Neonates vaccination

Respiratory Syncytial Virus. Respiratory syncytial vims (RSV) causes severe lower respiratory tract disease in infants. It is the major cause of hospitalization in the United States (- 90,000 events/yr) and it has a high mortaUty rate in neonates and other high risk populations, such as the geriatric population (51). Development of an RSV vaccine has always been a major priority, however, earlier attempts have mostiy failed (70). 

Niu, M.T., Saline, M.E. and Ellenberg, S.S. (1999). Neonatal deaths after hepatitis B vaccine The vaccine adverse event reporting system, 1991-1998. Arch. Pediatr. Adolesc. Med. 153 1279-1282. 

Herpes Simplex. There are two types of herpes simplex virus (HSV) that infect humans. Type I causes orofacial lesions and 30% of the U.S population suffers from recurrent episodes. Type II is responsible for genital disease and anywhere from 3 x 104 — 3 107 cases per year (including recurrent infectionsi occur. The primary source of neonatal herpes infections, which are severe and often fatal, is the mother infected with type II. In addition, there is evidence to suggest that cervical carcinoma may be associated with HSV-II infection. Vaccine development is hampered by die fact that recurrent disease is common. Thus, natural infection does not provide immunity and the best method to induce immunity artificially is not clear. A much better understanding of the pathogenesis of die virus and virus-host interactions are required for the efficient development of the vaccine. 

A full-term neonate was accidentally given carboprost 250 pg intramuscularly in an error for hepatitis vaccine. Within 15 minutes, he became tachypneic and hypertensive and then developed bronchospasm and dys-tonic movements and/or seizure activity in the arms. He was hyperthermic and had diarrhea. He recovered within 18 hours. 

Fig. 22.9 Screening of pregnant women in the final trimester with indications for simultaneous vaccination of the neonate...

Osteitis occurred in <0.1-30/100000 vaccinees and has been reported mainly among infants immunized with BCG in the neonatal period in the Scandinavian countries. A retrospective study showed that BCG osteitis was present in Sweden from 1949 onwards. The reported incidence was one per 40000 in children bom between 1960 and 1969 (53,54). In Sweden, the reported incidence of osteitis rose to one per 3000 and one per 4000 for children vaccinated in the neonatal period during 1972-75. Compulsory notification of BCG adverse effects to the Swedish Adverse Dmg Reaction Committee was introduced at that time. 

Adverse events after hepatitis B vaccine reported between 1 January 1991 and 31 May 1995 to the US Vaccine Adverse Events Reporting System have been reviewed (6). The patients included 58 neonates and 192 infants who were immunized with hepatitis B... 

Niu MT, Davis DM, Ellenberg S. Recombinant hepatitis B vaccination of neonates and infants emerging safety data from the Vaccine Adverse Event Reporting System. Pediatr Infect Dis J 1996 15(9) 771-6. 

Siegrist CA. Neonatal and early life vaccinology. Vaccine. 2001 19 3331-3346. 

Mor G, Yamshchikov G, Sedegah M. Induction of neonatal tolerance by plasmid DNA vaccination of mice./. Clin.Invest. 1996 98 2700-2705. 

Much debate surrounds the use of BCG vaccine, a matter of some importance, considering that TB kills c. 3 million people annually and that drug-resistant strains have emerged. While the vaccine has demonstrated some efficacy in preventing juvenile TB, it has little prophylactic effect against postprimary TB in those already infected. One solution is to bring forward the BCG immunization to include neonates. Immunization at 2-4 weeks of age will ensure that immunization precedes infection,... 

Less than 50 cases of fetal vaccinia have occurred, usually following primary vaccination of the mother in early pregnancy. Fetal vaccinia generally causes a stillbirth or neonatal death. The vaccine is not associated with congenital anomalies. No cases occurred among the 39,213 civilians receiving vaccination in 2003 (15). 

Economic and humanistic outcome evaluations are now made as part of healthcare governance. The information gained from valid outcome measures can be used on a national level to allocate expenditures for treating various sectors of the population (e.g. the elderly, neonates, etc.) or to determine which programs will receive financial resources (e.g. vaccine programs vs. acute influenza treatments). Outcome information can be used to help make decisions regarding the inclusion or exclusion of drugs on formularies. Complete information about the economic, humanistic... 

Some of the clinical consequences in SS disease include megaloblastic erythropoiesis, aplastic crisis, stroke, bone pain crisis, proneness to infection particularly by Pneumococcus, Salmonella, and Haemophilus due to hypos-plenism and acute chest syndrome. Prophylactic use of penicillin and antipneumococcal and Haemophilus vaccines has aided in the management of life-threatening infectious complications of SS disease. Neonatal screening has been used in the identification of infants with sickle cell disease so that risk of infection can be modulated by appropriate immunizations and penicillin prophylaxis. The acute chest syndrome characterized by chest pain is due to clogged pulmonary capillaries in a small number of studies, patients have been treated with inhaled nitric oxide, which dilates blood vessels with clinical improvement. 

BCG has also been found to have no effect on IgE sensitisation or even may have a protective effect. A retrospective case-controlled cohort study in children bom in Stockholm found that the BCG vaccination in infancy, beyond the neonatal period, had no primary preventive effect on the development of IgE sensitisation in children with atopic heredity [173(IIIC)]. The effects of BCG in early life in non-atopic families have not been studied. A study in Guinea-Bissau showed that children who were vaccinated with BCG in early infancy were less likely to be atopic, defined as positive skin prick testing at... 

Vandelaer, J., Birmingham, M., Gasse, F., Kurian, M., Shaw, C., and Gamier, S. 2003. Tetanus in developing countries an update on the maternal and neonatal tetanus elimination initiative. Vaccine 21 3442-3445. 

Fitzgerald M, Anand KJS. Development neuroanatomy and neurophysiology of pain. In Schechter NL, Berde CB, Yaster M, eds. Pain in Infants, Children and Adolescents. Baltimore, Williams Wilkins, 1993 11-31. Taddio A, Katz J, Ilersich Al, et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997 349 559-603. 

Worldwide, over 400 million people are infected with some form of chronic HBV. HBV is a leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. The economic consequences of infection with HBV are staggering. Primary prevention through universal vaccination of neonates and adolescents is likely to have the largest impact on curtading this disease. ... 

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