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Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT

Kent, A; Ladhani, SN; Andrews, NJ; Scorrer, T; Pollard, AJ; Clarke, P; Hughes, SM; ... Heath, PT; + view all (2016) Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT. Pediatrics , 138 (3) , Article e20153945. 10.1542/peds.2015-3945. Green open access

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Abstract

BACKGROUND AND OBJECTIVE: Premature infants have a higher risk of invasive pneumococcal disease and are more likely to have lower vaccine responses compared with term infants. Increasingly, immunization schedules are including a reduced, 2-dose, pneumococcal conjugate vaccine priming schedule. Our goal was to assess the immunogenicity of 3 commonly used 13-valent pneumococcal conjugate vaccine (PCV13) priming schedules in premature infants and their response to a 12-month booster dose. METHODS: Premature infants (<35 weeks’ gestation) were randomized to receive PCV13 at 2 and 4 months (reduced schedule); 2, 3, and 4 months (accelerated schedule); or 2, 4, and 6 months (extended schedule). All infants received a 12-month PCV13 booster. Serotype-specific pneumococcal immunoglobulin G (IgG) for PCV13 serotypes was measured by using enzyme-linked immunosorbent assay 1 month after the primary and booster vaccinations. RESULTS: A total of 210 infants (median birth gestation, 29+6 weeks; range, 23+2–34+6 weeks) were included. After the primary vaccination, 75% (95% confidence interval [CI], 62–85), 88% (95% CI, 76–95), and 97% (95% CI, 87–99) of participants had protective antibody concentrations for at least one-half the PCV13 serotypes for the reduced, accelerated, and extended schedules, respectively. After the booster vaccination, participants receiving the extended schedule had significantly lower (P < .05) geometric mean concentrations compared with reduced (for 9 of 13 serotypes) and accelerated (for 4 of 13 serotypes) schedules, but nearly all participations, regardless of schedule or serotype, had seroprotective IgG concentrations. CONCLUSIONS: A reduced priming schedule of PCV13 resulted in higher post-booster IgG concentrations but lower post-primary concentrations. The optimum vaccine schedule for preterm infants will therefore depend on when they are most at risk for invasive pneumococcal disease.

Type: Article
Title: Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT
Open access status: An open access version is available from UCL Discovery
DOI: 10.1542/peds.2015-3945
Publisher version: http://doi.org/10.1542/peds.2015-3945
Language: English
Additional information: Copyright © 2017 by the American Academy of Pediatrics published, and trademarked by the American Academy of Pediatrics. All rights reserved.
Keywords: Science & Technology, Life Sciences & Biomedicine, Pediatrics, Acellular Pertussis-vaccine, C Conjugate Vaccine, B-cell Responses, United-kingdom, Immunological Memory, Controlled-trial, Immune-response, Uk Infants, Immunogenicity, Age
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1508331
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