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Saeed Z, Greer O, Shah NM. Is the Host Viral Response and the Immunogenicity of Vaccines Altered in Pregnancy? Antibodies (Basel) 2020; 9:E38. [PMID: 32759839 PMCID: PMC7551810 DOI: 10.3390/antib9030038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/06/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
The intricacy of the maternal immune system arises from its ability to prevent a maternal immune response against a semi-allogenic fetus, while protecting the mother against harmful pathogens. However, these immunological adaptations may also make pregnant women vulnerable to developing adverse complications from respiratory viral infections. While the influenza and SARS pandemics support this theory, there is less certainty regarding the clinical impact of SARS-CoV-2 in pregnancy. In the current COVID-19 pandemic, vaccine development is key to public preventative strategies. Whilst most viral vaccines are able to induce a seroprotective antibody response, in some high-risk individuals this may not correlate with clinical protection. Some studies have shown that factors such as age, gender, and chronic illnesses can reduce their effectiveness and in this review, we discuss how pregnancy may affect the efficacy and immunogenicity of vaccines. We present literature to support the hypothesis that pregnant women are more susceptible to respiratory viral infections and may not respond to vaccines as effectively. In particular, we focus on the clinical implications of important respiratory viral infections such as influenza during pregnancy, and the pregnancy induced alterations in important leukocytes such as TFH, cTFH and B cells, which play an important role in generating long-lasting and high-affinity antibodies. Finally, we review how this may affect the efficacy of vaccines against influenza in pregnancy and highlight areas that require further research.
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Affiliation(s)
| | | | - Nishel Mohan Shah
- Academic Department of Obstetrics & Gynaecology, Imperial College London, Level 3, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; (Z.S.); (O.G.)
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Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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Llamas A, Amirthalingam G, Andrews N, Edelstein M. Delivering prenatal pertussis vaccine through maternity services in England: What is the impact on vaccine coverage? Vaccine 2020; 38:5332-5336. [PMID: 32563605 DOI: 10.1016/j.vaccine.2020.05.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/29/2020] [Accepted: 05/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prenatal pertussis vaccination was introduced in 2012 in England and is primarily delivered through general practice. Since 2017 some maternity services are commissioned to offer it too. We aimed to describe the maternity service delivery of prenatal pertussis vaccination and its impact on vaccine uptake. METHODS We described the proportion of maternity services in England commissioned to offer pertussis vaccination to pregnant women in 2017/18 and the proportion of women vaccinated in this setting using a self-administered survey of NHS commissioners. We categorised clinical commissioning groups (CCGs) in England into "implementing" and "non-implementing" pertussis vaccination in maternity services. We identified CCGs where vaccination data was reliably transferred from maternity services to primary care records (source of routine data on vaccine uptake) and among those compared changes in vaccine uptake in implementing vs non-implementing CCGs between March 2016 (before implementation) and March 2018 (after). FINDINGS Of 141 maternity service units in England, 61% delivered prenatal pertussis vaccine in 2017/18. Of those 57.0% of maternity services immunized less than 10% of pregnant women and only 7.1% of maternity services immunized more than 40% of pregnant women. Between March 2016 and March 2018, coverage increased by 19.6% among non-implementing CCGs compared with 17.8% among all implementing CCGs (difference -2.2, p = 0.48) and 28.2% among implementing CCGs with reliable methods of data transfer (difference 8.6, p = 0.04). This difference translated to a difference of 1.6 percentage points in absolute terms. INTERPRETATION Delivering pertussis vaccine through maternity services has a moderate but important impact on vaccine uptake. There is a need to improve data transfer on vaccines administered in maternity service units to primary care. Maternity services should offer the vaccine to improve coverage and thus optimise protection for young infants. Barriers to effective programme implementation should be investigated and addressed.
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Affiliation(s)
- Ana Llamas
- London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, UK; Public Health England, Wellington House, 133 - 155 Waterloo Road, London SE1 8UG, UK.
| | - Gayatri Amirthalingam
- Immunisation Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick Andrews
- Immunisation Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Michael Edelstein
- London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Immunisation Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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54
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Glover C, Crawford N, Leeb A, Wood N, Macartney K. Active SMS-based surveillance of adverse events following immunisation with influenza and pertussis-containing vaccines in Australian pregnant women using AusVaxSafety. Vaccine 2020; 38:4892-4900. [PMID: 32499067 DOI: 10.1016/j.vaccine.2020.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Maternal immunisation is important to protect both mother and baby, but safety concerns can lead to low uptake. AusVaxSafety participant-based surveillance actively monitors adverse events following immunisation (AEFI) in Australia. We aimed to analyse AEFI in the days following vaccination with seasonal inactivated influenza vaccine (IIV) and/or reduced antigen diphtheria-tetanus-acellular pertussis vaccine (dTpa) in pregnant women in Australia. METHODS De-identified AEFI reports were solicited from vaccine recipients via automated SMS survey (using SmartVax software) following routine vaccination with IIV and/or dTpa at 219 national sentinel surveillance sites from 2015 to 2018. AEFI rates were compared by vaccine group (IIV alone, dTpa alone, or IIV and dTpa together), vaccine brand, trimester (IIV only) and vaccination period (April to August 2016-2018; IIV only). Women who had two vaccination encounters during surveillance were identified and AEFI rates compared for each dose. RESULTS Among 13,758 participants, overall AEFI rates were lower following IIV (4.9%) than dTpa (6.4%) or IIV and dTpa given concomitantly (7.4%). The AEFI profile was similar for both vaccines, with injection site reactions, tiredness, and headache most commonly reported. Injection site pain and swelling/redness were significantly more common in women who received dTpa than IIV. Reports of medical attendance following immunisation were similar (0.3%) for each vaccine group. AEFI rates did not differ by IIV brand (FluQuadri®, Fluarix® Tetra), dTpa brand (Boostrix®, Adacel®), or by trimester. Among women with sequential dTpa vaccinations, 6.0% (7/116) had an AEFI following their second dTpa dose. CONCLUSIONS Self-reported AEFI rates did not differ by trimester (IIV), or by vaccine brand (IIV or dTpa). Concomitant influenza and pertussis vaccination was associated with more frequent, but low rates of minor, expected AEFI. These real world 'citizen science-based' data provide further reassuring evidence of the safety of maternal vaccination.
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Affiliation(s)
- Catherine Glover
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| | - Nigel Crawford
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Alan Leeb
- SmartVax, Illawarra Medical Centre, Ballajura, Western Australia, Australia; Illawarra Medical Centre, Ballajura, Western Australia, Australia.
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia; Department of Microbiology and Infectious Disease, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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55
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Alimohamadi Y, Zahraei SM, Karami M, Yaseri M, Lotfizad M, Holakouie-Naieni K. Spatio-temporal analysis of Pertussis using geographic information system among Iranian population during 2012-2018. Med J Islam Repub Iran 2020; 34:22. [PMID: 32551311 PMCID: PMC7293812 DOI: 10.34171/mjiri.34.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 01/29/2023] Open
Abstract
Background: In spite of existing vaccination programs in many countries, outbreaks of pertussis are still reported. In Iran, the suspected and confirmed cases of pertussis are reported annually. Due to the lack of similar studies, the purpose of the current study was to determine the Spatio-temporal distribution of Pertussis using Geographic Information System (GIS) to identify high-risk areas in Iran during 2012-2018. Methods: In the current cross-sectional study, registered data in the department of vaccine-preventable diseases in the Iranian ministry of health were used. To assess the temporal trend, the Cochran–Armitage test was used. To show the spatial distribution and to identify hotspot areas, Choropleth map and Getis-Ord Gi statistics were used. All analyses performed by Arc.map10.5, Stata 15 and Excel 2010. Results: The incidence of suspect pertussis cases had an increasing trend but did not have a linear trend (p=0.06). Most of the cases happened in under 1 year infants (62.66%). The incidence of reported cases in northern areas was higher than in the Southern areas. The Zanjan had the most reported cases during the understudied period with a median of 7.63 reported cases per 100,000. The clustering of infection and hotspots were identified in northern areas of Iran including Qazvin, Qom, Markazi, and Hamadan. Conclusion: Our results showed that the cumulative incidence of reported cases is increasing. The northern provinces had the highest incidence of Pertussis. Therefore, the causes of this spatio-temporal pattern of pertussis should be determined. Also, supervision on vaccination programs in high-risk areas is recommended.
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Affiliation(s)
- Yousef Alimohamadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Zahraei
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Manoochehr Karami
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfizad
- School of Electrical & Computer Engineering, Tarbiat Modares University, Tehran, Iran
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Nasser R, Rakedzon S, Dickstein Y, Mousa A, Solt I, Peterisel N, Feldman T, Neuberger A. Are all vaccines safe for the pregnant traveller? A systematic review and meta-analysis. J Travel Med 2020; 27:5588086. [PMID: 31616947 DOI: 10.1093/jtm/taz074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
Abstract
Pregnant travellers and their offspring are vulnerable to severe outcomes following a wide range of infections. Vaccine-preventable diseases can have a particularly severe course in pregnant women, but little is known about the safety of travel vaccines in pregnant women. We performed a systematic review of all published literature concerning the safety of vaccines frequently given to travellers such as yellow fever, MMR (mumps, measles and rubella), influenza, Tdap (tetanus, diphtheria and pertussis), meningococcus, hepatitis A and B, rabies, polio, typhoid fever, tick-borne encephalitis and Japanese encephalitis vaccines. We included case series, cohort studies and randomized controlled trials (RCTs). For the meta-analysis, we included only RCTs that compared the administration of a vaccine to placebo or to no vaccine. Outcome measures included severe systemic adverse events, maternal outcomes related to the course of pregnancy, neonatal outcomes and local adverse events. We calculated the risk ratio and its 95% confidence interval as the summary measure. The safety of influenza vaccine is supported by high-quality evidence. For Tdap vaccine, no evidence of any harm was found in the meta-analysis of RCTs. A slight increase in chorioamnionitis rate was reported in 3 out of 12 observational studies. However, this small possible risk is far outweighed by a much larger benefit in terms of infant morbidity and mortality. Meningococcal vaccines are probably safe during pregnancy, as supported by RCTs comparing meningococcal vaccines to other vaccines. Data from observational studies support the safety of hepatitis A, hepatitis B and rabies vaccines, as well as that of the live attenuated yellow fever vaccine. We found little or no data about the safety of polio, typhoid, Japanese encephalitis, tick-borne encephalitis and MMR vaccines during pregnancy.
