早產兒常規接種疫苗可有效獲得免疫，但抗體濃度較低
作者：
小柯機器人發布時間：2020/9/19 22:47:57
荷蘭國家公共衛生和環境研究所Guy A. M. Berbers團隊研究了早產兒常規接種疫苗與抗體水平的關係。2020年9月15日，該研究發表在《美國醫學會雜誌》上。
國家針對嬰兒的免疫接種計劃的標準時間表可能不足以保護極早產和超早產的嬰兒。
為了評估常規接種對早產兒的免疫原性，2015年10月至2017年10月，研究組在荷蘭的8家醫院進行了一項多中心、前瞻性、觀察性隊列研究，招募了296名早產兒，並將其與2011年研究的66名健康足月兒對照組進行比較，所有嬰兒均按照相同時間表來進行疫苗接種。即在出生後2、3和4個月分別接種三劑白喉-破傷風類毒素-無細胞百日咳-滅活脊髓灰質炎-乙型流感嗜血桿菌-B型肝炎聯合疫苗，然後在11個月加強接種，並在出生後2、4和11個月接種10價肺炎球菌結合疫苗。
296例早產兒中男嬰佔56.1%，平均胎齡為30周，有220例（74.3%）早產兒完成了所有接種。至嬰兒1歲時，所有胎齡早產兒中達到針對百日咳毒素、白喉、破傷風和6種肺炎球菌血清型的最低保護閾值IgG抗體水平的比例為83.0%至100%不等，b型流感嗜血桿菌為34.7%至46.2%不等（在所有早產兒中佔40.6%），肺炎球菌血清型4、6B、18C和23F為45.8%至75.1%不等。
加強劑量接種後，除b型流感嗜血桿菌（88.1％）外，所有早產兒中達到保護性抗體水平的比例超過95％。一般來說，在初次接種和加強接種後，除百日咳毒素和肺炎球菌血清型4和19F外，所有早產兒與足月兒相比，所有疫苗誘導的抗體的幾何平均濃度均顯著降低。
總之，早產兒接受初次接種和加強免疫後，除b型流感嗜血桿菌外，大多數嬰兒在出生後第一年進行常規疫苗接種可達到針對大多數抗原的保護性抗體水平。但早產兒的抗體濃度通常比足月兒要低。
附：英文原文
Title: Association of Routine Infant Vaccinations With Antibody Levels Among Preterm Infants
Author: Elsbeth D. M. Rouers, Patricia C. J. Bruijning-Verhagen, Pieter G. M. van Gageldonk, Josephine A. P. van Dongen, Elisabeth A. M. Sanders, Guy A. M. Berbers
Issue&Volume: 2020/09/15
Abstract:
Importance The standard schedule of national immunization programs for infants may not be sufficient to protect extremely and very preterm infants.
Objective To evaluate the immunogenicity of routine vaccinations administered to preterm infants.
Design, Setting, and Participants A multicenter, prospective, observational cohort study of preterm infants stratified according to gestational age recruited from 8 hospitals across the Netherlands between October 2015 and October 2017, with follow-up until 12 months of age (October 2018). In total, 296 premature infants were enrolled and compared with a control group of 66 healthy term infants from a 2011 study, immunized according to the same schedule with the same vaccines.
Exposures Three primary doses of the diphtheria–tetanus toxoids–acellular pertussis–inactivated poliomyelitis–Haemophilus influenza type b–hepatitis B combination vaccine were given at 2, 3, and 4 months after birth followed by a booster at 11 months and a 10-valent pneumococcal conjugate vaccine at 2, 4, and 11 months after birth.
Main Outcomes and Measures Primary end points were (1) proportion of preterm infants who achieved IgG antibody against vaccine antigens at concentrations above the internationally defined threshold for protection after the primary series and booster dose and (2) serum IgG geometric mean concentrations after the primary series and booster vaccination. Proportions and geometric mean concentrations were compared in preterm infants and the control group of term infants.
Results Of 296 preterm infants (56.1% male; mean gestational age, 30 weeks), complete samples before vaccination, 1 month after the primary series, and 1 month after the booster were obtained from 220 preterm infants (74.3%). After the primary series, the proportion of preterm infants across all gestational age groups who achieved protective IgG antibody levels against pertussis toxin, diphtheria, tetanus and 6 of 10 pneumococcal serotypes varied between 83.0% and 100%, Haemophilus influenzae type b between 34.7% and 46.2% (40.6% among all preterm infants overall), and pneumococcal serotypes 4, 6B, 18C, and 23F between 45.8% and 75.1%. After the booster dose, protective antibody levels were achieved in more than 95% of all preterm groups, except for Haemophilus influenzae type b (88.1%). In general, geometric mean concentrations of all vaccine-induced antibodies were significantly lower in all preterm infants vs term infants, except for pertussis toxin and pneumococcal serotypes 4 and 19F after the primary series and booster vaccination.
Conclusions and Relevance Among preterm infants, administration of routine vaccinations during the first year of life was associated with protective antibody levels against most antigens in the majority of infants after the primary series and booster, except for Haemophilus influenzae type b. However, antibody concentrations were generally lower among preterm infants compared with historical controls.
DOI: 10.1001/jama.2020.12316
Source: https://jamanetwork.com/journals/jama/article-abstract/2770621