Published online June 22, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. e574-e579 (doi:10.1542/peds.2006-2241)
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ARTICLE

Measles-Mumps-Rubella and Varicella Vaccine Responses in Extremely Preterm Infants

Carl T. D'Angio, MDa, Paulina A. Boohene, MDa, Anne Mowrer, RNb, Susette Audet, BSc, Marilyn A. Menegus, PhDd, D. Scott Schmid, PhDe and Judy A. Beeler, MDc

a Departments of Pediatrics
b Medicine
d Microbiology and Immunology, University of Rochester, Rochester, New York
c Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland
e National VZV Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVE. Extremely preterm infants mount lower antibody responses than term infants to several vaccines. The objective of this study was to measure the immunogenicity of measles-mumps-rubella and varicella vaccines in preterm and term children.

METHODS. Immune status before immunization and immune response after immunization with measles-mumps-rubella and varicella vaccines at 15 months of age were compared in 32 infants, 16 of whom were preterm (<29 weeks' gestation) and 16 of whom were term (≥37 weeks' gestation) at birth. Blood was drawn before vaccination and 3 to 6 weeks thereafter. Measles antibody was measured by plaque reduction neutralization assay. Mumps and rubella immunoglobulin G were measured in available sera by enzyme-linked fluorescent immunoassay. Varicella immunoglobulin G was measured in available sera by glycoprotein enzyme-linked immunosorbent assay. Values that were above or below the assay limits were assigned values double or half those limits, respectively. The primary outcome was the geometric mean antibody titer.

RESULTS. Preterm children had lower mumps and rubella geometric mean titers than did term children before vaccine, and nearly all children were seronegative for each of the 4 vaccine antigens before immunization. Measles, mumps, rubella, and varicella geometric mean titers were similar between groups after vaccine. All children were seropositive for measles after vaccine, whereas 13 of 14 preterm and 11 of 13 term children were seropositive for mumps, 13 of 14 preterm and 13 of 13 term children were seropositive for rubella, and 11 of 16 preterm and 9 of 15 term children were seropositive for varicella.

CONCLUSIONS. Preterm children mounted antibody responses that were similar to those of term children after measles-mumps-rubella and varicella vaccines at 15 months of age.

Key Words: vaccines • premature infant • measles-mumps-rubella vaccine • varicella vaccine • very low birth weight infant • immunology • humoral immunity • immunization

Abbreviations: MMR—measles-mumps-rubella • GMT—geometric mean titer • IgG—immunoglobulin G • ELISA—enzyme-linked immunosorbent assay • RFV—relative fluorescence value • OD—optical density

Accepted Oct 18, 2006.