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Sunday, May 29, 2022

Antibiotics in childhood may weaken response to childhood vaccines

New research warns that infants and toddlers who have been given antibiotics may have a less vigorous immune response to routine childhood vaccinations.

This is the first study to suggest that antibiotics may reduce a youth’s ability to produce infection-fighting antibodies in response to vaccination.

Experts cautioned that more research is necessary, and it is not clear whether antibiotic use is associated with higher rates of success infections.

But the study builds on earlier work, in a study of laboratory animals and adults, indicating that antibiotics may hinder antibody production: The drugs temporarily kill off some of the beneficial bacteria living in the gut, And those bugs play an important role in immune function.

Routine childhood vaccines are highly effective against diseases such as polio, measles, mumps and chickenpox. They work by exposing the body to killed or weakened versions of a germ (or part thereof), which trains the immune system to fight off the foreign invader when a child later encounters it. Crucially, vaccines prompt the immune system to produce antibodies that recognize particular proteins on the surface of the germ.

But it has long been clear that children differ in the strength of their antibody response to vaccination. The reasons for that variation are largely unknown.

“So far, it’s been a big black box,” said senior researcher Dr. Michael Pichichero. “Some people used to say it was bad luck, which is not a very good answer.”

According to Pichichero, his team’s findings make a compelling case that antibiotic use is a factor. And they underscore the importance of using drugs only when necessary, he said.

The study included 560 infants and children whose blood samples were taken during routine screening between the ages of 6 months and 2 years. The researchers used them to measure the children’s antibody responses to four routine childhood vaccinations.

Overall, 342 youth (or 61%) received at least one antibiotic prescription. And the vaccine was more likely to show antibody responses in children who were “sub-protective,” versus children who had received no antibiotics.

The investigators found that among 12-month-olds who were given antibiotics, for example, only more than 20% of the vaccines had a sub-protective antibody response to certain antigens.

The researchers also found that the more antibiotic prescriptions a child received in the first year of life, the lower the level of vaccine antibodies at 12 to 15 months of age. Each prescription was linked to a 6% to 11% drop in antibody levels, depending on the vaccine.

“I think this study has important implications,” said Pichichero, who directs the Rochester General Hospital Research Institute in Rochester, NY. The findings were published online April 27 in the journal Pediatrics.

This underscores the importance of “judicious” antibiotic use — prescribing drugs only when necessary, he said.

Pichichero stressed that antibiotics only treat bacterial infections, and should not be used for viral infections such as the common cold or flu. Therefore, parents should not prompt their pediatrician for antibiotic prescriptions for those types of diseases, he said.

That’s an important message for parents, agreed Dr. Octavio Ramillo, chief of infectious diseases at Nationwide Children’s Hospital in Columbus, Ohio.

“We know that excessive antibiotic use is not good,” he said.

Ramillo called the antibody findings “very provocative,” but cautioned that more studies are needed to understand whether and how antibiotics affect the immune response to vaccination.


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“We know that the gut microbiome helps educate the immune system,” said Ramillo, who co-wrote an editorial published with the findings.

But, he said, the study could not show whether changes in the children’s gut bacteria explained the low antibody levels associated with antibiotic use. Future studies, Ramillo said, could investigate that by collecting stool samples from young people.

They also noted that the end result of the reduced antibody response is unclear: Do children given antibiotics have higher rates of any vaccine-preventable infections?

Even though a course of antibiotics can disturb the normal bacterial makeup of the gut, it tends to rebound, Pichichero said.

According to Ramillo, one question is how recent antibiotic use would have to affect the child’s antibody response to vaccination.

What is clear, however, is that parents must get their child vaccinated on time. Both doctors cautioned against delaying the baby’s next dose because of a recent antibiotic prescription.

more information

The American Academy of Pediatrics has information on antibiotics for parents.

SOURCES: Michael Pichichero, MD, director, Rochester General Hospital Research Institute, Rochester, NY; Octavio Ramillo, MD, chief, infectious diseases, Nationwide Children’s Hospital, and professor, pediatrics, The Ohio State University College of Medicine, Columbus; PediatricsApril 27, 2022, Online

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