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Affiliation(s)
- Roni Nasser
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Stav Rakedzon
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Amjad Mousa
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Ido Solt
- The Rappaport's Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.,Department of Gynaecology and Obstetrics, Rambam Healthcare Campus, Haifa, Israel
| | - Neta Peterisel
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.,Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Tzah Feldman
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Ami Neuberger
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.,Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,The Rappaport's Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Fan H, Gilbert R, O'Callaghan F, Li L. Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study. BMJ 2020; 368:m331. [PMID: 32075790 PMCID: PMC7190043 DOI: 10.1136/bmj.m331] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the association between macrolide antibiotics prescribing during pregnancy and major malformations, cerebral palsy, epilepsy, attention deficit hyperactivity disorder, and autism spectrum disorder in children. DESIGN Population based cohort study. SETTING The UK Clinical Practice Research Datalink. PARTICIPANTS The study cohort included 104 605 children born from 1990 to 2016 whose mothers were prescribed one macrolide monotherapy (erythromycin, clarithromycin, or azithromycin) or one penicillin monotherapy from the fourth gestational week to delivery. Two negative control cohorts consisted of 82 314 children whose mothers were prescribed macrolides or penicillins before conception, and 53 735 children who were siblings of the children in the study cohort. MAIN OUTCOME MEASURES Risks of any major malformations and system specific major malformations (nervous, cardiovascular, gastrointestinal, genital, and urinary) after macrolide or penicillin prescribing during the first trimester (four to 13 gestational weeks), second to third trimester (14 gestational weeks to birth), or any trimester of pregnancy. Additionally, risks of cerebral palsy, epilepsy, attention deficit hyperactivity disorder, and autism spectrum disorder. RESULTS Major malformations were recorded in 186 of 8632 children (21.55 per 1000) whose mothers were prescribed macrolides and 1666 of 95 973 children (17.36 per 1000) whose mothers were prescribed penicillins during pregnancy. Macrolide prescribing during the first trimester was associated with an increased risk of any major malformation compared with penicillin (27.65 v 17.65 per 1000, adjusted risk ratio 1.55, 95% confidence interval 1.19 to 2.03) and specifically cardiovascular malformations (10.60 v 6.61 per 1000, 1.62, 1.05 to 2.51). Macrolide prescribing in any trimester was associated with an increased risk of genital malformations (4.75 v 3.07 per 1000, 1.58, 1.14 to 2.19, mainly hypospadias). Erythromycin in the first trimester was associated with an increased risk of any major malformation (27.39 v 17.65 per 1000, 1.50, 1.13 to 1.99). No statistically significant associations were found for other system specific malformations or for neurodevelopmental disorders. Findings were robust to sensitivity analyses. CONCLUSIONS Prescribing macrolide antibiotics during the first trimester of pregnancy was associated with an increased risk of any major malformation and specifically cardiovascular malformations compared with penicillin antibiotics. Macrolide prescribing in any trimester was associated with an increased risk of genital malformations. These findings show that macrolides should be used with caution during pregnancy and if feasible alternative antibiotics should be prescribed until further research is available. TRIAL REGISTRATION ClinicalTrials.gov NCT03948620.
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Affiliation(s)
- Heng Fan
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Ruth Gilbert
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Finbar O'Callaghan
- Developmental Neurosciences Programme, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Leah Li
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
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Vygen-Bonnet S, Hellenbrand W, Garbe E, von Kries R, Bogdan C, Heininger U, Röbl-Mathieu M, Harder T. Safety and effectiveness of acellular pertussis vaccination during pregnancy: a systematic review. BMC Infect Dis 2020; 20:136. [PMID: 32054444 PMCID: PMC7020352 DOI: 10.1186/s12879-020-4824-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/24/2020] [Indexed: 12/31/2022] Open
Abstract
Background Infants < 3 months of age are at highest risk for developing severe complications after pertussis. The majority of pregnant women has low concentrations of pertussis-specific antibodies and thus newborns are insufficiently protected by maternally transferred antibodies. Acellular pertussis vaccination during pregnancy was recently implemented in various countries. Here, we assessed the evidence for safety and effectiveness of pertussis vaccination during pregnancy. Methods We searched Medline, Embase, and ClinicalTrials.gov from January 1st 2010 to January 10th 2019. We assessed risk of bias (ROB) using the Cochrane ROB tool and ROBINS-I. We evaluated the quality of evidence using the GRADE approach. Results We identified 1273 articles and included 22 studies (14 for safety; 8 for effectiveness), comprising 1.4 million pregnant women in safety studies and 855,546 mother-infant-pairs in effectiveness studies. No significant differences between vaccinated and unvaccinated women and their infants were observed for safety outcomes with the exception of fever and chorioamnionitis. Compared to no vaccination, three studies showed a significantly increased relative risk for the presence of the ICD-9 code for chorioamnionitis in electronic patient data after pertussis vaccination. However, no study reported an increased risk for clinical sequelae of chorioamnionitis after vaccination during pregnancy, such as preterm birth or neonatal intensive care unit admission. Vaccine effectiveness against pertussis in infants of immunized mothers ranged from 69 to 91% for pertussis prevention, from 91 to 94% for prevention of hospitalization and was 95% for prevention of death due to pertussis. Risk of bias was serious to critical for safety outcomes and moderate to serious for effectiveness outcomes. GRADE evidence quality was moderate to very low, depending on outcome. Conclusion Although an increased risk for a diagnosis of fever and chorioamnionitis was detected in pregnant women after pertussis vaccination, there was no association with a higher frequency of clinically relevant sequelae. Vaccine effectiveness for prevention of infant pertussis, hospitalization and death is high. Pertussis vaccination during pregnancy has an overall positive benefit-risk ratio. In view of the overall quality of available evidence ongoing surveillance of chorioamnionitis and its potential sequelae is recommended when pertussis vaccination in pregnancy is implemented. Trial registration PROSPERO CRD42018087814, CRD42018090357.
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Affiliation(s)
- Sabine Vygen-Bonnet
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany.
| | - Wiebke Hellenbrand
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Edeltraut Garbe
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Rüdiger von Kries
- Institute of Social Pediatrics and Adolescent Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Bogdan
- Institut für klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Medical Immunology Campus Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Heininger
- University of Basel Children's Hospital, Infectious Diseases and Vaccinology, Basel, Switzerland
| | - Marianne Röbl-Mathieu
- Working Group on Immunization of the federal state of Bavaria (LAGI), Munich, Germany.,Private practice for gynecology/obstetrics, Munich, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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Chander S, Gonzalez-Casanova I, Chaves SS, Otieno NA, Widdowson MA, Verani J, Frew P, Wilson A, Omer SB, Malik F. Antenatal care providers' attitudes and beliefs towards maternal vaccination in Kenya. Gates Open Res 2020; 4:19. [PMID: 34136751 PMCID: PMC8181780 DOI: 10.12688/gatesopenres.13091.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Maternal immunization is known to be one of the best strategies to protect both mothers and their infants from infectious diseases. Studies have shown that healthcare providers play a critical role in implementation of maternal immunization. However, little is known about providers' attitudes and beliefs towards vaccination that can influence their vaccine recommendations, specifically in low to middle income countries (LMIC). Methods: A self-administrated knowledge, attitude and behavior (KAB) survey was provided to 150 antenatal care providers across four different regions (Nairobi, Mombasa, Marsabit, and Siaya counties) of Kenya. The research staff visited the 150 clinics and hospitals and distributed a quantitative KAB survey. Results: Nearly all of the antenatal care providers (99%) recommended tetanus maternal vaccination. Similarly, 99% of the providers agreed that they would agree to provide additional vaccinations for pregnant women and reported that they always advise their patients to get vaccinated. Between 80 and 90% of the providers reported that religious beliefs, ethnicity, cultural background and political leaders do not affect their attitude or beliefs towards recommending vaccines. Conclusions: Considering the positive responses of healthcare providers towards vaccine acceptance and recommendation, these results highlight an opportunity to work in partnership with these providers to improve coverage of maternal vaccination and to introduce additional vaccines (such as influenza). In order to achieve this, logistical barriers that have affected the coverage of the currently recommended vaccines, should be addressed as part of this partnership.
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Affiliation(s)
- Subhash Chander
- Department of Global Health, Emory University, Atlanta, GA, 30322, USA
| | | | - Sandra S. Chaves
- Influenza Program, Kenya Center for Disease Control and Prevention, Nairobi, Kenya
| | - Nancy A. Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Kenya Center for Disease Control, Nairobi, Kenya
| | - Jennifer Verani
- Division of Global Health Protection, Kenya Center for Disease Control, Nairobi, Kenya
| | - Paula Frew
- Population Health & Health Equity Initiative, University of Nevada Las Vegas, Las Vegas, NV, USA
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Andrew Wilson
- Department of Global Health, Emory University, Atlanta, GA, 30322, USA
| | - Saad B. Omer
- Department of Global Health, Emory University, Atlanta, GA, 30322, USA
| | - Fauzia Malik
- Department of Global Health, Emory University, Atlanta, GA, 30322, USA
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Abstract
Vaccines administered to women during pregnancy can provide protection against serious infectious diseases for the mother, for the newborn, or both. Maternal immunization boosts the concentration of maternal antibodies that can be transferred across the placenta to directly protect infants too young to be immunized. In addition, indirect protection through prevention of maternal infection and through breast milk antibodies can be achieved through maternal immunization. In general, inactivated vaccines are considered safe for pregnant women and their fetuses, whereas live vaccines are avoided owing to the theoretical potential risk to the fetus. However, the risks and benefits of vaccination must be carefully weighed and whenever possible, protection to the mother and her infant should be prioritized. Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines are routinely recommended for all pregnant women in the United States. Seasonal inactivated influenza vaccine is recommended for all pregnant women in any trimester of pregnancy, mainly to protect the mother, but there is growing evidence that infants benefit from passive antibody protection against influenza complications. The Tdap vaccine is recommended during the third trimester of each pregnancy to provide optimal protection to infants who are at particularly high risk of pertussis complications and mortality in the first 3 months of life. The effects of maternal immunization on the prevention of maternal and infant disease have been demonstrated in observational and prospective studies of influenza and pertussis disease in the United States and worldwide. Maternal immunization has the potential to improve the health of mothers and young infants and therefore, other diseases of relevance during this period are now targets of active research and vaccine development, including group B streptococcus and respiratory syncytial virus. Similarly, several vaccines can be administered during pregnancy in special circumstances, when maternal health, travel, or other special situations arise. This article reviews the current recommendations for vaccination of women during pregnancy.
