Vaccination in Preterm
General Principles
- Administer vaccines based on chronological age, irrespective of birth weight or gestation period.
- Provide full standard dose of vaccines without reduction.
- Ensure deep intramuscular administration in anterolateral thigh using a 5/8 inch or smaller needle.
- Preterm infants mount adequate immune responses comparable to term newborns.
- Prematurity itself is not a contraindication to immunization.
Specific Vaccine Recommendations
Hepatitis B Vaccine Management For Infants Weighing <2000 Grams
- Decreased immune response observed when vaccine administered before one month of chronological age.
- Birth dose must not be counted as part of the primary series.
| Maternal HBsAg Status | Action Plan |
|---|---|
| Positive | Give Hepatitis B immune globulin + Hepatitis B vaccine within 12 hours of birth. Do not count birth dose. Give three additional doses at 6, 10, and 14 weeks. |
| Unknown | Give Hepatitis B immune globulin + Hepatitis B vaccine within 12 hours. Test mother for HBsAg. Do not count birth dose. Give three additional doses at 6, 10, and 14 weeks. |
| Negative | Give birth dose but do not count as part of primary series. Follow with standard primary doses. Alternatively, first dose may be postponed by one month. |
Bacillus Calmette-Guerin Vaccine
- Recommend early administration in stable preterm and low birth weight infants.
- Best administered after stabilization and preferably at time of hospital discharge.
Rotavirus Vaccine
- Consider vaccination if infant is clinically stable and at least 6 weeks of age.
- Defer administration until hospital discharge to prevent potential health care-associated viral spread.
Pneumococcal And Influenza Vaccines
- Prioritize administration due to increased infection susceptibility.
- Very low birth weight infants face up to ninefold higher incidence of invasive pneumococcal disease.
- Administer age-appropriate pneumococcal conjugate vaccine.
Respiratory Syncytial Virus Immunization
- High-risk preterm infants require protection against lower respiratory tract disease.
- Administer long-acting monoclonal antibodies like Nirsevimab or Clesrovimab during or entering first respiratory syncytial virus season.
Post-Exposure Prophylaxis For Varicella
- Significant exposure warrants varicella zoster immunoglobulin or intravenous immunoglobulin administration.
- Preterm infants >28 weeks gestation require prophylaxis if no maternal immunity exists.
- Preterm infants <28 weeks gestation or birth weight <1000g require prophylaxis irrespective of maternal immunity status.