What 2012 vaccini

WHAT YOU SHOULD HAVE READ BUT….2012

 Vaccines
Attilio Boner
University of
Verona, Italy

Infant Pertussis Epidemiology and Implications
for Tetanus Toxoid, Reduced Diphtheria Toxoid,
and Acellular Pertussis (Tdap) Vaccination
Hanson APAM 2011;165:647
• Among 176 confirmed cases of
 Retrospective infants with pertussis,
analysis of reported the median age was 3 months;
80.1% were younger than 6 mo.
pertussis cases
among infants • 77% were age-appropriately
younger than 1 year. vaccinated.
• Households were the suspected
exposure location for
 January 1, 2002 - 70.0% of cases.
December 31, 2007.
• Case households had a
median of 3 (range, 1-15)
Tdap-eligible persons.

Infant Pertussis Epidemiology and Implications
for Tetanus Toxoid, Reduced Diphtheria Toxoid,
and Acellular Pertussis (Tdap) Vaccination
Hanson APAM 2011;165:647
• Among 176 confirmed cases of
Tdap vaccination
 Retrospective infants with pertussis,
analysis ofeligible
of reported the median age was 3 months;
household members
pertussis cases
80.1% were younger than 6 mo.
and close contacts
among infants • 77% were age-appropriately
younger thanpromoted
should be 1 year. vaccinated.
as an additional
• Households were the suspected
means of exposure location for
 January 1, 2002 -
protecting infants 70.0% of cases.
Decemberpertussis.
from 31, 2007.
• Case households had a
median of 3 (range, 1-15)
Tdap-eligible persons.

Spontaneous resolution of diphteria-tetanus vaccine
hypersensitivity in a pediatric population
Bégin, Allergy 2011;66:1508

 Allergy to the Diphteria and tetanus (DT ) vaccine is a clinical
challenge considering that the regular immunization schedule
includes multiple doses of DT-containing vaccine and that
boosters are needed throughout life;

 Although desensitization is an option in these patients, in our
experience, it is seldom performed, either because of lack of
access to a specialist or for fear of reactions.

Spontaneous resolution of diphteria-tetanus vaccine
hypersensitivity in a pediatric population
Bégin, Allergy 2011;66:1508

 Patients referred to our
institution from 1998 to 2009; On re-evaluation, only
3 patients still had
 15 patients whose allergy to positive skin test to
the DT component had been DT toxoids.
confirmed by a positive The remaining patients
immediate intradermal skin tolerated vaccination
test were contacted and challenges with DT
re-evaluated; vaccine, all 3 patients
with persistent allergy
 Initial reactions to vaccine had experienced
included 11 systemic reactions generalized reactions.
and 4 large local reactions.

The Risk of Immune Thrombocytopenic Purpura
After Vaccination in Children and Adolescents
O'Leary, Pediatrics 2012;129;248

WHAT’S KNOWN ON THIS SUBJECT: Studies on
vaccine safety are crucial to the ongoing success of our
national immunization program.
Immune Thrombocytopenic Purpura (ITP) has a known
association with MMR in young children, occurring
in 1 in 40 000 doses.
The risk after other childhood vaccines is unknown.


 Data from 5 managed
care organizations There were 197
for 2000 to 2009. chart-confirmed ITP
 1.8 million children cases out of 1.8 million
(6 weeks to 17 years). (0.01%)
children in the cohort.
 Incidence rate ratios
were calculated comparing
the risk of ITP in risk (1 to
42 days after vaccination)
and control periods.


 Data from 5 managed There was no elevated
care organizations
for 2000 to 2009. risk of ITP after
any vaccine in early
 1.8 million children childhood other
(6 weeks to 17 years). than MMR in the
12-19-month age group.
 Incidence rate ratios
were calculated comparing


There was a significantly
 Data from 5 managed elevated risk of ITP
care organizations after hepatitis A vaccine
for 2000 to 2009.
at 7 to 17 years of age,
 1.8 million children and
(6 weeks to 17 years). for varicella vaccine
and tetanus-diphtheria-
 Incidence rate ratios acellular pertussis
were calculated comparing vaccine at 11 to 17
years of age.