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Safety of tetanus, diphtheria, and acellular pertussis vaccination among pregnant active duty U.S. military women. Vaccine 2020; 38:1982-1988. [PMID: 31952872 DOI: 10.1016/j.vaccine.2020.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/01/2020] [Accepted: 01/04/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The tetanus, diphtheria, and acellular pertussis (Tdap) vaccine was approved for U.S. adults in 2005 and recommended for administration in every pregnancy in 2012, with optimal timing between 27 and 36 weeks' gestation. In the military, however, a current Tdap vaccination status is compulsory for service, and active duty women may be inadvertently exposed in early pregnancy. Safety data in this population are limited. OBJECTIVES To assess safety of inadvertent (0-13 weeks' gestation) and recommended (27-36 weeks' gestation) exposure to the Tdap vaccine in pregnancy. METHODS Pregnancies and live births from Department of Defense Birth and Infant Health Research program data were linked with military personnel immunization records to determine pregnancy Tdap vaccine exposure among active duty women, 2006-2014. Multivariable Cox and generalized linear regression models estimated associations between Tdap vaccine exposure and adverse pregnancy or infant outcomes. RESULTS Of 145,883 pregnancies, 1272 were exposed to the Tdap vaccine in the first trimester and 9438 between 27 and 36 weeks' gestation. Neither inadvertent nor recommended vaccine exposure were associated with spontaneous abortion, preeclampsia, or preterm labor. Among 117,724 live born infants, 984 were exposed to the Tdap vaccine in the first trimester and 9352 between 27 and 36 weeks' gestation. First trimester exposure was not associated with birth defects, growth problems in utero, growth problems in infancy, preterm birth, or low birth weight. Tdap vaccine exposure between 27 and 36 weeks' gestation was not associated with any adverse infant outcome. CONCLUSIONS Among a population of active duty women in the U.S. military who received the Tdap vaccine during pregnancy, we detected no increased risks for adverse maternal, fetal, or infant outcomes. Our findings corroborate existing literature on the safety of exposure to the Tdap vaccine in pregnancy.
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D'Heilly C, Switzer C, Macina D. Safety of Maternal Immunization Against Pertussis: A Systematic Review. Infect Dis Ther 2019; 8:543-568. [PMID: 31531826 PMCID: PMC6856234 DOI: 10.1007/s40121-019-00265-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Indexed: 01/02/2023] Open
Abstract
The WHO recommends vaccination of all children against pertussis. However, newborn infants remain vulnerable to infection. Pertussis vaccination during pregnancy has been introduced in several countries to protect newborns via transplacental transfer of maternal pertussis antibodies to the infant. We reviewed the impact of maternal pertussis vaccination on the health of pregnant women, the developing fetus, and health of the newborn. We searched PubMed/MEDLINE, EMBASE, Scopus (Elsevier), Cochrane Database of Systematic Reviews, ProQuest, and Science Direct to identify studies that assessed the safety of maternal pertussis vaccination. Twenty-seven English language publications published between January 1995 and December 2018 were included in this review. Pregnant women receiving pertussis vaccines did not have increased rates of systemic or local reactions. There were no safety concerns with repeat vaccination with other tetanus-containing vaccines or their concomitant administration with influenza vaccines. Maternal pertussis vaccination did not adversely affect pregnancy, birth or neonatal outcomes. This review confirms the safety of maternal pertussis vaccination during pregnancy. FUNDING: Sanofi Pasteur. Plain language summary available for this article.
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Affiliation(s)
| | | | - Denis Macina
- Sanofi Pasteur, Vaccines Epidemiology and Modeling, Lyon, France.
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63
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Immunogenicity, transplacental transfer of pertussis antibodies and safety following pertussis immunization during pregnancy: Evidence from a randomized, placebo-controlled trial. Vaccine 2019; 38:2095-2104. [PMID: 31776029 DOI: 10.1016/j.vaccine.2019.10.105] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pertussis immunization during pregnancy is recommended in many countries. Data from large randomized controlled trials are needed to assess the immunogenicity, reactogenicity and safety of this approach. METHODS This phase IV, observer-blind, randomized, placebo-controlled, multicenter trial assessed immunogenicity, transplacental transfer of maternal pertussis antibodies, reactogenicity and safety of a reduced-antigen-content diphtheria-tetanus-three-component acellular pertussis vaccine (Tdap) during pregnancy. Women received Tdap or placebo at 27-36 weeks' gestation with crossover ≤ 72-hour-postpartum immunization. Immune responses were assessed before the pregnancy dose and 1 month after, and from the umbilical cord at delivery. Superiority (primary objective) was reached if the lower limits of the 95% confidence intervals (CIs) of the pertussis geometric mean concentration (GMC) ratios (Tdap/control) in cord blood were ≥ 1.5. Solicited and unsolicited adverse events (AEs) and pregnancy-/neonate-related AEs of interest were recorded. RESULTS 687 pregnant women were vaccinated (Tdap: N = 341 control: N = 346). Superiority of the pertussis immune response (maternally transferred pertussis antibodies in cord blood) was demonstrated by the GMC ratios (Tdap/control): 16.1 (95% CI: 13.5-19.2) for anti-filamentous hemagglutinin, 20.7 (15.9-26.9) for anti-pertactin and 8.5 (7.0-10.2) for anti-pertussis toxoid. Rates of pregnancy-/neonate-related AEs of interest, solicited general and unsolicited AEs were similar between groups. None of the serious AEs reported throughout the study were considered related to maternal Tdap vaccination. CONCLUSIONS Tdap vaccination during pregnancy resulted in high levels of pertussis antibodies in cord blood, was well tolerated and had an acceptable safety profile. This supports the recommendation of Tdap vaccination during pregnancy to prevent early-infant pertussis disease. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02377349.
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Cable J, Srikantiah P, Crowe JE, Pulendran B, Hill A, Ginsberg A, Koff W, Mathew A, Ng T, Jansen K, Glenn G, Permar S, Wilson I, Weiner DB, Weissman D, Rappuoli R. Vaccine innovations for emerging infectious diseases-a symposium report. Ann N Y Acad Sci 2019; 1462:14-26. [PMID: 31659752 DOI: 10.1111/nyas.14235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 12/29/2022]
Abstract
Vaccines have been incredibly successful at stemming the morbidity and mortality of infectious diseases worldwide. However, there are still no effective vaccines for many serious and potentially preventable infectious diseases. Advances in vaccine technology, including new delivery methods and adjuvants, as well as progress in systems biology and an increased understanding of the human immune system, hold the potential to address these issues. In addition, maternal immunization has opened an avenue to address infectious diseases in neonates and very young infants. This report summarizes the presentations from a 1-day symposium at the New York Academy of Sciences entitled "Innovative Vaccines against Resistant Infectious Diseases and Emerging Threats," held on May 20, 2019.
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Affiliation(s)
| | | | - James E Crowe
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center; and Vanderbilt University, Nashville, Tennessee
| | - Bali Pulendran
- Institute for Immunity, Transplantation and Infection; Department of Pathology; and Department of Microbiology & Immunology, Stanford University, Stanford, California
| | - Adrian Hill
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Ann Ginsberg
- International AIDS Vaccine Initiative, New York, New York
| | - Wayne Koff
- The Human Vaccines Project, New York, New York
| | - Anuja Mathew
- Department of Cell and Molecular Biology, The University of Rhode Island, Kingston, Rhode Island
| | - Tony Ng
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, New York, New York
| | | | | | | | - Ian Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, San Diego, California
| | - David B Weiner
- Vaccine and Immunotherapy Center, The Wistar Institute, Philadelphia, Pennsylvania
| | - Drew Weissman
- Department of Medicine, The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Routine immunizations during pregnancy, doctors' compliance and patient hesitancy: A two stage study on vaccination uptake. Eur J Obstet Gynecol Reprod Biol 2019; 243:36-40. [PMID: 31671289 DOI: 10.1016/j.ejogrb.2019.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/07/2019] [Accepted: 10/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the compliance of healthcare professionals with national guidelines and the hesitancy of pregnant women to be immunized against influenza and pertussis. STUDY DESIGN We conducted a two-stage study. The first stage of our study included all women (n = 197) who gave birth in Alexandra Maternity Hospital in Athens, Greece during a 3-month period (April-June) 2018. They completed a questionnaire regarding their immunization status against influenza and pertussis. If pertinent, they detailed their reasons for not getting immunized. During the second stage of our study, we actively recommended both vaccines to the outpatients of Alexandra Maternity Hospital (n = 195) between September 2018 and January 2019. RESULTS The majority of women (92.9%) were immunized during childhood according to Greek national immunization guidelines. Almost all the women (98%) stated that they will vaccinate their children. More than half (65.5%) responded that they would have been vaccinated during pregnancy if their doctor had recommended it, but in 73.6% of cases, their doctor did not do so. Only a small proportion of women (16.2%) were immunized against influenza during pregnancy while none of them (0%) received the Tdap vaccine. In most cases (65%), study participants stated they were not immunized because their doctor did not recommend vaccination. Additionally, 9.7% of participants feared possible side effects. During the second stage of our study 94.9% out of 195 women agreed to get vaccinated against influenza and 92.8% against pertussis. CONCLUSIONS It is apparent that the compliance with the immunization guidelines during pregnancy is surprisingly low. However, health professionals appear to be reluctant to recommend vaccination during pregnancy. Women appear to trust their doctors and usually agree with their recommendations.
