The vaccine is not the same for everyone. We are referring to the one against measles, and to the 21% of children who, according to the latest estimates from the World Health Organization, are born by caesarean section. In fact, according to a study conducted by a group of researchers from the University of Cambridge, in the United Kingdom, and Fudan University, in China, the first dose of the measles vaccine could be 2.6 times more likely to be ineffective in children born by cesarean section compared to those born by natural birth. Or, more precisely, scientists have shown that in the former a single dose of vaccine fails to elicit a sufficient immune response to immunize them from the infection, highlighting, however, at the same time, that the administration of a second dose induces a “strong immunity ” against the disease. The study was published in the journal Nature Microbiology.
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Measles, a disease not to be underestimated
Il measles it is caused by such an RNA virus Morbillivirus, is widespread throughout the world and has humans as its only natural host. History and numbers say that it is a serious disease and should not be underestimated: before the introduction of the vaccine, in the sixties, and the extensive vaccination programmes, measles epidemics occurred approximately every two or three years, and these epidemics caused an estimated number of over two and a half million deaths each year. Vaccination has helped to significantly reduce the incidence of the disease, which however still remains an important cause of morbidity and mortality: it is estimated that in 2022 almost 140 thousand people died from measles, especially in underdeveloped countries and mostly in children below under the age of five. Precisely for this reason, all six regions of the World Health Organization have set objectives for the elimination of measles – which requires the achievement of very high levels of immunity in the population (at least 95% vaccination coverage): to date only the Americas region reached this milestone in 2016, only to retreat in subsequent years. This is why it is important to keep your guard very high.
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I study
It is known that the development of a child’s immune system is (also) linked to the microbiome, i.e. the set of microorganisms that reside in the intestine. And in recent years several studies have tried to understand whether vaginal birth favors the transfer of these microorganisms from the mother to the newborn, who in some way could benefit from this “inheritance” process of the immune system. This was the starting point of the authors of the work: “We discovered that the way we are born, via cesarean section or natural birth – he explained Henrik Salje, one of the authors and professor in the Department of Genetics at the University of Cambridge – has long-term consequences on our immunity to disease during growth. In children born by caesarean section the measles vaccine is much more likely to fail, and therefore we would like to ensure that they receive a second dose to be adequately protected, and also to protect the rest of the population by keeping the immunization rate high.”
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To study the phenomenon, the researchers put together data from other studies (it is therefore a meta-analysis, i.e. a study of studies) relating, overall, to over 1,500 children born in the Hunan region, in China, and in particular blood samples taken at periodic intervals from the birth of children up to their twelfth birthday. In this way they were able to examine the change in the levels of antibodies against measles in the first years of life and after vaccination, and they discovered, precisely, that 12% of children born by cesarean section showed no immune response to the first vaccination: more than double those born with natural birth. If we wanted to look at the glass half full, we could say that many children born by cesarean section develop an immune response after the first vaccination; but, as previously mentioned, it is necessary for this percentage to be as high as possible to guarantee maximum safety for the individual and the population, and this is why the authors recommend the administration of the second dose especially for children born by cesarean section.
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The expert’s opinion
The newly published results, in any case, should be taken with a pinch of salt. “The authors of the work – he explains Rocco Russo, coordinator of the vaccination technical table of the Italian Society of Paediatrics (Sip) – measured the level of antibodies and compared it with the threshold considered ‘standard’ to be considered ‘protected’ by the vaccine. However, there are also other factors to consider: first of all the fact that the role of the maternal microbiome and how this is transmitted to the unborn child is not yet certain, and above all the fact that it is not only the number of antibodies that is important, but also the their quality. In other words, it is difficult to quantify whether or not a vaccine is effective simply based on the number of antibodies. Among other things, the Chinese vaccination calendar is different from ours – in China the first measles vaccination is administered at the eighth month of life, a period in which there could still be ‘interferences’ with maternal antibodies. In my opinion, the most important message that emerges from studies of this type is clear: whatever the method of delivery, you must always be vaccinated with two doses and within the times established by the national plan. It is essential to keep population coverage high.”
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