Abstract
Childhood vaccination plays critical role in protecting infants from several dreaded diseases. Of the global 15 million preterm (PT) infants with compromised immune system born annually, India contributes to >3.5 million. Generation of adequate vaccine-induced immune response needs to be ensured of their protection. Immune response of Indian PT (n = 113) and full-term (FT, n = 80) infants to pentavalent vaccine administered as per the national recommendation was studied. Antibody titers against component antigens of pentavalent vaccine, immune cells profiling (T and B cells, monocytes and dendritic cells) and plasma cytokines were determined pre- and post-vaccination. Additionally, cell-mediated recall immune responses to pentavalent antigens were evaluated after short time antigenic exposure to infant PBMCs. Irrespective of gestational age (GA), all the infants developed adequate antibody response against tetanus, diphtheria, and protective but lower antibody levels for Haemophilus influenzae type-b and hepatitis B in preterm infants. Lower (~74%) protective antibody response to pertussis was independent of gestational age. PT-infants exhibited lower frequencies of CD4 T cells/dendritic cells/monocytes, increased plasma IL-10 levels and lower proliferation of central and effector memory T cells than in term-infants. Proliferative central memory response of FT-infants without anti-pertussis antibodies suggests protection from subsequent infection. Responder/non-responder PT-infants lacked immunological memory and could be infected with Bordetella. For hepatitis B, the recall response was gestational age-dependent and antibody status-independent. Humoral/cellular immune responses of PT-infants were dependent on the type of the immunogen. Preterm infants born before 32 weeks of gestation may need an extra dose of pentavalent vaccine for long lived robust immune response.
Highlights
The introduction of universal immunization program for infants has drastically reduced the dreaded diseases-associated mortality and morbidity in children
To understand basis for such differences, we examined circulating immune cells, cytokines and recall immune responses to immunogens of pentavalent vaccine
The primary aim of our study was to assess if the current national recommendations for pentavalent immunization of preterm infants are appropriate and ensure adequate immune response
Summary
The introduction of universal immunization program for infants has drastically reduced the dreaded diseases-associated mortality and morbidity in children. Immunization of preterm infants from Poland and Spain with a 13-valent pneumococcal conjugate vaccine at the ages of 2, 3, 4 and 12 months led to lower but acceptable antibody levels [11]. While revisiting data on immune response of preterm infants from different countries to hexavalent DTPa-HBV-IPV/Hib vaccine (>1600 preterm infants including 596 with GA ≤32 weeks, and 127 with GA
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