Rivista di formazione e aggiornamento professionale del pediatra e del medico di base, fondata nel 1982. In collaborazione con l'Associazione Culturale Pediatri.
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Vaccinare i neonati contro l’influenza stagionale?

Seasonal influenza immunization in infants younger than 6 months, too?

Maurizio Bonati

Laboratorio per la Salute Materno-Infantile, Dipartimento di Salute Pubblica, Istituto “Mario Negri”, Milano

Gennaio 2012 - pagg. 46 -48

Abstract
Vaccination against seasonal influenza is recognized worldwide as the main strategy for prevention and control. However, efficacy and effectiveness of influenza vaccines, both in people aged ≥65 years and in children, are lower than believed. Pediatricians, parents, and caregivers of infants and children in particular, are doubtful as to whether to recommend or accept influenza immunization of children or not. The majority of countries continues to apply World Health Organization recommendations that suggest vaccinating only children older than 6 months of age with certain coexisting conditions (chronic heart or lung diseases, metabolic or renal disease, chronic neurological conditions, or immunodeficiencies) through strategies that involve an active promotion of the vaccine. Currently, this vaccination is not recommended in any country for healthy, preterm, or low birth weight infants, even if they have chronic diseases that are contemplated by immunization strategies for infants ≥ 6 months. Based on scant evidence of efficacy and the wide methodological differences between the only three available studies, any attempt to suggest immunizing infants < 6 months of age against seasonal influenza would be arbitrary and unethical. Therefore, this population can be protected by limiting their exposure to influenza through both educational interventions targeting health care workers, family members, caregivers, and all individuals who reside with newborns, in particular ill ones, and “cocoon” immunization strategies immunizing all individuals who come into contact with infants.
Bibliografia
1. Vaccinazioni ai neonati. Scontro sull’antinfluenzale. Ravizza S, Corriere della Sera (Milano) del 10 ottobre 2011, pag. 5. 2. Jefferson T, Di Pietrantonj C, Al-Ansary LA, Ferroni E, Thorning S, Thomas RE. Vaccines for preventing infl uenza in the elderly. Cochrane Database Syst Rev 2010;2:CD-004876. 3. Vu T, Farish S, Jenkins M, Kelly H. A meta-analysis of effectiveness of influenza vaccine in persons aged 65 years and over living in the community. Vaccine 2002;20: 1831-36. 4. Jefferson T, Rivetti A, Harnden A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev 2008;2:CD-004879. 5. Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis 2011 Oct 25. [Epub ahead of print] 6. Morbidity and Mortality Weekly Report (MMWR). Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. http://www.cdc.gov/ mmwr/preview/mmwrhtml/mm6033a3.htm. 7. World Health Organization. Influenza (Seasonal). Fact sheet N°211. April 2009. http://www.who.int/mediacentre/factsheets/fs211/en/ 8. Flood EM, Rousculp MD, Ryan KJ, et al. Parents’ decision-making regarding vaccinating their children against influenza: A web-based survey. Clin Ther. 2010;32:1448-67. 9. http://www.salute.gov.it/influenza/pagi-naInternaMenuInfluenza.jsp?id=686&lin-gua=italiano&menu=vaccinazione. 10. http://www.arsliguria.it/images/sto-ries/docs/pdf/protocollo_studio.pdf. 11. Nair H, Brooks WA, Katz M, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet 2011; 378:1917-30. 12. Poehling KA, Edwards KM, Weinberg GA, et al., for the New Vaccine Surveillance Network. The underrecognized burden of influenza in young children. N Engl J Med 2006;355:31-40. 13. Esposito S, Cantarutti L, Molteni CG, et al. Clinical manifestations and socio-economic impact of influenza among healthy children in the community. J Infect 2011;62:379-87. 14. Rhorer J, Ambrose CS, Dickinson S, et al. Efficacy of live attenuated influenza vaccine in children: a meta-analysis of nine randomized clinical trials. Vaccine 2009;27:1101-10. 15. Vesikari T, Knuf M, Wutzler P, et al. Oil-in-water emulsion adjuvant with influenza vaccine in young children. N Engl J Med 2011; 365:1406-16. 16. Saari TN; American Academy of Pediatrics Committee on Infectious Diseases. Immunization of preterm and low birth weight infants. Pediatrics 2003;112(1 Pt 1):193-8. 17. Gaudelus J, Lefèvre-Akriche S, Roumegoux C, et al. Vaccination du prematuré. Arch Pédiatr 2007;14:S24-S30. 18. Bhat N, Wrigth JG, Broder KR, et al. Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med 2005;353:2559-67. 19. Groothuis JR, Levin MJ, Rabalais GP, Meiklejohn G, Lauer BA. Immunization of high-risk infants younger than 18 months of age with split-product influenza vaccine. Pediatrics 1991;87(6):823-8. 20. Halasa NB, Gerber MA, Chen Q, Wright PF, Edwards KM. Safety and immunogenicity of trivalent inactivated influenza vaccine in infants. J Infect Dis 2008;197:1448-54. 21. Chiu SS, Chan KH, Tu W, Lau YL, Peiris JS. Immunogenicity and safety of intradermal versus intramuscular route of influenza immunization in infants less than 6 months of age: a randomized controlled trial. Vaccine 2009;27:4834-9. 22. Blanchard-Rohner G, Siegrist CA. Vaccination during pregnancy to protect infants against influenza: Why and why not? Vaccine 2011;29:7542-50. 23. Influenza vaccines. Rélève épidemiologique hebdomadaire/Section d’hygiene du Sécrétariat de la Société des Nations= weekly epidemiological record/Health Section of the Secretariat of the League of Nations 2005;80:279-87. 24. Lawrence RM, Pane CA. Human breast milk: current concepts of immunology and infectious diseases. Curr Probl Pediatr Adolesc Health Care 2007;37:7-36. 25. Dòrea JG. Breastfeeding is an essential complement to vaccination. Acta Paediatr 2009;98:1244-50. 26. Jefferson T, Del Mar CB, Dooley L, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2011;(7):CD006207. 27. Burke BL Jr, Nesmith CC, Ott RE, Hedrick ML. Through with the flu: how free family and caregiver immunization protects sick neonates. Clin Pediatr (Phila) 2010;49: 20-3.