Baby vaccine schedule
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Baby Vaccine Schedule: Key Insights from Recent Research
Pneumococcal Conjugate Vaccine (PCV) Schedules
Comparison of 1+1 and 2+1 Schedules
A study conducted in the UK compared the immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) administered in two different schedules: a 1+1 schedule (doses at 3 and 12 months) and a 2+1 schedule (doses at 2, 4, and 12 months). The findings indicated that for nine out of the 13 serotypes in PCV13, the post-booster antibody responses in infants primed with a single dose were equivalent or superior to those following the standard 2+1 schedule. This suggests that a 1+1 schedule could maintain population control of vaccine-type pneumococcal disease in countries with established herd immunity1.
Immunogenicity in Preterm Infants
Preterm infants are at a higher risk for invasive pneumococcal disease and may have lower vaccine responses. A study assessed the immunogenicity of three PCV13 priming schedules in preterm infants: a reduced schedule (2 and 4 months), an accelerated schedule (2, 3, and 4 months), and an extended schedule (2, 4, and 6 months). The results showed that the reduced schedule resulted in higher post-booster IgG concentrations but lower post-primary concentrations. The choice of schedule may depend on the timing of the highest risk for invasive pneumococcal disease10.
Rotavirus Vaccine Schedules
RV3-BB Vaccine Efficacy
The RV3-BB human neonatal rotavirus vaccine was tested in two schedules: a neonatal schedule (doses at 0-5 days, 8 weeks, and 14 weeks) and an infant schedule (doses at 8, 14, and 18 weeks). The vaccine was found to be immunogenic and well-tolerated in both schedules. The neonatal schedule showed a vaccine efficacy of 75% in preventing severe rotavirus gastroenteritis, while the infant schedule showed an efficacy of 51%. This suggests that a birth dose strategy could improve the effectiveness of rotavirus vaccines2 6.
Hepatitis B Vaccine Schedules
Timing in Preterm Infants
The World Health Organization recommends administering the first dose of the hepatitis B vaccine within 24 hours of birth. However, guidelines vary significantly across countries, especially for preterm infants. Some guidelines recommend delaying the first dose until the infant reaches a certain weight (2000-2200 g). Further research is needed to determine the optimal timing for the first dose in preterm infants to ensure both safety and immunogenicity4.
Accelerated vs. Routine Schedules
A study compared the routine hepatitis B vaccine schedule (0, 1, 6 months) with an accelerated schedule (0, 1, 2 months) in newborns. The accelerated schedule resulted in quicker development of seroprotective antibody concentrations, although the antibody levels were lower at 7 months compared to the routine schedule. This suggests that an accelerated schedule can be used effectively in the newborn period, but further studies are needed to assess long-term protection8.
Combined Vaccines for High-Risk Infants
Penta- and Hexavalent Vaccines
A systematic review examined the use of penta- and hexavalent vaccines in high-risk infants, including those born prematurely. The immunogenicity and safety profiles were generally similar to those in full-term infants, although preterm infants experienced more cardiorespiratory adverse events such as apnea and bradycardia. Despite these risks, the completion rate of the primary immunization schedule was relatively high, although often delayed, increasing vulnerability to vaccine-preventable diseases3.
Conclusion
Recent research highlights the importance of tailoring vaccine schedules to the specific needs of infants, particularly those born preterm or in regions with high disease burdens. While alternative schedules such as the 1+1 PCV13 schedule and accelerated hepatitis B vaccine schedules show promise, further studies are needed to optimize these schedules for maximum efficacy and safety. Additionally, the use of combined vaccines in high-risk infants requires careful monitoring to mitigate adverse events while ensuring timely protection against multiple diseases.
Sources and full results
Most relevant research papers on this topic
Pneumococcal conjugate vaccine 13 delivered as one primary and one booster dose (1 + 1) compared with two primary doses and a booster (2 + 1) in UK infants: a multicentre, parallel group randomised controlled trial
A reduced priming schedule of PCV13 (1 + 1) compared to the current 2 + 1 schedule does not significantly impact post-booster antibody response in UK infants.
RCT
Rigorous Journal
Highly CitedSafety and immunogenicity of RV3-BB human neonatal rotavirus vaccine administered at birth or in infancy: a randomised, double-blind, placebo-controlled trial.
The RV3-BB vaccine is immunogenic and well-tolerated when administered as a three-dose neonatal or infant schedule, potentially improving the effectiveness and implementation of rotavirus vaccines.
RCTHighly CitedPenta- and hexavalent vaccination of extremely and very-to-moderate preterm infants born at less than 34 weeks and/or under 1500 g: A systematic literature review
Preterm infants respond to penta- and hexavalent vaccines similarly to full-term infants, but side effects like pauses in breathing and slow heart rate are more common, requiring close monitoring.
Systematic ReviewTiming of the First Dose of the Hepatitis B Vaccine in Preterm Infants
Existing guidelines on timing of the first dose of hepatitis B vaccine in preterm infants vary significantly between countries and regions.
Systematic ReviewRigorous JournalImmunogenicity of alternative ten-valent pneumococcal conjugate vaccine schedules in infants in Ho Chi Minh City, Vietnam: results from a single-blind, parallel-group, open-label, randomised, controlled trial
A three-dose PCV10 vaccination schedule at ages 2, 3, and 4 months is the most effective in Vietnam, with a two-dose schedule at ages 2 and 6 months showing the best results.
RCTHuman neonatal rotavirus vaccine (RV3-BB) targets rotavirus from birth
The RV3-BB neonatal rotavirus vaccine effectively prevents rotavirus gastroenteritis in newborns, with high vaccine response rates and minimal adverse events.
RCT
Large Human TrialRigorous JournalHighly CitedImmunisation of the preterm baby.
Preterm infants, regardless of gestational age, have adequate immunity to four infections after routine childhood immunisations, with no need for prematurity corrections.
RCTComparative study of the immunogenicity and safety of two dosing schedules of Engerix-B hepatitis B vaccine in neonates.
The accelerated vaccination schedule for hepatitis B vaccine in newborns led to faster antibody development but lower levels at 7 months of age compared to the routine schedule.
RCTA non-randomized vaccine effectiveness trial of accelerated infant hepatitis B immunization schedules with a first dose at birth or age 6 weeks in Côte d'Ivoire.
African infants may benefit from a first dose at birth or age 6 weeks, but both schedules have high failure rates among those born to HBeAg-positive mothers.
RCTSchedules for Pneumococcal Vaccination of Preterm Infants: An RCT
A reduced priming schedule of PCV13 in premature infants leads to higher post-booster IgG concentrations but lower post-primary concentrations, suggesting the optimum vaccine schedule depends on their risk for invasive pneumococcal disease.
RCT