Dammann Marie-Theres, Kraft Hannah, Stichtenoth Guido, Hanke Kathrin, Zemlin Michael, Soler Wenglein Janina, Ricklefs Isabell, Herz Alexander, Humberg Alexander, Viemann Dorothee, Engels Geraldine, Kopp Matthias Volkmar, Brinkmann Folke, Fortmann-Grote Carsten, Göpel Wolfgang, Herting Egbert, Härtel Christoph, Fortmann Ingmar
Department of Pediatrics, University Hospital of Lübeck, 23538 Lübeck, Germany.
Department of General Pediatrics and Neonatology, Saarland University, 66123 Homburg, Germany.
Vaccines (Basel). 2025 Jan 7;13(1):42. doi: 10.3390/vaccines13010042.
Very-low-birth-weight infants (VLBWIs; birth weight < 1500 g) are at an increased risk of complicated influenza infection, which frequently includes pneumonia, encephalitis or even death. Data on influenza immunization and its outcome in VLBWIs are scarce. This study aimed to provide epidemiological data on influenza immunization for German VLBWIs and hypothesized that immunization would protect VLBWIs from infection-mediated neurodevelopmental impairment and preserves lung function at early school age.
In this observational population-based German Neonatal Network (GNN) study, infants born between 2009 and 2015 were invited to partake in a 6-year follow-up investigation including lung function and developmental testing. Uni- and multivariate analyses were performed to evaluate the clinical characteristics and outcomes of influenza-immunized VLBWIs compared to non-immunized VLBWIs.
Influenza immunization was performed in 871 out of the 3358 VLBWIs (26%) with six-year follow-up. Immunized infants were characterized by a low gestational age and higher rates of morbidity, particularly bronchopulmonary dysplasia. Although early immunization showed no safety signals and had protective effects on the long-term risk of bronchitis (OR: 0.2; CI: 0.1-0.6; = 0.002), most VLBWIs (88.0%) were unimmunized in their first influenza season.
Influenza immunization was not associated with improved lung function (forced expiratory volume in one second and forced vital capacity) or a better neurocognitive outcome (intelligence quotient and strengths and difficulties questionnaire) at early school age. In Germany, only one quarter of 6-year-old VLBWIs were immunized against influenza, particularly those born <28 gestational weeks and/or BPD. Specific influenza immunization guidelines that define evidence-based recommendations are needed for this vulnerable group.
极低出生体重儿（出生体重<1500克）发生流感感染并发症的风险增加，常见并发症包括肺炎、脑炎甚至死亡。关于极低出生体重儿流感疫苗接种及其效果的数据很少。本研究旨在提供德国极低出生体重儿流感疫苗接种的流行病学数据，并假设疫苗接种可保护极低出生体重儿免受感染介导的神经发育损害，并在学龄早期维持肺功能。
在这项基于德国新生儿网络（GNN）的观察性人群研究中，邀请2009年至2015年间出生的婴儿参加一项为期6年的随访调查，包括肺功能和发育测试。进行单因素和多因素分析，以评估接种流感疫苗的极低出生体重儿与未接种疫苗的极低出生体重儿的临床特征和结局。
3358例极低出生体重儿中有871例（26%）进行了流感疫苗接种并随访6年。接种疫苗的婴儿具有胎龄小和发病率较高的特点，尤其是支气管肺发育不良。虽然早期接种未显示出安全信号，且对支气管炎的长期风险有保护作用（比值比：0.2；可信区间：0.1 - 0.6；P = 0.002），但大多数极低出生体重儿（88.0%）在其第一个流感季节未接种疫苗。
流感疫苗接种与学龄早期肺功能改善（一秒用力呼气量和用力肺活量）或更好的神经认知结局（智商和长处与困难问卷）无关。在德国，6岁的极低出生体重儿中只有四分之一接种了流感疫苗，尤其是那些胎龄<28周和/或患有支气管肺发育不良的婴儿。这一弱势群体需要明确基于证据的建议的特定流感疫苗接种指南。