There was a significantly
 For hepatitismanaged
Data from 5 A,varicella, elevated risk of ITP
care tetanus-diphtheria-
and organizations
after hepatitis A vaccine
foracellular 2009.
2000 to pertussis
vaccines, elevated risks at 7 to 17 years of age,
 1.8 million children to two
were based on one and
vaccine-exposed cases.
(6 weeks to 17 years). for varicella vaccine
Most cases were acute and tetanus-diphtheria-
and mild with no
 Incidence rate ratios acellular pertussis
long-term
were calculated comparing vaccine at 11 to 17
the risk sequelae. risk (1 to
of ITP in
years of age.


CONCLUSIONS: ITP is unlikely after early childhood
vaccines other than MMR. Because of the small number of
exposed cases and potential confounding, the possible
association of ITP with hepatitis A, varicella, and
tetanus-diphtheria-acellular pertussis vaccines
in older children requires further investigation.

Anaphylaxis to diphtheria, tetanus, and pertussis
vaccines among children with cow’s milk allergy
Kattan JACI 2011;128:215

 The US national Vaccine Adverse Events Reporting System
lists 39 anaphylactic reactions to DTaP, DTP, or Tdap
vaccines for patients aged 0 to 17 years from 2007-2010.

 We noted that these vaccines are labeled as being
processed in medium containing casamino acids (derived
from cow’s milk), raising the concern that residual casein
in the vaccines might have triggered these reactions.

 To investigate this possibility, we tested 8 lots of the
vaccines for residual casein.


Mean casein concentrations in vaccine samples examined


 8 children were obtained by means of chart review.
 These patients were selected based on reports of
anaphylactic reactions to the vaccines and not because
of a history of milk allergy.

 Six of the patients had prior acute allergic reactions
to cow’s milk, including severe reactions in 5 patients
and reactions to trace exposures in 4 patients.

 In conclusion, our novel observation raises a concern
regarding booster vaccination of children with high
levels of milk allergy with Tdap and DTaP.

Recommendations for prevention and control of influenza
in children, 2011-2012
Committee on infectious diseases Pediatrics 2011;128:813
The key points for the upcoming
2011–2012 season are:

(1) the influenza vaccine composition for the 2011–2012 season is
unchanged from the 2010 –2011 season,


(2) annual universal influenza immunization is indicated,


(3) a simplified dosing algorithm for administration of influenza vaccine
to children 6 months through 8 years of age has been created,


(4) most children presumed to have egg allergy can safely receive
influenza vaccine in the office without need for an allergy
consultation,

Ù

(4) most children presumed to have egg allergy can safely receive
influenza vaccine in the office without need for an allergy
consultation,
(5) an intradermal trivalent inactivated influenza vaccine has been
licensed for the 2011–2012 season for use in people 18 through 64
years of age.

Special efforts should be made
to vaccinate people (1):
 All people 6 months of age and older should receive
trivalent seasonal influenza vaccine each year,
especially those who are at high risk of influenza
complications (eg, children with chronic medical conditions :
asthma, diabetes mellitus, immunosuppression, or neurologic
disorders).
 Annual trivalent seasonal influenza vaccine is recommended for
household members and out-of home care providers
of children and adolescents at high risk of complications
of influenza and healthy children younger than 5 years,
especially infants younger than 6 months.

Special efforts should be made
to vaccinate people (2):
 As soon as the trivalent seasonal influenza vaccine
is available locally, health care personnel (HCP)
should be immunized, publicize vaccine availability to
parents and caregivers.
 Any female who is pregnant, considering pregnancy, or
breastfeeding during the influenza season.


The number of trivalent
seasonal influenza vaccine
doses to be administered this
year depends on the child’s age
at the time of the first
administered dose and his or
her vaccine history :


• Infants < 6 months
The number of trivalent are too young to be
seasonal influenza vaccine immunized
doses to be administered this with influenza vaccine.
year depends on the child’s age
at the time of the first • Children 9 years
administered dose and his or of age and older need
her vaccine history : only 1 dose.


