Neonatal vaccine effectiveness and the role of adjuvants

Expert Rev Clin Immunol. 2019 Aug;15(8):869-878. doi: 10.1080/1744666X.2019.1642748. Epub 2019 Jul 25.


Introduction: Neonates are less responsive to vaccines than adults, making it harder to protect newborns against infection. Neonatal differences in antigen-presenting cell, B and T cell function, all likely contribute. A key question is whether novel adjuvants might be able to make neonatal vaccines more effective. Areas covered: This review addresses the issues of how to improve neonatal vaccines, which we have defined as vaccines given in the first 4 weeks of life in a human infant or the first week of life in a mouse. A search was performed using keywords including 'neonatal immunity', 'neonatal immunisation', 'vaccine' and 'adjuvant' of PubMed articles published between 1960 and 2018. Expert opinion: Sugar-like structures have recently been shown to prime the infant adaptive immune system to respond to vaccines, being potentially more effective than traditional adjuvants. Sugar-based compounds with beneficial adjuvant effects in neonatal vaccine models include delta inulin (Advax), curdlan, and trehalose 6,6'-dibehenate. Such compounds make interesting neonatal adjuvant candidates, either used alone or in combination with traditional innate immune adjuvants.

Keywords: Advax; Neonate; adjuvant; carbohydrate; delta inulin; immunity; influenza; vaccine.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adjuvants, Immunologic / administration & dosage
  • Glycolipids / administration & dosage
  • Glycolipids / immunology
  • Humans
  • Immune System / drug effects
  • Immune System / growth & development
  • Immune System / immunology*
  • Immunity, Innate / drug effects
  • Immunity, Innate / immunology*
  • Infant, Newborn / growth & development
  • Infant, Newborn / immunology*
  • Inulin / administration & dosage
  • Inulin / analogs & derivatives
  • Inulin / immunology
  • Vaccination*
  • Vaccines / administration & dosage
  • Vaccines / immunology*
  • beta-Glucans / administration & dosage
  • beta-Glucans / immunology


  • Adjuvants, Immunologic
  • Glycolipids
  • Vaccines
  • beta-Glucans
  • delta inulin
  • trehalose 6,6'-dibehenate
  • curdlan
  • Inulin