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Petousis-Harris H, Jiang Y, Yu L, Watson D, Walls T, Turner N, Howe AS, Griffin JB. A Retrospective Cohort Study of Safety Outcomes in New Zealand Infants Exposed to Tdap Vaccine in Utero. Vaccines (Basel) 2019; 7:vaccines7040147. [PMID: 31614582 PMCID: PMC6963487 DOI: 10.3390/vaccines7040147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 01/02/2023] Open
Abstract
We aimed to evaluate the safety of maternal Tdap; thus, we assessed health events by examining the difference in birth and hospital-related outcomes of infants with and without fetal exposure to Tdap. This was a retrospective cohort study using linked administrative datasets. The study population were all live-born infants in New Zealand (NZ) weighing at least 400 g at delivery and born to women who were eligible for the government funded, national-level vaccination program in 2013. Infants were followed from birth up to one year of age. There were a total of 69,389 eligible infants in the cohort. Of these, 8299 infants were born to 8178 mothers exposed to Tdap (12%), primarily between 28 and 38 weeks gestation as per the national schedule. Among the outcomes, we found a reduced risk for moderate to late preterm birth, low birth weight, small for gestational age, large for gestational age, respiratory distress syndrome, transient tachypnea of newborn, tachycardia or bradycardia, haemolytic diseases, other neonatal jaundice, anaemia, syndrome of infant of mother with gestational diabetes, and hypoglycemia in infants born to vaccinated mothers. There was no association between maternal Tdap, infant Apgar score at 5 min after birth, asphyxia, sepsis or infection, or hypoxic ischemic encephalopathy. Infant exposure to Tdap during pregnancy was associated with a higher mean birthweight (not clinically significant) and higher odds for ankyloglossia and neonatal erythema toxicum diagnoses. There were insufficient observations to allow examination of the effect of Tdap on extreme preterm and very preterm birth, and stillbirth, infant death, or microcephaly. Overall, we found no outcomes of concern associated with the administration of Tdap during pregnancy. NZ Health and Disability Ethics Committee Approval #14/N.T.A/169/AM05.
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Affiliation(s)
- Helen Petousis-Harris
- Vaccine Datalink and Research Group, Department of General Practice & Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Yannan Jiang
- Department of Statistics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Lennex Yu
- Department of Statistics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Donna Watson
- Immunisation Advisory Centre, Department of General Practice & Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Tony Walls
- Department of Paediatrics, University of Otago, PO Box 4345, Christchurch Mail Centre 8140, New Zealand.
| | - Nikki Turner
- Immunisation Advisory Centre, Department of General Practice & Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Anna S Howe
- Vaccine Datalink and Research Group, Department of General Practice & Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Jennifer B Griffin
- Social, Statistical, and Environmental Sciences, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
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Zhu DD, Wang XL, Zhang XP, Ma JJ, Kong DL, Zhang MM, Guo XD, Wang C. A Dissolvable Microneedle Formulation of Bordetella pertussis Subunit Vaccine: Translational Development and Immunological Evaluation in Mice. ACS APPLIED BIO MATERIALS 2019; 2:5053-5061. [DOI: 10.1021/acsabm.9b00730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dan Dan Zhu
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Xiao Li Wang
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
| | - Xiao Peng Zhang
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Jing Jing Ma
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
| | - De Ling Kong
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, People's Republic of China
| | - Ming Ming Zhang
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin 300192, People's Republic of China
| | - Xin Dong Guo
- Beijing Laboratory of Biomedical Materials, College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, People's Republic of China
| | - Chun Wang
- Department of Biomedical Engineering, University of Minnesota, 7-105 Hasselmo Hall, 312 Church Street S.E., Minneapolis, Minnesota 55455, United States
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Kitano T, Onishi T, Takeyama M, Shima M. Questionnaire survey on maternal pertussis vaccination for pregnant women and mothers in Nara prefecture, Japan. Hum Vaccin Immunother 2019; 16:335-339. [PMID: 31368853 DOI: 10.1080/21645515.2019.1651000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Infantile pertussis is a major concern and causes a significant health burden worldwide. Maternal adult tetanus, diphtheria, and acellular pertussis (Tdap) vaccination is very effective way of preventing infantile pertussis. However, Tdap has not been approved by the Japanese government or been included in Japan's national immunization program (NIP). We carried out a questionnaire survey to investigate whether Japanese women would accept the Tdap vaccination if they were provided with appropriate information.Methods: The questionnaire survey was administered to pregnant women who visited the Obstetrics and Gynecology Department and mothers who visited the Pediatrics Department of Nara Medical University, Kashihara City, Japan, between October 2018 and May 2019. The questionnaire included information about pertussis infection and maternal vaccination, followed by seven questions.Results: A total of 943 participants answered the questionnaire (481 pregnant women and 462 mothers). Before reading the information, just 4.6% of participants knew that infantile pertussis can be prevented by maternal vaccination. After reading the information, 93.0% and 92.6% of participants thought that the maternal Tdap vaccine should be approved by the Japanese government and be included in the NIP, respectively. Although only 67.6% of participants wished to have the maternal Tdap vaccine without government financial support after reading the information, 92.5% said they would have the vaccine with government support (P < .001).Conclusion: Most Japanese mothers and pregnant women would like the maternal Tdap vaccine to be approved by the government and included in the NIP, once they have been provided with appropriate information.
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Affiliation(s)
- Taito Kitano
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
| | - Tomoko Onishi
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
| | - Masahiro Takeyama
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara-shi, Japan
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Marchetti F, Vilca LM, Cetin I. Insights and expectations for Tdap vaccination of pregnant women in Italy. J Matern Fetal Neonatal Med 2019; 34:2132-2139. [PMID: 31456459 DOI: 10.1080/14767058.2019.1659240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pertussis is a widespread vaccine-preventable disease, associated with an increasing trend to hospitalization among newborns. Pertussis in newborns can be fatal, and the most effective way to prevent it is maternal immunization (MI) with a reduced antigen content tetanus, diphtheria, and acellular pertussis vaccine (Tdap). In Italy, the National Immunization Plan (NIP) 2017-2019 introduced de novo Tdap vaccination during each pregnancy at no cost for the recipient. Despite this, vaccination coverage is suboptimal. This survey of pregnant women across Italy was conducted to investigate their knowledge and expectations of Tdap. METHODS A cross-sectional survey was conducted. Pregnant women up to 28th gestational weeks were interviewed by Telephone using a questionnaire with 16 questions. Statistics were descriptive. RESULTS The final sample recruited 600 respondents evenly distributed across Italy. The average duration of pregnancy at the time of the interview was 20.8 weeks (standard deviation [SD] 6.0). Most women (60.7%) were between 30 and 40 years of age. About half were aware of the risks of pertussis for newborns (54.5%) and the increased risk of hospitalization (59.8%); 47.2% were aware that Tdap MI was offered free of charge under the NIP. Safety information regarding the mother and newborn was considered the most important information in deciding whether to be vaccinated (47.4%), followed by safety information related only to the newborn (29.5%). About half (52.2%) stated that they would "certainly" accept MI, and 25.3% would like to receive more information. Gynecologists were the preferred healthcare providers (HCPs) for the provision of MI information (34.3%), followed by pediatricians (25.5%). Two-thirds of the respondents would prefer to be informed about MI before getting pregnant (66.0%). Vaccines investigated specifically for use in pregnancy were preferred by respondents. Overall, no relevant differences were observed between women pregnant for the first time and those with more than one pregnancy, nor between geographical regions. CONCLUSIONS The results show room for improving the awareness and understanding of the risks of pertussis for infants and the protective role of MI. The pregnant women preferred to receive advice on MI from an HCP, primarily their gynecologist. They were most interested in information on the safety profile of Tdap during pregnancy, on the mother, fetus, and newborn. The potential impact of this study to support clinical practice of Healthcare Providers is highlighted in the Focus on the Patient section. [Formula: see text].