• Children 6 mo-8 yrs
The number of trivalent should receive
seasonal influenza vaccine 2 doses of vaccine
doses to be administered this if they did not receive
year depends on the child’s age any dose of vaccine last
at the time of the first season.
administered dose and his or
her vaccine history : The second dose should be
administered at least
4 weeks after the first
dose.


• Children 6 mo-8 yrs
The number of trivalent who received at least
seasonal influenza vaccine 1 dose of the 2010–2011
doses to be administered this trivalent seasonal
year depends on the child’s age influenza vaccine last
at the time of the first season, need only 1 dose
administered dose and his or of the 2011–2012
her vaccine history : influenza vaccine this
season.

Children Who Should Not Be
Vaccinated With TIV
(trivalent inactivated influenza vaccine):

<6 months;
who have a moderate-to-severe febrile illness;
who have experienced Guillain-Barré syndrome within 6 weeks
after a previous influenza vaccination;

Vaccinated With LAIV
(live attenuated influenza vaccine) (1):

<2 years;
who have a moderate-to-severe febrile illness;
with copious nasal congestion that would impede vaccine
delivery;
who have experienced Guillain-Barré syndrome within 6 weeks
after a previous influenza vaccination;


 who have received other live-virus vaccines within the previous
4 weeks; however, other livevirus vaccines can be given on the
same day as LAIV;
 with asthma, other chronic disorders of the pulmonary or
cardiovascular systems, or with a history of recurrent
wheezing ;
 with chronic medical conditions: metabolic disease, diabetes
mellitus, renal dysfunction, hemoglobinopathies.


 who have known or suspected immunodeficiency disease or
receiving immunosuppressive or immunomodulatory therapies ;
 who are receiving aspirin or other salicylates ;
 any female who is pregnant or considering pregnancy ;
 with any condition that can compromise respiratory function or
handling of secretions or can increase the risk for aspiration.


Pediatricians, nurses, and all health care
personnel
have leadership roles in the prevention of influenza
through
vaccine use and public education.

Randomized Controlled Trial of Dose Response to
Influenza Vaccine in Children Aged 6 to 23 Months
Skowronski, Pediatrics 2011;128:e276

 Reactogenicity in infants
(aged 6–11 months)
and toddlers
(aged 12–23 months). In toddlers,
post-immunization
 2 full (0.5-mL) or sero-protection rates
2 half (0.25-mL) doses exceeded 85%
of 2008–2009 for all 3 vaccine
split TIV components
(trivalent inactivated without significant
influenza vaccine). difference by dose.
 Full dose: n=124;
half-dose: n=128.


and toddlers In infants,
(aged 12–23 months). the full dose induced
 2 full (0.5-mL) or higher responses for all
2 half (0.25-mL) doses 3 vaccine components.
of 2008–2009 Rates of fever were
split TIV not increased
(trivalent inactivated among full- versus
influenza vaccine). half-dose recipients
in either age group.
half-dose: n=128.


and toddlers
Administration of In infants,
(aged 12–23 months).
2 full TIV doses the full dose induced
may improve
 2 full (0.5-mL) or higher responses for all
immunogenicity
without increasing
reactogenicity
in infants.
half-dose: n=128.


and toddlers
Current In infants,
(agedTIV dosing
12–23 months). the full dose induced
 2 full (0.5-mL) or for
recommendations higher responses for all
young children
warrant
additional
evaluation.
half-dose: n=128.

Influenza vaccination is associated with reduced severity
of community-acquired pneumonia Tessmer ERJ 2011;38:147

Pneumonia is an important cause of influenza-associated
morbidity and mortality.
Influenza vaccination has been shown to reduce morbidity and
mortality during influenza seasons.
Protection from severe pneumonia may contribute to the
beneficial effect of influenza vaccination.
Therefore, we investigated the impact of prior influenza
vaccination on disease severity and mortality in patients
with community-acquired pneumonia (CAP).

