Reactogenicity of vaccines in prematurely born infants

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It is recommended that the primary immunization series against diphtheria, tetanus, pertussis, polio, Haemophilus influenzae b, and seven serotypes of Streptococcus pneumoniae be initiated at 2 months of age in stable prematurely born infants. Several studies using varying methodologies have tested the immediate safety of administration of vaccines. The current study of Pourcyrous et al used a prospective observational format to evaluate effects of administration of single vaccines compared with multiple vaccines simultaneously on clinical course and elevations of serum C-reactive protein (CRP) concentration. Overall, 16% of infants had cardiorespiratory events within 48 hours of immunization episodes, which were significantly associated with presence of gastroesophageal reflux (OR 4.76, 95% CI 1.22-18.52), and marginally associated with multiple versus single injections (OR 3.62, 95% CI 0.99-13.25). Elevation of CRP occurred in most infants (and more frequently when multiple injections were given simultaneously) and thus would not be a discriminating test for infection in infants with change in clinical course within 48 hours of immunization.