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Affiliation(s)
| | - Luz Maria Vilca
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Cetin
- Department of Obstetrics and Gynecology, University of Milano, Milano, Italy
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Präkonzeptionelle Impfberatung. GYNAKOLOGISCHE ENDOKRINOLOGIE 2019. [DOI: 10.1007/s10304-019-0257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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71
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McHugh L, Crooks K, Creighton A, Binks M, Andrews RM. Safety, equity and monitoring: a review of the gaps in maternal vaccination strategies for Aboriginal and Torres Strait Islander women. Hum Vaccin Immunother 2019; 16:371-376. [PMID: 31368832 DOI: 10.1080/21645515.2019.1649552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Influenza and pertussis infections are disproportionately higher among Aboriginal and Torres Strait Islander women and their infants compared to other Australians. These infections are potentially preventable through vaccination in pregnancy; however, there is a lack of systematic monitoring and therefore knowledge of vaccine uptake, safety and effectiveness in Australia, and specifically among Aboriginal and Torres Strait Islander women. The limited data available suggest there is a lower uptake of maternal vaccination among Aboriginal and Torres Strait Islander women compared to non-Aboriginal and Torres Strait Islander women, and this review seeks to explore potential reasons and the knowledge gaps in this regard. Other key gaps include the equitable access to quality antenatal care for Aboriginal and Torres Strait Islander women; and pregnancy loss <20 weeks gestation. Furthermore, our review highlights the importance of addressing these gaps in maternal vaccination strategies in partnership with Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.,Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Amy Creighton
- Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Michael Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.,Department of Population Health, National Centre for Epidemiology, Australian National University, Canberra, Australian Capital Territory, Australia
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Mesfin YM, Cheng A, Lawrie J, Buttery J. Use of routinely collected electronic healthcare data for postlicensure vaccine safety signal detection: a systematic review. BMJ Glob Health 2019; 4:e001065. [PMID: 31354969 PMCID: PMC6615875 DOI: 10.1136/bmjgh-2018-001065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/13/2018] [Accepted: 12/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background Concerns regarding adverse events following vaccination (AEFIs) are a key challenge for public confidence in vaccination. Robust postlicensure vaccine safety monitoring remains critical to detect adverse events, including those not identified in prelicensure studies, and to ensure public safety and public confidence in vaccination. We summarise the literature examined AEFI signal detection using electronic healthcare data, regarding data sources, methodological approach and statistical analysis techniques used. Methods We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Five databases (PubMed/Medline, EMBASE, CINAHL, the Cochrane Library and Web of Science) were searched for studies on AEFIs monitoring published up to 25 September 2017. Studies were appraised for methodological quality, and results were synthesised narratively. Result We included 47 articles describing AEFI signal detection using electronic healthcare data. All studies involved linked diagnostic healthcare data, from the emergency department, inpatient and outpatient setting and immunisation records. Statistical analysis methodologies used included non-sequential analysis in 33 studies, group sequential analysis in two studies and 12 studies used continuous sequential analysis. Partially elapsed risk window and data accrual lags were the most cited barriers to monitor AEFIs in near real-time. Conclusion Routinely collected electronic healthcare data are increasingly used to detect AEFI signals in near real-time. Further research is required to check the utility of non-coded complaints and encounters, such as telephone medical helpline calls, to enhance AEFI signal detection. Trial registration number CRD42017072741.
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Affiliation(s)
- Yonatan Moges Mesfin
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Clayton, Victoria, Australia
| | - Allen Cheng
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Clayton, Victoria, Australia
| | - Jock Lawrie
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Clayton, Victoria, Australia
| | - Jim Buttery
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Clayton, Victoria, Australia
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Minassian C, Williams R, Meeraus WH, Smeeth L, Campbell OM, Thomas SL. Methods to generate and validate a Pregnancy Register in the UK Clinical Practice Research Datalink primary care database. Pharmacoepidemiol Drug Saf 2019; 28:923-933. [PMID: 31197928 PMCID: PMC6618019 DOI: 10.1002/pds.4811] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/08/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE Primary care databases are increasingly used for researching pregnancy, eg, the effects of maternal drug exposures. However, ascertaining pregnancies, their timing, and outcomes in these data is challenging. While individual studies have adopted different methods, no systematic approach to characterise all pregnancies in a primary care database has yet been published. Therefore, we developed a new algorithm to establish a Pregnancy Register in the UK Clinical Practice Research Datalink (CPRD) GOLD primary care database. METHODS We compiled over 4000 read and entity codes to identify pregnancy-related records among women aged 11 to 49 years in CPRD GOLD. Codes were categorised by the stage or outcome of pregnancy to facilitate delineation of pregnancy episodes. We constructed hierarchical rule systems to handle information from multiple sources. We assessed the validity of the Register to identify pregnancy outcomes by comparing our results to linked hospitalisation records and Office for National Statistics population rates. RESULTS Our algorithm identified 5.8 million pregnancies among 2.4 million women (January 1987-February 2018). We observed close agreement with hospitalisation data regarding completeness of pregnancy outcomes (91% sensitivity for deliveries and 77% for pregnancy losses) and their timing (median 0 days difference, interquartile range 0-2 days). Miscarriage and prematurity rates were consistent with population figures, although termination and, to a lesser extent, live birth rates were underestimated in the Register. CONCLUSIONS The Pregnancy Register offers huge research potential because of its large size, high completeness, and availability. Further validation work is underway to enhance this data resource and identify optimal approaches for its use.
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Affiliation(s)
- Caroline Minassian
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Rachael Williams
- Clinical Practice Research DatalinkMedicines and Healthcare Products Regulatory AgencyLondonUK
| | - Wilhelmine H. Meeraus
- Clinical Practice Research DatalinkMedicines and Healthcare Products Regulatory AgencyLondonUK
| | - Liam Smeeth
- Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Oona M.R. Campbell
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Sara L. Thomas
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
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74
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Sancovski M, Mesaros N, Feng Y, Ceregido MA, Luyts D, De Barros E. Safety of reduced antigen content diphtheria-tetanus-acellular pertussis vaccine when administered during pregnancy as part of the maternal immunization program in Brazil: a single center, observational, retrospective, cohort study. Hum Vaccin Immunother 2019; 15:2873-2881. [PMID: 31216218 PMCID: PMC6930109 DOI: 10.1080/21645515.2019.1627161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Reduced antigen diphtheria-tetanus-acellular pertussis (Tdap) vaccination is included in the maternal immunization program in Brazil since September 2014. We investigated associations between maternal Tdap vaccination and pregnancy-related adverse events (AEs) (gestational diabetes, pregnancy-related hypertension, and pregnancy hemorrhage) and neonatal AEs of interest (preterm birth and small for gestational age). This descriptive, observational, retrospective, single-center study in Brazil (NCT02757950) compared data from medical charts of 1203 pregnant women who received Tdap as part of the maternal immunization program and delivered between May 2015 and February 2017 (exposed cohort) and 1259 unvaccinated women who delivered between September 2012 and August 2014 (unexposed cohort). Index dates were defined as the time of vaccination (27–39 gestational weeks; exposed cohort) or 27 gestational weeks (unexposed cohort). Cumulative incidences were calculated as the number of women with each event between index and delivery dates divided by the total number of women with vaccination date available in the exposed cohort (N = 1199) or the total number of women in the unexposed cohort (N = 1259). Cumulative incidences per 1000 persons were 8.34 versus 17.47 for gestational diabetes, 9.17 versus 24.62 for pregnancy-related hypertension, 3.34 versus 15.09 for pregnancy hemorrhage, 53.38 versus 96.11 for preterm birth, and 57.55 versus 49.25 for small for gestational age in the exposed versus unexposed cohorts. No increased risk of pregnancy-related AEs or neonatal AEs of interest was found following maternal vaccination with Tdap. These results should be interpreted cautiously due to limitations inherent to retrospective observational studies.
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Affiliation(s)
| | | | - Yang Feng
- Ningyang Group Co., Limited, C/O GSK, Wavre, Belgium
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75
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Psarris A, Sindos M, Daskalakis G, Chondrogianni ME, Panayiotou S, Antsaklis P, Loutradis D. Immunizations during pregnancy: How, when and why. Eur J Obstet Gynecol Reprod Biol 2019; 240:29-35. [PMID: 31226574 DOI: 10.1016/j.ejogrb.2019.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/13/2019] [Indexed: 12/25/2022]
Abstract
Maternal immunization during pregnancy provide protection for the mother and the fetus against certain pathogens. Immunizations during pregnancy are divided to routine immunizations recommended for all pregnant women, immunizations for certain medical indications and vaccines that are potentially harmful during pregnancy and should be avoided. We conducted a comprehensive review of the literature regarding immunizations during pregnancy. The search terms used were immunization, vaccine, pregnancy, influenza, pertussis, safety and efficacy. We gathered all available guidelines on vaccination during pregnancy. Generally, vaccines are allowed during pregnancy when the benefits outweigh the risks. Tdap and inactivated flu vaccines are routinely recommended during pregnancy. Vaccines containing live attenuated viruses are contraindicated during pregnancy. These are LAIV influenza, MMR, Varicella, Zoster, BCG and smallpox pre-exposure. All other vaccines are given when medically indicated and the possible benefits outweigh the risks. Obstetricians and gynecologists should be familiar with the indications of vaccination during pregnancy. Vaccination coverage of pregnant women with routinely recommended vaccines has increased but further efforts are needed. Our aim is to review vaccination practices during pregnancy, demonstrate the benefits and dangers of different vaccines, evaluate their effectiveness and define the proper timing of vaccination.
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Affiliation(s)
- Alexandros Psarris
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece.
| | - Michael Sindos
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Maria Eleni Chondrogianni
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Stefani Panayiotou
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Panagiotis Antsaklis
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
| | - Dimitrios Loutradis
- 1st Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vas. Sophias Av., 115 28, Athens, Greece
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76
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Ghosh RE, Crellin E, Beatty S, Donegan K, Myles P, Williams R. How Clinical Practice Research Datalink data are used to support pharmacovigilance. Ther Adv Drug Saf 2019; 10:2042098619854010. [PMID: 31210923 PMCID: PMC6545638 DOI: 10.1177/2042098619854010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/18/2019] [Indexed: 11/17/2022] Open
Abstract
Pharmacovigilance can be defined as the science of monitoring medicines and vaccines after license for use, the purpose of which is to quantify and characterise the safety profile of a medicine, identify previously unknown adverse reactions, inform risk-benefit assessment, and support the development of actions that can be taken to reduce risks, optimise benefits and monitor their effectiveness. This review discusses the Clinical Practice Research Datalink (CPRD), which is the source of the largest research database in the UK with longitudinal, representative primary care data linked to data from other healthcare settings. CPRD supports international pharmacovigilance by providing a large, anonymised representative general population database with comprehensive capture of patient risk factors and outcomes to researchers within academic, regulatory and pharmaceutical organisations. The specific advantages of CPRD data are discussed in the context of the 'six Vs of big data' including volume, velocity, variety, veracity, validity and value. Examples of where CPRD data have been used for pharmacovigilance research and how these have fed into guidelines and policy are discussed.