During the influenza
season in vaccinated
subjects OR
1.0 –

 Patients were
analysed separately
as an influenza
0.76
0.53
season (2.368 0.5 –
patients) and
off-season cohort.
 Vaccination status.
0
Severe Procalcitonin
pneumonia ≥2.0 ng/ml

subjects OR
These patients 1.0 –

 Patients were a
showed
analysed separately
significantly
as an influenza
0.76
better overall
0.53
season and 2.368 0.5 –

survival within the
off-season cohort.
6-month
follow-up period. 0

subjects OR
1.0 –
Within the
 Patients were cohort
off-season
analysed separately
(2,632 patients)
as an influenza
0.76
there was no
0.53
season (2.368 0.5 –
patients) and influence
significant
of vaccination
off-season cohort.
status on CAP
severity 0

Influenza Coinfection and Outcomes in Children
With Complicated Pneumonia. Williams APAM 2011;165:506

A bacterial pathogen was identified
in 1201 cases (35.5%).
The most commonly identified
 3382 children bacteria were
discharged from
Staphylococcus aureus
hospitals with
in children with
complicated
influenza coinfection
pneumonia (22.9% of cases)
requiring a and
pleural drainage. Streptococcus pneumoniae
in children without coinfection
(20.0% of cases).

Multivariable analysis comparing outcomes
between patients with complicated pneumonia
with and without influenza

Multivariable analysis comparing outcomes
between patients with complicated pneumonia
with and without influenza

Influenza coinfection
was associated with
higher odds of
intensive care unit
admission,
mechanical ventilation,
vasoactive infusions,
blood product
transfusions,
higher costs
and a
longer hospital stay.

Adherence to Expanded Influenza Immunization
Recommendations among Primary Care Providers
O’Leary, J Pediatr 2012;160:480
% doctors reporting adherence
to Advisory Committee on Immunization Practices
(ACIP)
100 –
 A survey July to 90 –
October 2009 80 –
70 –
 416 pediatricians 60 –
50 –
65%
 424 family 40 –
medicine physicians
35%
30 –
(FMs). 20 –
10 –
0

Pediatricians FMs


% of physician reporting routinely vaccinating patients
of different age groups during the ‘08-’09
influenza season (pediatrician vs FMs).
 A survey July to
October 2009

 416 pediatricians

 424 family
medicine physicians
(FMs).


RR for routine vaccination

 A survey July to 2 –
October 2009

 416 pediatricians 1 –
1.33
 424 family
medicine physicians
(FMs). 0
Having dedicated influenza vaccination
clinics after hours or weekends


1) The Advisory Committee on Immunization Practices (ACIP) has
incrementally expanded the recommendations for influenza vaccination
in children.
2) For many years, influenza vaccination has been recommended for
children aged >6 months with a chronic medical condition.
3) In 2002, the ACIP encouraged the vaccination of healthy children aged
6-23 months when feasible.
4) The recommendation was again expanded in 2006 to include children
aged 24-59 months.
5) Most recently, in 2008 the ACIP recommended expanding coverage to
all children aged 5-18 yrs.

Effectiveness of Pandemic H1N1 Vaccine Against
Influenza-Related Hospitalization in Children
Gilca Pediatrics 2011;128:e1084

Objective:
Young children are generally considered immunologically naive
with respect to influenza exposure opportunities; thus,
a 2-dose schedule is recommended when a child is first
immunized with conventional influenza vaccine lacking adjuvant.

We estimated the effectiveness of a single pediatric dose of
AS03-adjuvanted vaccine against hospitalization for confirmed
pandemic influenza A/H1N1 (pH1N1) infection in children aged 6
months to 9 years during the fall 2009 vaccination campaign.


1. The overall effectiveness of
 Case subjects were a single pediatric dose of
children hospitalized vaccine administered
for pH1N1 infection ≥14 days before illness
in the Fall of 2009. onset was 85%.
 Controls were 2. Overall vaccine
non-hospitalized effectiveness for
children, matched by age immunization ≥10 days
and region of residence. before illness onset was
slightly lower at 80% with
 Vaccination status in similar variation according
case subjects and to age.
controls.


