| Autor: |
Chiappini E; SODc Malattie Infettive AOU Meyer, Dipartimento di Scienze della Salute, Università di Firenze, Firenze, Italy. elena.chiappini@unifi.it., Petrolini C; Dipartimento di Scienze della Salute, Università di Firenze, Firenze, Italy., Caffarelli C; Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy., Calvani M; Dipartimento di Pediatria, Ospedale S. Camillo-Forlanini, Roma, Italy., Cardinale F; UOC Pediatria, Servizio di Allergologia e Pneumologia Pediatrica, Azienda Ospedaliera-Universitaria 'Consorziale-Policlinico', Ospedale Pediatrico Giovanni XXIII, Bari, Italy., Duse M; Dipartimento di Pediatria, Policlinico Umberto I, Università Sapienza di Roma, Roma, Italy., Licari A; Clinica Pediatrica, Fondazione IRCCS Policlinico 'S. Matteo', Università di Pavia, Pavia, Italy., Manti S; Dipartimento di Medicina Clinica e Sperimentale, Unità di Broncopneumologia Pediatrica, Università di Catania, Catania, Italy., Martelli A; UOC Pediatria, Azienda Ospedaliera G. Salvini, Ospedali di Garbagnate Milanese e Bollate, Milano, Italy., Minasi D; Unità Pediatria, Ospedale di Polistena, Reggio Calabria, Italy., Miraglia Del Giudice M; Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università della Campania Luigi Vanvitelli, Napoli, Italy., Pajno GB; Dipartimento di Pediatria, Unità di Allergologia, Università di Messina, Messina, Italy., Pietrasanta C; Terapia intensiva neonatale, Fondazione IRCCS 'Ca' Granda', Ospedale Maggiore Policlinico; Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italy., Pugni L; Terapia intensiva neonatale, Fondazione IRCCS 'Ca' Granda', Ospedale Maggiore Policlinico; Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italy., Tosca MA; Allergologia Pediatrica, Istituto Giannina Gaslini, Genova, Italy., Mosca F; Terapia intensiva neonatale, Fondazione IRCCS 'Ca' Granda', Ospedale Maggiore Policlinico; Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italy., Marseglia GL; Clinica Pediatrica, Fondazione IRCCS Policlinico 'S. Matteo', Università di Pavia, Pavia, Italy. |
| Abstrakt: |
Hexavalent vaccines, protecting against six diseases (diphtheria, tetanus, pertussis [DTaP], poliovirus, hepatitis B virus [HBV], and Haemophilus influenzae type b [Hib], are routinely the standard of care in Europe. The use of combined vaccines allows the reduction of number of injections and side effects, the reduction of costs, and the increase in adherence of the family to the vaccination schedule both in terms of the number of doses and timing. The safety profile, efficacy and effectiveness of hexavalent vaccines have been extensively documented in infants and children born at term, and data are accumulating in preterm infants. Hexavalent vaccines are particularly important for preterm infants, who are at increased risk for severe forms of vaccine preventable diseases. However, immunization delay has been commonly reported in this age group. All the three hexavalent vaccines currently marketed in Italy can be used in preterm infants, and recent data confirm that hexavalent vaccines have a similar or lower incidence of adverse events in preterm compared to full-term infants; this is likely due to a weaker immune system response and reduced ability to induce an inflammatory response in preterm infants. Apnoea episodes are the adverse events that can occur in the most severe preterm infants and / or with history of respiratory distress. The risk of apnoea after vaccination seems to be related to a lower gestational age and a lower birth weight, supporting the hypothesis that it represents an unspecific response of the preterm infant to different procedures. High seroprotection rates have been reported in preterm infants vaccinated with hexavalent vaccine. However, a lower gestational age seems to be associated with lower antibody titres against some vaccine antigens (e.g. HBV, Hib, poliovirus serotype 1, and pertussis), regardless of the type of hexavalent vaccine used. Waiting for large effectiveness studies, hexavalent vaccines should be administered in preterm infants according to the same schedule recommended for infants born at term, considering their chronological age and providing an adequate monitoring for cardio-respiratory events in the 48-72 h after vaccination, especially for infants at risk of recurrence of apnoea. |