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Affiliation(s)
- Rebecca E. Ghosh
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Elizabeth Crellin
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Sue Beatty
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Katherine Donegan
- Vigilance and Risk Management of Medicines, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Puja Myles
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
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77
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Antigen specific vaccine hesitancy in pregnancy. Vaccine 2019; 37:2814-2820. [DOI: 10.1016/j.vaccine.2019.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/21/2019] [Accepted: 04/08/2019] [Indexed: 11/20/2022]
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Strongman H, Williams R, Meeraus W, Murray‐Thomas T, Campbell J, Carty L, Dedman D, Gallagher AM, Oyinlola J, Kousoulis A, Valentine J. Limitations for health research with restricted data collection from UK primary care. Pharmacoepidemiol Drug Saf 2019; 28:777-787. [PMID: 30993808 PMCID: PMC6618795 DOI: 10.1002/pds.4765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/30/2018] [Accepted: 02/14/2019] [Indexed: 11/12/2022]
Abstract
Purpose UK primary care provides a rich data source for research. The impact of proposed data collection restrictions is unknown. This study aimed to assess the impact of restricting the scope of electronic health record (EHR) data collection on the ability to conduct research. The study estimated the consequences of restricted data collection on published Clinical Practice Research Datalink studies from high impact journals or referenced in clinical guidelines. Methods A structured form was used to systematically analyse the extent to which individual studies would have been possible using a database with data collection restrictions in place: (1) retrospective collection of specified diseases only; (2) retrospective collection restricted to a 6‐ or 12‐year period; (3) prospective and retrospective collection restricted to non‐sensitive data. Outcomes were categorised as unfeasible (not reproducible without major bias); compromised (feasible with design modification); or unaffected. Results Overall, 91% studies were compromised with all restrictions in place; 56% studies were unfeasible even with design modification. With restrictions on diseases alone, 74% studies were compromised; 51% were unfeasible. Restricting collection to 6/12 years had a major impact, with 67 and 22% of studies compromised, respectively. Restricting collection of sensitive data had a lesser but marked impact with 10% studies compromised. Conclusion EHR data collection restrictions can profoundly reduce the capacity for public health research that underpins evidence‐based medicine and clinical guidance. National initiatives seeking to collect EHRs should consider the implications of restricting data collection on the ability to address vital public health questions.
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Affiliation(s)
| | | | | | | | | | - Lucy Carty
- Clinical Practice Research Datalink (CPRD)MHRALondonUK
| | - Daniel Dedman
- Clinical Practice Research Datalink (CPRD)MHRALondonUK
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79
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Park HJ, Kim SJ, Song R, Chen J, Kim JH, Devadiga R, Kang HC. A 6-year Prospective, Observational, Multi-Center Post-Marketing Surveillance of the Safety of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Korea. J Korean Med Sci 2019; 34:e105. [PMID: 30940999 PMCID: PMC6439203 DOI: 10.3346/jkms.2019.34.e105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/10/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. METHODS This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. RESULTS The analysis included 672 Korean subjects (mean age, 44 years; range, 11-81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was 'live infant, no apparent congenital anomaly' in 195 subjects (92.42%) or 'lost to follow-up' in 16 subjects. CONCLUSION Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01929291.
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Affiliation(s)
- Hee-Jin Park
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | | | | | | | | | | | - Hee-Cheol Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Rice TF, Diavatopoulos DA, Smits GP, van Gageldonk PGM, Berbers GAM, van der Klis FR, Vamvakas G, Donaldson B, Bouqueau M, Holder B, Kampmann B. Antibody responses to Bordetella pertussis and other childhood vaccines in infants born to mothers who received pertussis vaccine in pregnancy - a prospective, observational cohort study from the United Kingdom. Clin Exp Immunol 2019; 197:1-10. [PMID: 30758857 PMCID: PMC6591149 DOI: 10.1111/cei.13275] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/28/2023] Open
Abstract
The maternal Tdap (tetanus, diphtheria and acellular pertussis) vaccination programme in the United Kingdom has successfully reduced cases of pertussis in young infants. In addition to prevention of pertussis cases, it is also important to investigate the persistence of maternal antibodies during infancy and the possible interference of maternal antibodies with infant responses to vaccines. We recruited mother–infant pairs from vaccinated and unvaccinated pregnancies and measured concentrations of immunoglobulin (Ig)G against pertussis toxin (PTx), filamentous haemagglutinin (FHA), pertactin (Prn), diphtheria toxin (DTx), tetanus toxoid (TTx) Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae in mothers and infants at birth, and in infants at 7 weeks and at 5 months. Thirty‐one mother–infant pairs were tested. Tdap‐vaccinated women had significantly higher antibody against Tdap antigens, compared to unvaccinated women (DTx, P = 0·01; PTx, FHA, Prn and TTx, P < 0·001). All antibodies were actively transferred to the infants (transfer ratio > 1) with higher transfer of DTx (P = 0·04) and TTx (P = 0·02) antibody in Tdap‐vaccinated pregnancies compared to unvaccinated pregnancies. Infants from Tdap‐vaccinated pregnancies had significantly elevated antibodies to all antigens at birth (P < 0.001) and at 7 weeks (FHA, Prn, TTx, P < 0·001; DTx, P = 0.01; PTx, P = 0·004) compared to infants from unvaccinated pregnancies. Infants from Tdap‐vaccinated and ‐unvaccinated pregnancies had comparable antibody concentrations following primary pertussis immunization (PTx, P = 0·77; FHA, P = 0·58; Prn, P = 0·60; DTx, P = 0·09; TTx, P = 0·88). These results support maternal immunization as a method of protecting vulnerable infants during their first weeks of life.
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Affiliation(s)
- T F Rice
- Section of Paediatrics, Department of Medicine, Imperial College London, UK
| | - D A Diavatopoulos
- Section for Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - G P Smits
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - P G M van Gageldonk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - F R van der Klis
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G Vamvakas
- Department of Biostatistics, Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK
| | - B Donaldson
- Section of Paediatrics, Department of Medicine, Imperial College London, UK
| | - M Bouqueau
- Section of Paediatrics, Department of Medicine, Imperial College London, UK
| | - B Holder
- Section of Paediatrics, Department of Medicine, Imperial College London, UK
| | - B Kampmann
- Section of Paediatrics, Department of Medicine, Imperial College London, UK.,The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK.,Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
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81
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Affiliation(s)
- Dipesh P Gopal
- Centre for Primary Care and Public Health, Barts and The London School of Medicine & Dentistry, London E1 2AB, UK
| | - John Barber
- Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London NW3 2PF, UK
| | - Daniel Toeg
- Caversham Group Practice, London NW5 2UP, UK
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82
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Mikheeva IV, Saltykova TS, Mikheeva MA. Expediency and prospects of a vaccinal prevention of whooping cough without age restrictions. JOURNAL INFECTOLOGY 2018. [DOI: 10.22625/2072-6732-2018-10-4-14-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The goal of study was the epidemiological substantiationof optimization measures of a vaccinal prevention of whooping cough in the Russian Federation. Materials and methods. The retrospective descriptive epidemiological research has been conducted by analysis of the official statistical data on the whooping cough case rate (form No. 2) in 2005–2017 in the Russian Federation, as well as the data about preventive whooping cough inoculations (forms No. 5, No. 6) in 2005–2017 and about epidemic outbreakes in 2017 (form No. 23-17). The assessment of an economic damage from whooping cough in 2005-2017 has been carried out. Results. The following adverse characteristics of a modern epidemiological situation on whooping cough in Russia are shown: long-term recurrence of epidemic process, tendency of rising of a case rate of children of 0-2 years; high percentage of children of preschool and school age among whooping cough cases; prevalence among the patients with whooping cough of the children who have been vaccinated against this infection previously, epidemic outbreakes in children’s collectives, the stability of a case rate of teenagers and adults with prevalence of the mild and the erased clinical forms of this infection. The risks due to weaknesses of the whooping cough vaccinal prevention are noted: the insufficient immunization coverage owing to falce contraindications and refusals of parents of vaccinations of children, noncompliance with terms and intervals between inoculations, lack of domestic vaccine for revaccination of children at the age of 5 years and older. Conclusion. It is necessary to introduce in the national vaccination schedule a preschool booster dose for children at the age of 6 and adolescents at 14 years with the combined reduced antigen content tetanus–diphtheria and acellular pertussis vaccines as well as the inoculations of this vaccine according to epidemiological indications to health workers, employees of educational institutions. A revaccination against whooping cough is recommended as “cocoon” for the persons contacting to not vaccinated child under 1 year of age.
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Affiliation(s)
- I. V. Mikheeva
- Central Research Institute of Epidemiology of The Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow
| | - T. S. Saltykova
- Central Research Institute of Epidemiology of The Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow; First Moscow State Medical University named after I.M. Sechenov, Moscow
| | - M. A. Mikheeva
- Central Research Institute of Epidemiology of The Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow
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83
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Did two booster doses for schoolchildren change the epidemiology of pertussis in Israel? J Public Health Policy 2018; 39:304-317. [PMID: 29807998 DOI: 10.1057/s41271-018-0130-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pertussis is the only vaccine-preventable disease that has re-emerged in Israel. In the last two decades, despite high primary immunization coverage, crude incidence increased over tenfold, with especially high morbidity among infants and adolescents and with 19 infant deaths. Two pertussis vaccine boosters were added, in 2005 for 7-year-olds and in 2011 for 13-year-olds. We reviewed age group incidence from 1999 to 2016, before and after the booster program introduction. We compared three groups of 13-15 year-olds with identical primary immunization but different booster immunization histories. Vaccine effectiveness was calculated before and after adjustment for specific incidence in those aged 65 and over. Two years after one booster, adjusted vaccine effectiveness was 74.5%. Two years after two boosters, adjusted vaccine effectiveness was 91.8%. However, crude morbidity rates were not reduced. The booster program has been effective only among recipient groups. The program will be continued. Israel is now encouraging pregnant women to be vaccinated against pertussis to improve protection of infants.