Varying according to age
 Case subjects were
children hospitalized
category but with wide and
for pH1N1 infection overlapping confidence
in the Fall of 2009. intervals:
 Controls were
1) 92% in 6 –23 month-old
non-hospitalized
children, matched by age children,
and region of residence.
2) 89% in 2– 4 year-olds,
 Vaccination status in
case subjects and
controls.
3) 79% in 5–9 year-olds.

pH1N1 vaccination coverage in children younger than 10
years in Quebec, positive pH1N1 tests, and
number of study cases (children hospitalized for pH1N1)
according to CDC week.

77%
60%

27%

Children With Asthma Hospitalized With Seasonal
or Pandemic Influenza, 2003–2009
Dawood Pediatrics 2011;128:e27

% children hospitalized with
 2003–2009 influenza
influenza had asthma
seasons. 50 –

 2009 pandemic. 40 –
44%
 Surveillance of 5.3
32%
30 –
million children aged
17 yrs or younger. 20 –

 Hospitalization with 10 –
laboratory-confirmed
influenza and 0
identified those 2003–2009 2009
with asthma. influenza seasons pandemic


% children hospitalized with
 2003–2009 influenza
influenza had asthma
seasons.
Compared with 50 –

asthmatic children
 2009 pandemic.
with seasonal influenza,
40 –
44%
Surveillance of 5.3
a higher proportion with
32%
30 –
2009 pandemic H1N1
17 influenza required
yrs or younger. 20 –
intensive care
 Hospitalization with
(16% vs 22%; 10 –
laboratory-confirmed
influenzaP=0.01)
and 0
identified those 2003–2009 2009
with asthma. influenza seasons pandemic

% asthmatic children with
 2003–2009 influenza diagnoses of asthma exacerbations
seasons.
60 –
 2009 pandemic.
50 –

 Surveillance of 5.3 40 –
51%
17 yrs or younger. 30 –

 Hospitalization with 20 – 29%
laboratory-confirmed 10 –
influenza and
0
identified those influenza A influenza B
with asthma. (seasonal or pandemic)

Guillain-Barré syndrome and H1N1 influenza vaccine
in UK children. Verity, Lancet 2011;378:1546

Background:

• In 1976, the US National Influenza Immunization Programme
(against swine influenza) was discontinued because of an increased
risk of Guillain-Barré syndrome within 6 weeks of vaccination.

• Guillain-Barré syndrome surveillance was therefore imperative for
pandemic H1N1 influenza vaccines.


Children reported with symptoms of
Guillain-Barré syndrome

 September 2009-
August 2010.
 55 children with
Guillain-Barré syndrome.


49 had evidence of
an infection in the
prior 3 months:

 September 2009- • 22 respiratory;
August 2010. • 13 gastroenteritis;
• 7 H1N1 influenza;
 55 children with • 2 seasonal influenza;
Guillain-Barré syndrome. • 2 Epstein-Barr virus;
• 1 Chickenpox;
• 2 unexplained fevers;


49 had evidence of
an infection in the
prior 3 months:

 September 2009- of • 22 respiratory;
Of the 55 cases • 13 gastroenteritis;
August 2010.
Guillain-Barré • 7 H1N1 influenza;
 55 children with ,
Syndrome • 2 seasonal influenza;
9 had influenza.
• 1 Chickenpox;


49 had evidence of
an infection in the
Only 1 case with prior 3 months:

 Septemberor seasonal
H1N1 2009- • 22 respiratory;
• 13 gastroenteritis;
influenza
August 2010. vaccines
• 7 H1N1 influenza;
with an interval
 55 children with • 2 seasonal influenza;
potentially indicating
a causal relation. • 1 Chickenpox;


49 had evidence of
Given the proven an infection in the
effectiveness of prior 3 months:
pandemic influenza vaccine
 SeptemberUK children,
used in 2009- • 22 respiratory;
the vaccination
August 2010. • 13 gastroenteritis;
programme might have • 7 H1N1 influenza;
 55 children withprotective
had an overall • 2 seasonal influenza;
Guillain-Barréagainst
effect syndrome. • 2 Epstein-Barr virus;
Guillain- • 1 Chickenpox;
Barré syndrome. • 2 unexplained fevers;

Meningococcal Conjugate Vaccines Policy Update:
Booster Dose Recommendations
Committee on Infectious Diseases Pediatrics 2011;128:1213
The American Academy of Pediatrics approved updated recommendations
for the use of quadravalent (serogroups A, C, W-135, and Y)
meningococcal conjugate vaccines in adolescents and in people at persistent
high risk of meningococcal disease.

