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Pertussis (Whooping Cough)
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PEDIATRICS Vol. 113 No. 4 April 2004, pp. 733-737

Antibody Response to Diphtheria-Tetanus-Pertussis Immunization in Preterm Infants Who Receive Dexamethasone for Chronic Lung Disease

Michael J Robinson, BM, FRCPCH*, Carrie Heal, MB, MRCPCH*, Elizabeth Gardener, MSc{ddagger}, Peter Powell, MB, BChir, FRCPCH§ and Douglas G. Sims, MB, FRCPCH||

* Neonatal Department, Hope Hospital, Salford, United Kingdom
{ddagger} Department of Research and Development, Hope Hospital, Salford, United Kingdom
§ Neonatal Department, Royal Bolton Hospital, Bolton, United Kingdom
|| Neonatal Department, St Mary’s Hospital, Manchester, United Kingdom

Objective. To study the effect of dexamethasone in preterm infants with chronic lung disease (CLD) on antibody response to routine immunization against diphtheria, tetanus, and pertussis (DTP).

Methods. Serum samples were obtained before and after immunization with DTP (Trivax-AD) from an unselected cohort of 93 preterm infants in the United Kingdom. Antibodies to diphtheria and tetanus and to 4 pertussis antigens (pertussis toxin, filamentous hemagglutinin, pertactin, and fimbrial agglutinogens 2 + 3) were measured by an enzyme-linked immunosorbent assay. Linear regression models were fitted to the natural log of antibody titers to compare the dexamethasone-treated and -untreated infants adjusting for potential risk factors.

Results. Sixty-seven (72%) of 93 infants received dexamethasone. Preimmunization geometric mean titers (GMTs) were comparable in both groups for all antibodies. The rise in GMT after immunization was reduced in the dexamethasone-treated group. Final GMT was significantly lower for tetanus, diphtheria, pertussis toxin, and fimbrial agglutinogens 2 + 3 but not for filamentous hemagglutinin or pertactin. Using the minimum protective titer of 0.01 IU/mL, there was no significant reduction in protection for diphtheria and tetanus in the dexamethasone-treated infants. Using the higher reference titer of 0.1 IU/mL, there was a 16% reduction in protection for diphtheria (95% confidence interval: 3%–27%) and a 9% reduction in protection for tetanus (95% confidence interval: –7% to 20%).

Conclusions. The use of dexamethasone for CLD in preterm infants is associated with a reduction in antibody titer to routine immunization against diphtheria and tetanus. Antibody responses to 2 of 4 pertussis antigens are reduced, but the clinical significance of this observation is unclear. Protection against tetanus and diphtheria is not impaired when the lower reference value for protective antibody is used. On the basis of this study of UK preterm infants who were treated with dexamethasone for the management of CLD, we conclude that the current DTP immunization schedule is adequate and do not recommend additional booster protection against tetanus or diphtheria during early infancy. When diphtheria prevalence is increased, however, additional protection should be considered.

Key Words: preterm • dexamethasone • chronic lung disease • diphtheria • tetanus • pertussis • immunization

Abbreviations: DTP, diphtheria, tetanus, and pertussis • Hib, Haemophilus influenzae type b • CLD, chronic lung disease • PT, pertussis toxin • FHA, filamentous hemagglutinin • AGG2+3, fimbrial agglutinogens 2+3 • PRN, pertactin • CI, confidence interval

Received for publication Aug 19, 2002; Accepted Aug 14, 2003.


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