants. Vaccination is well tolerated in preterm infants and there is no evidence that vaccines should be delayed in this group. The incidence of IMD is higher in preterm than term infants, and the incidence is higher in infants born at <32 weeks of gestation (WG) compared to those born at 32-37 WG. The immunogenicity of 4CMenB in preterm infants vaccinated according to a 2+1 or 3+1 schedule is similar for strains 5/99 and 44/76-SL,although somewhat reduced for strain NZ98/254 in those infants vaccinated with a 2+1 schedule. There is no evidence of differences in SBA titres when using adult compared with neonatal complement.

Conclusions
IMD has significant consequences for infants. Preterm infants have a higher incidence of IMD than term infants; whilst the current 4CMenB vaccine schedule is acceptable ongoing surveillance must be prioritised.

Publication Type:	Thesis (Doctoral)
Subjects:	Q Science > QR Microbiology > QR180 Immunology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RJ Pediatrics
Departments:	School of Health & Medical Sciences > Infection and Immunity Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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