1. adolescents should be routinely immunized at 11 through 12 years
of age and given a booster dose at 16 years of age;


2. adolescents who received their first dose at age 13 through 15
years should receive a booster at age 16 through 18 years or up to
5 years after their first dose;


2. adolescents who received their first dose at age 13 through 15
years should receive a booster at age 16 through 18 years or up to
5 years after their first dose;
3. adolescents who receive their first dose of meningococcal
conjugate vaccine at or after 16 years of age do not need a
booster dose;


4. a 2-dose primary series should be administered 2 months apart
for those who are at increased risk of invasive meningococcal
disease because of persistent complement component deficiency
(eg, C5–C9, properdin, factor H, or factor D) (9 months through 54
years of age) or functional or anatomic asplenia (2–54 years of
age) and for adolescents with HIV infection;


5. a booster dose should be given 3 years after the primary series
if the primary 2-dose series was given from 2 through 6 years of
age and every 5 years for persons whose 2-dose primary series or
booster dose was given at 7 years of age or older who are at risk of
invasive meningococcal disease because of persistent component
deficiency (eg, C5–C9, properdin, factor H, or factor D) or
functional or anatomic asplenia.

Adolescent Perceptions of Risk and Need for Safer
Sexual Behaviors After First Human Papillomavirus
Vaccination. Kowalczyk Mullins T, APAM 2012;166:82
% girls sexually experienced
60 -
 Girls 13 to 21 yrs (n=339)
receiving their first
HPV vaccination.
50 –
57.5%
40 –
 Their mothers (n=235).
30 –

20 –

10 –

0

60 -
 Girls 13 to 21 yrs (n=339)
Girls perceived
receiving their to be
themselves first
HPVat less risk for
vaccination.
50 –
57.5%
HPV than for 40 –
other sexually
transmitted 30 –
infections after
HPV vaccination 20 –
(P<0.001)
10 –

0

60 -
 Girls adolescents perceived
Few 13 to 21 yrs (n=339)

57.5%
less need for safer
receiving their first 50 –
sexual behaviors after
HPV first HPV vaccination.
the
vaccination.
Education about 40 –
HPV vaccines and
encouraging communication 30 –
between girls and
their mothers may 20 –
prevent misperceptions
among these adolescents
10 –

0

pneumococco

The original 7-valent formulation contains
serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, and results in a 98%
probability of protection against these strains, which caused 80%
of the pneumococcal disease in infants in the US.

In 2010, Pfizer introduced Prevnar 13 which contains
six additional strains (i.e., 1, 3, 5, 6A, 19A and 7F), which protect
against the majority of the remaining pneumococcal infections

Increased incidence of bronchopulmonary
fistulas complicating pediatric pneumonia
McKee Pediatr Pulmonol 2011;46:717

Background
The frequency of complicated
pneumococcal disease, including necrotizing
pneumonia, has increased over the last
decade.
During 2008–2009, we noted an increase in
the number of children whose empyema
was complicated by the development of a
bronchopleural fistula and air leak.
We studied these children to see if there
was an associated cause.


% children with fistula
35 – 33%
 Retrospective review of
30 –
children admitted with a
parapneumonic effusion 25 –

or empyema from 20 –
p<0.0001
2002 to 2007, compared 15 –
with 2008 to 2009.
10 –

 310 children. 05 –

00
1%
2002-2007 2008-2009


35 – 33%
Pneumococcal serotype 30 –
3 was identified in
parapneumonic effusion
10/16 (63%) children
25 –

orwith a bronchopleural
empyema from 20 –
p<0.0001
2002 to 2007, compared
fistula and 1/33 (3%) 15 –
withwithout (<0.0001).
2008 to 2009.
10 –


