Bernstein, 1983). The second one is that an adjuvant derived from walls of the bacterial cells used in the vaccine's manufacture is present. The third one is that antigens exhibiting complimentarity are present. When these three criteria are present an antigenic challenge to the host evokes autoimmunity. This hypothesis has been named Multiple-Antigen-Mediated-Autoimmunity (MAMA) Syndrome. Root-Bernstein has presented evidence that it exists in AIDS patients who develop encephalomyelitis (Sela and Arnon, 1992). Waisbren suggested that the MAMA Syndrome might be a mechanism that induces autoimmunity in susceptible individuals after vaccination with virus components that are also present in human tissue. These antigens may be associated with other complimentary viral antigens and bacterial cell wall components present in the patient who has been vaccinated.

Premature Infants14

Each year about 300,000 premature infants are born in the United States, and most of these survive past infancy (Ventura et al., 1996). Preliminary studies suggest that premature large birthweight infants have the same or less risk of experiencing the usual adverse effects reported for full-term infants following vaccination with HBV or DPT (Bernbaum et al., 1989; Koblan et al., 1988; Ramsay et al., 1995; Losonsky, unpublished data). However, recent data with DPT immunization in very low birth weight infants suggest that moderate to severe adverse reactions can occur following routine vaccination with DPT in infants born less than 1,000 grams (Sudhakarow et al., 1996). Routine immunization of extremely premature infants is associated with significant adverse events. According to Losonsky, larger studies that cover the full range of vaccines given to infants need to be done to assess the risk of common adverse events in premature infants.

Current vaccine schedules are based largely on the immune responses seen in full-term rather than premature infants. The human immune system matures throughout fetal life and up until about 2 years of age, however, so even full-term infants do not develop an adequate protective immune response to most vaccines administered in the first weeks of life. Losonsky expressed concern that premature infants given vaccines at the standard times may not develop adequate immunity to the diseases against which the vaccines are designed to protect. There is also speculation that some premature infants might develop immunologic tolerance to the viral or bacterial antigens in vaccines such that


 This section is based on information presented by Genevieve Losonsky.

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