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84
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Recommendations to control pertussis prioritized relative to economies: A Global Pertussis Initiative update. Vaccine 2018; 36:7270-7275. [PMID: 30337176 DOI: 10.1016/j.vaccine.2018.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/21/2022]
Abstract
Pertussis is a vaccine-preventable disease that causes morbidity and mortality, particularly in infants and children <5 years of age. The Global Pertussis Initiative (GPI) recommendations represent a systematic evaluation and prioritization of strategies to prevent pertussis-related infant and child deaths, reduce global disease burden and prevent resurgence through vaccination strategies and public health policies at national, regional and local levels. The GPI recommendations are based on clinical trials and observational and surveillance data, which are essential in the planning, implementation and evaluation of vaccination practices and best use of available resources. Many low- and middle-income countries (LMIC) continue to use whole-cell pertussis (wP) vaccines for primary vaccination, while most high-income countries have replaced wP with the less-reactogenic acellular pertussis (aP) vaccines. This present manuscript pertains to discussions held during the GPI's meeting on November 11-13, 2016, in Cape Town, Republic of South Africa. The GPI recommends that LMIC aim for high coverage of infant series pertussis vaccines as a priority. In LMIC and countries with constrained vaccine funding, if wP vaccines are currently used, wP should continue to be used. Furthermore, given that protection against disease and death due to pertussis in neonates is a key priority of the GPI, it recommends that ap immunization in pregnancy should be implemented as a priority in all countries if resources allow. Given that surveillance and epidemiology data on which to base vaccine decisions are important, the GPI also suggests that, in areas where wP vaccines are implemented, standardization and calibration of wP vaccines are checked, considering the many different manufacturers and variable standards of production and quality control. In addition, as immunity to pertussis wanes following the primary infant series of vaccination, the GPI further recommends that toddlers, adolescents, healthcare and childcare workers receive booster vaccine doses, where resources allow.
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Healy CM, Rench MA, Swaim LS, Smith EO, Sangi-Haghpeykar H, Mathis MH, Martin MD, Baker CJ. Association Between Third-Trimester Tdap Immunization and Neonatal Pertussis Antibody Concentration. JAMA 2018; 320:1464-1470. [PMID: 30304426 PMCID: PMC6233794 DOI: 10.1001/jama.2018.14298] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Immunization with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is recommended in the United States during weeks 27 through 36 of pregnancy to prevent life-threatening infant pertussis. The optimal gestation for immunization to maximize concentrations of neonatal pertussis toxin antibodies is unknown. OBJECTIVE To determine pertussis toxin antibody concentrations in cord blood from neonates born to women immunized and unimmunized with Tdap vaccine in pregnancy and optimal gestational age for immunization to maximize concentrations of neonatal antibodies. DESIGN, SETTING, AND PARTICIPANTS Prospective, observational, cohort study of term neonates in Houston, Texas (December 2013-March 2014). EXPOSURES Tdap immunization during weeks 27 through 36 of pregnancy or no Tdap immunization. MAIN OUTCOMES AND MEASURES Primary outcome was geometric mean concentrations (GMCs) of pertussis toxin antibodies in cord blood of Tdap-exposed and Tdap-unexposed neonates and proportions of Tdap-exposed and Tdap-unexposed neonates with pertussis toxin antibody concentrations of 15 IU/mL or higher, 30 IU/mL or higher, and 40 IU/mL or higher, cutoffs representing quantifiable antibodies or levels that may be protective until the infant immunization series begins. Secondary outcome was the optimal gestation for immunization to achieve maximum pertussis toxin antibodies. RESULTS Six hundred twenty-six pregnancies (mean maternal age, 29.7 years; 41% white, 27% Hispanic, 26% black, 5% Asian, 1% other; mean gestation, 39.4 weeks) were included. Three hundred twelve women received Tdap vaccine at a mean gestation of 31.2 weeks (range, 27.3-36.4); 314 were unimmunized. GMC of neonatal cord pertussis toxin antibodies from the Tdap-exposed group was 47.3 IU/mL (95% CI, 42.1-53.2) compared with 12.9 IU/mL (95% CI, 11.7-14.3) in the Tdap-unexposed group, for a GMC ratio of 3.6 (95% CI, 3.1-4.2; P < .001). More Tdap-exposed than Tdap-unexposed neonates had pertussis toxin antibody concentrations of 15 IU/mL or higher (86% vs 37%; difference, 49% [95% CI, 42%-55%]), 30 IU/mL or higher (72% vs 17%; difference, 55% [95% CI, 49%-61%]), and 40 IU/mL or higher (59% vs 12%; difference, 47% [95% CI, 41%-54%]); P < .001 for each analysis. GMCs of pertussis toxin antibodies were highest when Tdap vaccine was administered during weeks 27 through 30 and declined thereafter, reaching a peak at week 30 (57.3 IU/mL [95% CI, 44.0-74.6]). CONCLUSIONS AND RELEVANCE Immunization with Tdap vaccine during the third trimester of pregnancy, compared with no immunization, was associated with higher neonatal concentrations of pertussis toxin antibodies. Immunization early in the third trimester was associated with the highest concentrations.
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Affiliation(s)
- C. Mary Healy
- Infectious Disease Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Marcia A. Rench
- Infectious Disease Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Laurie S. Swaim
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - E. O’Brian Smith
- Department of Statistics, Baylor College of Medicine, Houston, Texas
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Department of Statistics, Baylor College of Medicine, Houston, Texas
| | - Marsenia H. Mathis
- Pertussis and Diphtheria Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monte D. Martin
- Pertussis and Diphtheria Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol J. Baker
- Infectious Disease Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
- Now with Department of Pediatrics, The University of Texas Health Science Center at Houston
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86
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Wanlapakorn N, Maertens K, Chaithongwongwatthana S, Srimuan D, Suratannon N, Vongpunsawad S, Tran TMP, Hens N, Van Damme P, Locht C, Poovorawan Y, Leuridan E. Assessing the reactogenicity of Tdap vaccine administered during pregnancy and antibodies to Bordetella pertussis antigens in maternal and cord sera of Thai women. Vaccine 2018; 36:1453-1459. [PMID: 29426663 DOI: 10.1016/j.vaccine.2018.01.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pregnant Thai women have low antibody titers against B. pertussis antigens, which coincide with an increasing incidence of pertussis among Thai infants. Thus, there exists a potential benefit of a booster dose of tetanus- diphtheria-acellular pertussis (Tdap) vaccine administered during pregnancy. Here, we report the vaccine reactogenicity profile and birth outcomes in Tdap-vaccinated pregnant women who have or have not had prior immunization with tetanus vaccine, and the IgG levels to B. pertussis antigens in maternal and cord sera at delivery. MATERIALS AND METHODS Pregnant women (N = 370) aged 18-40 years were administered the Tdap vaccine (Boostrix®, GlaxoSmithKline, Rixensart, Belgium) at 26-36 weeks gestation. Adverse events following vaccination were identified by follow-up telephone call and medical record review. IgG against pertussis toxin (anti-PT), filamentous hemagglutinin (anti-FHA) and pertactin (anti-PRN) in both maternal and umbilical cord blood obtained at delivery were quantitatively evaluated using enzyme-linked immunosorbent assay (EUROIMMUN®, Lübeck, Germany). RESULTS There was no reported increase in the severity or duration of adverse events associated with the administration of an extra tetanus-containing vaccine within the previous five years (N = 181) or multiple doses of tetanus-containing vaccines during the current pregnancy (N = 98). Vaccination at least eight weeks prior to delivery resulted in high antibody titers to all B. pertussis antigens studied. CONCLUSIONS The reactogenicity of Tdap vaccine administered during pregnancy was not affected by prior tetanus toxoid immunization. High transplacental antibody against B. pertussis antigens in the cord blood provides evidence of antibody transfer and should thus help to protect newborns from pertussis during early life.
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Affiliation(s)
- Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Joint PhD program in Biomedical Sciences and Biotechnology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kirsten Maertens
- Center for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | | | - Donchida Srimuan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Narissara Suratannon
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thao Mai Phuong Tran
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Belgium; Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Center for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Camille Locht
- Univ. Lille, CNRS, INSERM, Institut Pasteur de Lille, U1019 - UMR8204, Center for Infection and Immunity of Lille, France
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Elke Leuridan
- Center for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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87
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Campbell H, Gupta S, Dolan GP, Kapadia SJ, Kumar Singh A, Andrews N, Amirthalingam G. Review of vaccination in pregnancy to prevent pertussis in early infancy. J Med Microbiol 2018; 67:1426-1456. [PMID: 30222536 DOI: 10.1099/jmm.0.000829] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Maternal pertussis vaccination has been introduced in several countries to protect infants from birth until routine infant vaccination takes place. This review assesses existing evidence on the effectiveness and safety of immunization in pregnancy. The search was finalized in April 2017 and was based on searches using several databases. The selection criteria included any experimental or observational study reporting on the immunogenicity, effectiveness or safety of vaccination with a pertussis-containing vaccine in pregnant women and their infants. Following de-duplication and exclusions, we identified 8395 studies, which were reduced to 46 for inclusion. The overall risk of bias was low, with the exception of some early studies and pharmacovigilance safety data. The evidence demonstrates efficient transplacental transfer of maternal antibodies in infants whose mothers were vaccinated with Tdap or Tdap/IPV in pregnancy, with good evidence that this protects against disease in young infants. Safety studies covering more than 150 000 women vaccinated mostly in the late second or third trimesters are generally consistent and provide reassurance of no significant increased risk of recognized maternal conditions or of adverse events (including congenital anomalies) in infants born to vaccinated women. The clinical significance of reduced seroconversion to pertussis following routine immunization is not yet clear, but no increased risk of pertussis in infants whose mothers were vaccinated in pregnancy was found following primary immunizations in North American and English studies. Most post-booster studies suggest that any blunting effect is short-lived and that longer-term protection in infants from active immunization is not compromised.