00
1%
2002-2007 2008-2009


35 – 33%
Pneumococcal serotype 30 –
3 infection, was not
parapneumonic effusion
covered by the
25 –

or empyema from 20 –
p<0.0001
heptavalent
2002 to 2007, compared
pneumococcal 15 –
with 2008 to 2009.
vaccine Prevenar. 10 –


00
1%
2002-2007 2008-2009

Immunogenicity and Safety of MMRV and PCV-7
Administered Concomitantly in Healthy Children
Leonardi Pediatrics 2011;128:e1387

 Immunogenicity and safety The immune responses to all
of a combination measles, antigens present in MMRV
mump, rubella, and varicella and PCV-7 were similar
vaccine (MMRV) (ProQuad) whether administered
administered to healthy concomitantly or sequentially.
children concomitantly The incidence of local and
with a pneumococcal systemic adverse experiences
7-valent conjugate vaccine (AEs) was comparable.
(PCV-7) (Prevnar). No vaccine-related serious
 1027 healthy 12- AEs were reported.
to 15-month-old children.

Pneumococcal polysaccharide vaccine at 12 months of
age produces functional immune responses
Licciardi, JACI 2012;129:794

Background: Infections with Streptococcus pneumoniae are a cause
of significant child mortality. Pneumococcal glycoconjugate vaccines
are expensive and provide limited serotype coverage.
The 23-valent pneumococcal polysaccharide vaccine (Pneumovax)
might provide wider serotype coverage but is reported to be weakly
immunogenic in children less than 2 years of age.
We have previously reported that Pneumovax administered to
healthy 12-month-old Fijian infants elicits significant serotype-
specific IgG responses.
However, the functional capacity of these responses in 12-month-
old infants is not known.

Proportion of infants with an opsonisation
index (OI) ≥8 to the 8 seroptypes tested
 Immunization with
Pneumovax 23
 Functional responses of
12-month-old infants
using the
opsonophagocytic and
antibody avidity assay
against 8 serotypes and
23 serotypes,
respectively

Proportion of infants with an opsonisation
index (OI) ≥8 to the 8 seroptypes tested

71%
Pneumovax
of infants
produced strong
opsonophagocytic
using the
activity against
4 of 8
serotypes
23 serotypes,
respectively

Proportion of infants with an avidity index
(AI) ≥50% to all vaccine seroptypes after
immunization with 23vPPV
Pneumovax 23
using the
23 serotypes,
respectively

(AI) ≥50% to all vaccine seroptypes after
30% immunization with 23vPPV
Produced
Pneumovax
high-avidity
serotype-specific
IgG antibodies to
using the
10 of 23
serotypes
2 weeks after
23 serotypes,
Pneumovax
respectively

Responses were (AI) ≥50% to all vaccine seroptypes after
protective for most immunization with 23vPPV
serotypes that cause
Pneumovax Western
disease in
Countries.
12-month-old infants to
Whereas responses
using most of the
the
epidemiologically
relevant serotypes
against 8developing and
for serotypes
23 serotypes,
countries
respectively low
were

Hospitalizations for Intussusception Before and After the
Reintroduction of Rotavirus Vaccine in the United States
Zickafoose APAM 2012;166:350
Observed and predicted hospital discharges for
intussusception for infants before (1997-2006)
and after (2009) rotavirus vaccine reintroduction

 Children < 1 year with a
discharge diagnosis of
intussusception in the US
 4 years prior to vaccine
reintroduction (1997,
2000, 2003, and 2006)
and 1 year after (2009).

Hospitalizations for Intussusception Before and After the
Reintroduction of Rotavirus Vaccine in the United States
Zickafoose APAM 2012;166:350
Observed and predicted hospital discharges for
intussusception for infants before (1997-2006)
and after (2009) rotavirus vaccine reintroduction
The reintroduction
 Children < 1 year with a
of rotavirus vaccine
discharge diagnosis of
since 2006 has not
intussusception in the US
resulted in a detectable
 4 years prior to vaccine
increase in the number
reintroduction (1997,
of hospital discharges
2000, 2003, and 2006)
for intussusception
and 1 year after (2009).
among US infants.

