The scenario of a drop in the protection of Brazilian children against vaccine-preventable diseases has worried specialists since 2015, and, among the alerts, is the need to vaccinate babies who are born prematurely. In an interview with Brazil Agencyat World Immunization Week, neonatologist Lilian Sadeck explains that premature babies need even more protection from vaccines.
“The premature baby has immunological immaturity. He receives less antibodies from the mother, because the antibodies pass mainly at the end of the pregnancy, and, with that, he is more susceptible (to diseases). And, in addition to being more vulnerable, they end up having more serious cases when they acquire the disease”, he explains. “The family needs to pay more attention, because they end up being hospitalized for a longer time and, in addition to having a more immature immune system, they are often unable to receive breastfeeding for a longer period of time”, says Lilian.
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Secretary of the Department of Neonatology of the Brazilian Society of Pediatrics (SBP), the doctor also calls for attention to the recommended ages for each vaccine, which remain the same, with the count from birth as a reference. Vaccines against meningitis, pneumonia, whooping cough, hepatitis B, rotavirus, flu and others in the first year of life should be applied according to the child’s chronological age, regardless of their weight or gestational age, warns the SBP.
What counts is the date the baby was born, says the doctor. “It’s something that confuses people, who sometimes think they have to give according to an age correcting prematurity.”
Premature babies are also at greater risk of adverse events when receiving some vaccines. Therefore, immunizers that prevent pertussis should preferably be acellular vaccines. In reference centers for special immunobiologicals (CRIEs), it is possible to find acellular penta (diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenzae type b) and hexacellular (diphtheria, tetanus, whooping cough, inactivated poliomyelitis (IPV), hepatitis B (HB) and Haemophilus influenzae type b (Hib)) for free.
“These are conjugate vaccines, in which the same dose protects against several diseases. They are vaccines that cause less suffering for the family and for the baby, because in one injection he receives several vaccines together”, advises the doctor. “Often, the family feels sorry for them, because the child was born prematurely, suffered, and was often hospitalized. So, we have to sensitize the family a lot so that they keep this calendar up to date.”
Pregnant women
Like premature babies, pregnant women also require more attention in relation to the vaccination schedule. Pregnant women have a specific immunization schedule and, if they have no history of dT vaccination (diphtheria and tetanus), they should receive two doses and, from the 20th week of gestation, one dose of dTpa vaccine (which also includes pertussis). Even if they have already received dT before, dTp is still recommended once per pregnancy.
“It is important that the mother receives these vaccines, mainly for the whooping cough component, because she will produce more antibodies and they will pass on to the fetus and protect the newborn in the first years of life.”
Hepatitis B vaccination history should also be checked. If it is not possible to complete the scheme during pregnancy, it should be completed after delivery, informs the maternity calendar updated last year by the Ministry of Health.
Lilian Sadeck also recommends that pregnant women receive vaccines against influenza and covid-19. The doctor points out that vaccination of pregnant women is also low. This occurs even though many of them are accompanied by health professionals.
“In addition to the pandemic having interfered with prenatal care, many pregnant women are unaware of the availability of these vaccines in the SUS (Unified Health System), which they can and should receive during prenatal care”, adds the doctor.
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