Vaccination of premature babies – why it can’t be delayed

On this week’s blog, Dr Helen Sisson, @hsisson1 lecturer in public health, reiterates the importance of timely vaccination in premature infants for World Prematurity Day on November 17, 2023

Vaccination has been recognized as a key strategy for stopping infection in children, and well-established programs have been introduced within the UK (1). Essentially the most recent survey of parental attitudes (2) indicates that over 90% of fogeys imagine that vaccines are protected and effective, yet the usage of vaccines in kid’s programs has declined in recent times (3). This highlights the necessity to observe uptake and discover strategies to advertise uptake, targeting vaccinated groups. Premature infants constitute a population at increased risk of infection (4), so timely vaccination is amazingly necessary.

Even infants born prematurely have a functioning immune system (5); In each premature and full-term newborns, the immune system matures with age (6). Nonetheless, premature infants could also be at additional risk of infection as a consequence of the necessity to undergo invasive clinical procedures (7). Prenatally, maternal antibodies begin to cross the placenta from roughly 13 weeks of age, providing necessary passive protection to infants within the early weeks of life. Nonetheless, the overwhelming majority of antibody transfer occurs after the thirty second week of pregnancy – which means infants born before this point won’t find a way to profit from this significant protection (8), which increases their susceptibility to infection.

The first vaccination series within the UK starts at 8 weeks of age and the vaccine is obtainable to all babies, no matter gestational age. Although preterm infants are known to tolerate vaccination and show a response that is taken into account protective (9), it is suggested that preterm infants be observed for a time frame after vaccination as a consequence of the increased risk of apnea (10). It’s recognized that some premature infants could have real reasons to delay vaccination, but prematurity should never be the only reason for delay or withholding vaccination (10).

Despite global recommendations that premature infants should receive vaccinations similtaneously their full-term infants, empirical evidence from outside the UK suggests that undue delays occur for premature infants, with infants at the bottom gestational age being vaccinated the longest ( 11, 12). ). It’s subsequently particularly necessary to grasp the extent of interest in premature babies within the UK, and the supply of huge digital datasets signifies that it’s now possible to check this issue at a population level. My recent study took a population-based approach to analyze the problem of delaying primary vaccine administration in premature infants; efforts were also made to find out any additional characteristics of infants and fogeys related to timeliness of vaccinations. This study has been submitted for publication (13) and its results are expected to support each practitioners and policymakers of their efforts to advertise timely vaccinations in premature infants.

This 12 months World Prematurity Day falls on the seventeenth^vol November; a day to acknowledge the challenges faced by premature babies and their families (14). This creates a chance to lift awareness amongst parents and healthcare professionals concerning the importance of timely vaccination for premature infants.

Public Health England (2019) has published information on vaccinations specifically for folks of premature babies (link below) – this will likely be an encouragement for folks to precise any concerns and a chance to begin a discussion concerning the importance of vaccinations for premature babies. https://www.gov.uk/government/publications/a-quick-guide-to-childhood-immunisation-for-the-parents-of-premature-babies

Further information for healthcare professionals will be present in Chapter 7 of Vaccination against Infectious Diseases (Green Book): https://www.gov.uk/government/publications/immunisation-of-individuals-with-underlying-medical-conditions-the-green-book-chapter-7 This is applicable to vaccinations of individuals with comorbidities, and premature infants are included as a consequence of their increased susceptibility.

1. UK Health Security Agency (2023) Full routine vaccination schedule. Available online: https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule [Accessed 06/10/2023].
2. UK Health Security Agency (2023) Vaccines for kids: Parental attitudes survey 2022. Available online: https://www.gov.uk/government/publications/childhood-vaccines-parental-attitudes-survey-2022 [Accessed 06/10/2023].
3. Digital NHS (2023) Statistics on vaccination coverage amongst children. Available online: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-immunisation-statistics [Accessed 06/10/2023].
4. Collins, A, Weitkamp, ​​JH, Wynn, J (2018) Why are premature babies at increased risk of infection? Archives of Diseases in Childhood Fetal Neonatal Edition. 103 section 4; F391-F394.
5. Vaccine Knowledge (2018) Vaccines and premature babies. Available online: https://vaccineknowledge.ox.ac.uk/premature-babies [Accessed 06/10/2023].
6. Crofts, K, Alexander-Miller, M (2020) Challenges for the newborn immune response to respiratory virus infection and vaccination. Vaccinations. 8 section 4; 558.
7. Lissauer, T, Fanaroff, A, Miall, L, Fanaroff, J (2020) Neonatology in brief, 4^vol edition. Chichester: John Wiley and Sons Ltd.
8. Ciobanu, A, Dumitru, A, Gica, N, Botexatu, R, Peltecu, G, Panaitescu, A (2020) Advantages and risks of transplacental IgG transfer. Diagnostics. 10 section 8; 583.
9. Sadeck, L, Kfouri, R (2023) Update on vaccinations in premature infants. Journal of Pediatrics. 99 (Supp 1); S81-S86.
10. UK Health Security Agency (2022) UK vaccination schedule: Green Paper, Chapter 11. Available online: https://www.gov.uk/government/publications/immunisation-schedule-the-green-book-chapter-11 [Accessed 06/10/2023].
11. Bary-Weisberg, D, Stein-Zamir, C (2021) Timeliness and completeness of vaccinations amongst premature and low birth weight infants: national; cohort study. Human vaccines and immunotherapeutics. 17 section 6; 1666-1674.
12. Rouers, E, Berbers, G, van Dongen J, Sanders, E, Bruijning-Verhagen P (2019) Timeliness of vaccinations in premature infants within the Netherlands. Vaccine. 37; 5862-5867.
13. Sisson, H. (2023) Vaccination of premature infants: a regional news study. Primary health care. Manuscript submitted for publication.
14. Bliss (2023) What’s World Prematurity Day? Available online: https://www.bliss.org.uk/support-bliss/world-prematurity-day/what-is-world-prematurity-day#:~:text=World%20Prematurity%20Day%20(seventeenth%20November,it %20can%20have%20on%20family. [Accessed 06/10/2023].

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