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Immunization of preterm infants: current evidence and future strategies to individualized approaches
(2022)
Preterm infants are at particularly high risk for infectious diseases. As this vulnerability extends beyond the neonatal period into childhood and adolescence, preterm infants benefit greatly from infection-preventive measures such as immunizations. However, there is an ongoing discussion about vaccine safety and efficacy due to preterm infants’ distinct immunological features. A significant proportion of infants remains un- or under-immunized when discharged from primary hospital stay. Educating health care professionals and parents, promoting maternal immunization and evaluating the potential of new vaccination tools are important means to reduce the overall burden from infectious diseases in preterm infants. In this narrative review, we summarize the current knowledge about vaccinations in premature infants. We discuss the specificities of early life immunity and memory function, including the role of polyreactive B cells, restricted B cell receptor diversity and heterologous immunity mediated by a cross-reactive T cell repertoire. Recently, mechanistic studies indicated that tissue-resident memory (Trm) cell populations including T cells, B cells and macrophages are already established in the fetus. Their role in human early life immunity, however, is not yet understood. Tissue-resident memory T cells, for example, are diminished in airway tissues in neonates as compared to older children or adults. Hence, the ability to make specific recall responses after secondary infectious stimulus is hampered, a phenomenon that is transcriptionally regulated by enhanced expression of T-bet. Furthermore, the microbiome establishment is a dominant factor to shape resident immunity at mucosal surfaces, but it is often disturbed in the context of preterm birth. The proposed function of Trm T cells to remember benign interactions with the microbiome might therefore be reduced which would contribute to an increased risk for sustained inflammation. An improved understanding of Trm interactions may determine novel targets of vaccination, e.g., modulation of T-bet responses and facilitate more individualized approaches to protect preterm babies in the future.
Background: Neuralgic amyotrophy (NA) has been described as a possible extrahepatic manifestation of hepatitis E virus (HEV) infection. Usually, HEV-associated NA occurs bilaterally. The clinical characteristics determining the course of HEV-associated NA have still not been defined. Methods: In this retrospective multicentric case series, 16 patients with HEV-associated NA were studied and compared to 176 HEV patients without NA in terms of their age, sex, and ALT levels. Results: Neither gender distribution (75% vs. 67% male) nor age (47 vs. 48 years median) differed significantly between the NA patients and controls. Eight NA patients (50%) presented with bilateral involvement — seven of these had right-side dominance and one had left-side dominance. Thirteen cases (81%) were hospitalized. Eight of these patients stayed in hospital for five to seven days, and five patients stayed for up to two weeks. The time from the onset of NA to the HEV diagnosis, as well as the diagnostic and therapeutic proceedings, showed a large variability. In total, 13 (81%) patients received treatment: 1/13 (8%) received intravenous immunoglobulins, 8/13 (62%) received glucocorticoids, 3/13 (23%) received ribavirin, and 6/13 (46%) received pregabalin/gabapentin. Patients with ages above the median (47 years) were more likely to be treated (p = 0.001). Conclusion: HEV-associated NA causes a relevant morbidity. In our case series neither the type of treatment nor the time of initiation of therapy had a significant effect on the duration of hospitalization or the course of the disease. The clinical presentation, the common diagnostic and therapeutic procedures, and the patients' characteristics showed large variability, demonstrating the necessity of standardized protocols for this rare but relevant disease.
The Northern Bald Ibis (Geronticus eremita, NBI) is an endangered migratory species, which went extinct in Europe in the 17th century. Currently, a translocation project in the frame of the European LIFE program is carried out, to reintroduce a migratory population with breeding colonies in the northern and southern Alpine foothills and a common wintering area in southern Tuscany. The population meanwhile consists of about 200 individuals, with about 90% of them carrying a GPS device on their back. We used biologging data from 2021 to model the habitat suitability for the species in the northern Alpine foothills. To set up a species distribution model, indices describing environmental conditions were calculated from satellite images of Landsat-8, and in addition to the well-proven use of optical remote sensing data, we also included Sentinel-1 actively sensed observation data, as well as climate and urbanization data. A random forest model was fitted on NBI GPS positions, which we used to identify regions with high predicted foraging suitability within the northern Alpine foothills. The model resulted in 84.5% overall accuracy. Elevation and slope had the highest predictive power, followed by grass cover and VV intensity of Sentinel-1 radar data. The map resulting from the model predicts the highest foraging suitability for valley floors, especially of Inn, Rhine, and Salzach-Valley as well as flatlands, like the Swiss Plateau and the agricultural areas surrounding Lake Constance. Areas with a high suitability index largely overlap with known historic breeding sites. This is particularly noteworthy because the model only refers to foraging habitats without considering the availability of suitable breeding cliffs. Detailed analyses identify the transition zone from extensive grassland management to intensive arable farming as the northern range limit. The modeling outcome allows for defining suitable areas for further translocation and management measures in the frame of the European NBI reintroduction program. Although required in the international IUCN translocation guidelines, the use of models in the context of translocation projects is still not common and in the case of the Northern Bald Ibis not considered in the present Single Species Action Plan of the African-Eurasian Migratory Water bird Agreement. Our species distribution model represents a contemporary snapshot, but sustainability is essential for conservation planning, especially in times of climate change. In this regard, a further model could be optimized by investigating sustainable land use, temporal dynamics, and climate change scenarios.