Development of Cystic Periventricular Leukomalacia in
Newborn Infants after rotavirus Infection.
Verboon-Maciolek, J Pediatr 2012;160:165

 5 preterm & 3 term infants who presented with seizures
during rotavirus infection within 6 weeks after birth.
 6 of these infants developed late-onset
cystic periventricular leukomalacia.
 4 of the preterm infants had neurodevelopmental delay,
and 4 (near) term infants had normal early outcome.

Newborn Infants after Rotavirus Infection.

cranial UltraSonography (cUS)
cUS showing
severe
periventricul
ar
echogenicity
at
4 days (A-B).
cUS showing
early cystic
evolution in
the white


MRI
T2-weighted spin-
echo sequence
MRI, transverse
plane, performed 11
days after
systemic rotavirus
infection showing
extensive cysts
throughout the
periventricular and
deep white matter,
along with


1) Our small case series suggests that rotavirus enteritis with
neurologic manifestation in newborn infants may be associated
with white matter necrosis.

2) Thus, it is our practice to perform sequential neuroimaging
(cUS and MRI) in newborns with rotavirus infection, especially
when apnea and seizures are present.

Rotavirus Vaccine and Health Care Utilization for
Diarrhea in U.S. Children. Cortes, NEJM 2011;365:1108

Background:
Routine vaccination of U.S. infants with pentavalent rotavirus vaccine
(RV5) began in 2006.

Objective:
We compared the rates of diarrhea associated health care use in
vaccinated and unvaccinated children in 2007-2009 with the
pre-vaccine rates.


% of children who received
≥1 dose of RV5 by December 2008
100

80
 MarketScan databases
(2001-2009) in USA. 60 73%
 RV5 coverage and 40
64%
diarrhea-associated
20
health care use.
0 8%
 Children <5 yrs of age. <1 year 1 year 2-4 years

Age of children


% Relative Reductions from 2001–2006
in hospitalization rates for diarrhea
and specific rotavirus infection
100
(2001-2009) in USA. 80

 RV5 coverage and 60 75%
diarrhea-associated 60%
40
health care use.
20
35%
 Children <5 yrs of age. 25%
0
2007-2008 2008-2009


% Relative Reductions from 2001–2006
Nationally, in hospitalization rates for diarrhea
for the 2007–2009 and specific rotavirus infection
100
period, there was an
(2001-2009) in USA.
estimated reduction 80
of 64855
 RV5 coverage and 75%
60
hospitalizations
diarrhea-associated
saving approximately 40 60%
health care use.
$278 million
20
35%
 Children <5 yrs of age.
in treatment costs. 25%
0
2007-2008 2008-2009

Policy Statement-Prevention of Varicella: Update of
Recommendations for Use of Quadrivalent and
Monovalent Varicella Vaccines in Children
Brady Pediatrics 2011;128:630

Two varicella-containing vaccines are licensed:
- monovalent varicella vaccine (Varivax ),
- quadrivalent measles-mumps-rubella-varicella vaccine (MMRV).
After vaccination at 12 through 23 months of age, 7 to 9 febrile
seizures occur per 10.000 children who receive the MMRV, and
3 to 4 febrile seizures occur per 10.000 children who receive the
measles-mumps-rubella (MMR) and varicella vaccines administered
concurrently but at separate sites.
No increased risk of febrile seizures is seen among patients
4 to 6 years of age receiving MMRV.

Policy Statement-Prevention of Varicella: Update of
Recommendations for Use of Quadrivalent and
Monovalent Varicella Vaccines in Children
Brady Pediatrics 2011;128:630

• The American Academy of Pediatrics recommends that either
MMR and varicella vaccines separately or the MMRV be used for
the first dose of measles, mumps, rubella, and varicella vaccines
administered at 12 through 47 months of age.
• For the first dose of measles, mumps, rubella, and varicella
vaccines administered at ages 48 months and older, and for dose 2
at any age (15 months to 12 years), use of MMRV generally is
preferred over separate injections of MMR and varicella vaccines.

Il pediatra ha la possibilità di programmare e proporre
la strategia preventiva.

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