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Affiliation(s)
- Helen Campbell
- 1Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Saurabh Gupta
- 2Public Health, Epidemiology and Biostatistics, Ambition Health Private Limited, Gurgaon, India
- 3National Technical Advisory Group on Immunization Secretariat, National Institute of Health and Family Welfare, New Delhi, India
| | - Gayle P Dolan
- 4North East PHE Centre, Public Health England, Newcastle upon Tyne, UK
| | - Smita J Kapadia
- 5Health Protection Team, Public Health England, East of England, Harlow, UK
| | - Awnish Kumar Singh
- 3National Technical Advisory Group on Immunization Secretariat, National Institute of Health and Family Welfare, New Delhi, India
| | - Nick Andrews
- 6Department of Statistics Modelling and Economics, Public Health England, London, UK
| | - Gayatri Amirthalingam
- 1Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
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88
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Maisa A, Milligan S, Quinn A, Boulter D, Johnston J, Treanor C, Bradley DT. Vaccination against pertussis and influenza in pregnancy: a qualitative study of barriers and facilitators. Public Health 2018; 162:111-117. [DOI: 10.1016/j.puhe.2018.05.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
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89
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Sadeghpour Heravi F, Nikbin VS, Nakhost Lotfi M, Badiri P, Jannesar Ahmadi N, Zahraei SM, Shahcheraghi F. Strain variation and antigenic divergence among Bordetella pertussis circulating strains isolated from patients in Iran. Eur J Clin Microbiol Infect Dis 2018; 37:1893-1900. [PMID: 30094521 DOI: 10.1007/s10096-018-3323-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/04/2018] [Indexed: 11/26/2022]
Abstract
Despite global efforts and widespread vaccination to control whooping cough (pertussis) caused by B. pertussis, the re-emergence of pertussis still is being reported all over the world. Antigenic divergence in B. pertussis virulence factors is one of the reasons of pertussis resurgence, resulting in dissimilarity of local and vaccine strains. In this study, clonal spread and variation of B. pertussis virulence factor in isolated strains from Iranian patients have been analyzed. A total of 100 B. pertussis isolates were obtained from Pertussis Reference Laboratory of Pasteur Institute of Iran. Real-time PCR were performed to confirm the B. pertussis strains. The genomic patterns of B. pertussis strains were analyzed by pulsed-field gel electrophoresis (PFGE). Predominant alleles of local strains were ptxP3, ptxA1, prn2, fim 2-1, fim3-2, and cya2. PFGE results showed 25 patterns clustered into 18 PFGE groups. A few similarities between the circulating isolates, vaccine, and standard strains were obtained. Significantly, 48% of the isolates showed dominant pattern with different allelic profiles from vaccine strains. According to the genomic profiles, the clonal spread was observed among the circulating strains. Predominant virulence factor profile was also comparable with other countries. It may be suggested that strain variation between vaccine and local strains may have an effect on pertussis resurgence in Iran like other parts of the world.
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Affiliation(s)
| | - Vajihe Sadat Nikbin
- Pertussis Reference Laboratory' Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Masomeh Nakhost Lotfi
- Pertussis Reference Laboratory' Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Pouran Badiri
- Pertussis Reference Laboratory' Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Nazanin Jannesar Ahmadi
- Pertussis Reference Laboratory' Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Mohsen Zahraei
- Pertussis Reference Laboratory' Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Fereshteh Shahcheraghi
- Pertussis Reference Laboratory' Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran.
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90
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Hoshi SL, Seposo X, Okubo I, Kondo M. Cost-effectiveness analysis of pertussis vaccination during pregnancy in Japan. Vaccine 2018; 36:5133-5140. [DOI: 10.1016/j.vaccine.2018.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 02/05/2023]
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91
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Griffin JB, Yu L, Watson D, Turner N, Walls T, Howe AS, Jiang Y, Petousis-Harris H. Pertussis Immunisation in Pregnancy Safety (PIPS) Study: A retrospective cohort study of safety outcomes in pregnant women vaccinated with Tdap vaccine. Vaccine 2018; 36:5173-5179. [PMID: 30031662 DOI: 10.1016/j.vaccine.2018.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND New Zealand has funded the administration of tetanus, diphtheria and acellular pertussis (Tdap) vaccine during pregnancy to prevent infant pertussis since 2013. The aim of this study was to assess the safety of Tdap vaccine administered to pregnant women as part of a national maternal immunisation programme. METHODS We conducted a national retrospective observational study using linked administrative New Zealand datasets. The study population consisted of pregnant women eligible to receive funded Tdap vaccination from 28 to 38 weeks gestation in 2013. Primary study outcomes were based on prioritised adverse events for the assessment of vaccine safety in pregnant women, as defined by WHO and Brighton Collaboration taskforces. We examined the effect of Tdap vaccination on prioritised maternal outcomes using Cox proportional hazard models. Adjusted hazard ratios controlled for key confounding variables. RESULTS In the cohort of 68,550 women eligible to receive funded antenatal Tdap vaccination during 2013, 8178 (11.9%) were vaccinated and 60,372 (88.1%) were unvaccinated. The use of Tdap in pregnancy was not associated with an increase in the rate of primary outcomes, including preterm labour; pre-eclampsia; pre-eclampsia with severe features; eclampsia; gestational hypertension; fetal growth restriction; or post-partum haemorrhage. Tdap also did not increase secondary outcomes, including gestational diabetes mellitus; antenatal bleeding; placental abruption; premature rupture of membranes; preterm delivery; fetal distress; chorioamnionitis; or, maternal fever during or after labour. Lactation disorders was the only secondary maternal outcome with a significantly increased hazard ratio. Tdap vaccine had a protective effect on pre-eclampsia with severe features, preterm labour, preterm delivery, and antenatal bleeding. CONCLUSION We did not detect any biologically plausible adverse maternal outcomes following Tdap vaccination during pregnancy. This study provides further assurance that Tdap administration during pregnancy is not associated with unexpected safety risks.
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Affiliation(s)
- Jennifer B Griffin
- Social, Statistical and Environmental Sciences, RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC, 27709, USA.
| | - Lennex Yu
- Statistical Consulting Centre, Department of Statistics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Donna Watson
- Department of General Practice & Primary Healthcare, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Nikki Turner
- Department of General Practice & Primary Healthcare, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Tony Walls
- Department of Pediatrics, University of Otago, Christchurch PO Box 4345, Christchurch, New Zealand.
| | - Anna S Howe
- Department of General Practice & Primary Healthcare, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Yannan Jiang
- Statistical Consulting Centre, Department of Statistics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Helen Petousis-Harris
- Department of General Practice & Primary Healthcare, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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92
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Small for gestational age: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine 2018; 35:6518-6528. [PMID: 29150057 PMCID: PMC5710996 DOI: 10.1016/j.vaccine.2017.01.040] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/13/2017] [Indexed: 12/13/2022]
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93
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Bryan P, Seabroke S, Wong J, Donegan K, Webb E, Goldsmith C, Vipond C, Feavers I. Safety of multicomponent meningococcal group B vaccine (4CMenB) in routine infant immunisation in the UK: a prospective surveillance study. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:395-403. [DOI: 10.1016/s2352-4642(18)30103-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
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94
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Affiliation(s)
- Paul Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Paris, France
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivia Anselem
- AP-HP, Maternité Port-Royal, Département de Gynécologie-Obstétrique, Hôpital Cochin Broca Hôtel-Dieu, Paris, France
- DHU Risk in pregnancy, Université Paris Descartes, Paris, France
| | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
- Inserm, CIC 1417, Université Paris Descartes, Paris, France
- AP-HP, Département de maladies infectieuses, CIC Cochin Pasteur, Paris, France
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95
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García-Franco AL, Baeyens Fernández JA, Bailón Muñoz E, Iglesias Piñeiro MJ, Cura González ID, Del Moral AO, Landa Goñi J, Alonso Coello P, Arribas Mir L. Actividades preventivas en la mujer. Actualización PAPPS 2018. Aten Primaria 2018; 50 Suppl 1:125-146. [PMID: 29866353 PMCID: PMC6836928 DOI: 10.1016/s0212-6567(18)30366-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | | | - Emilia Bailón Muñoz
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Universitario de Albaycín, Granada
| | | | - Isabel Del Cura González
- Especialista en Medicina Familiar y Comunitaria, Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Madrid
| | | | - Jacinta Landa Goñi
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Emisora, Pozuelo de Alarcón, Madrid
| | - Pablo Alonso Coello
- Especialista en Medicina Familiar y Comunitaria, Centro Cochrane Iberoamericano (CIBERESP-IIB Sant Pau), Barcelona
| | - Lorenzo Arribas Mir
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Universitario La Chana, Granada
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96
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Strategies for increasing uptake of vaccination in pregnancy in high-income countries: A systematic review. Vaccine 2018; 36:2751-2759. [DOI: 10.1016/j.vaccine.2018.04.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 11/19/2022]
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97
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Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, Clark TA. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2018; 67:1-44. [PMID: 29702631 PMCID: PMC5919600 DOI: 10.15585/mmwr.rr6702a1] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Adults who have never received Tdap also are recommended to receive a booster dose of Tdap. Women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks' gestation, regardless of previous receipt of Tdap. After receipt of Tdap, adolescents and adults are recommended to receive a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria.
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Affiliation(s)
- Jennifer L. Liang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Tejpratap Tiwari
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Pedro Moro
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Nancy E. Messonnier
- Office of the Director, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Mark Sawyer
- University of California, San Diego; La Jolla, California
| | - Thomas A. Clark
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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98
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Bergin N, Murtagh J, Philip RK. Maternal Vaccination as an Essential Component of Life-Course Immunization and Its Contribution to Preventive Neonatology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E847. [PMID: 29693575 PMCID: PMC5981886 DOI: 10.3390/ijerph15050847] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/13/2018] [Accepted: 04/21/2018] [Indexed: 12/16/2022]
Abstract
Maternal immunisation schedules are increasingly coming under the spotlight as part of the development of lifetime immunisation programmes for the role that they play in improving maternal, foetal, and neonatal health. Maternally-acquired antibodies are critical in protecting infants during the first months of their lives. Maternal immunisation was previously overlooked owing to concerns regarding vaccinations in this untested and high-risk population but is now acknowledged for its potential impact on the outcomes in many domains of foetal and neonatal health, aside from its maternal benefits. This article highlights the role that maternal immunisation may play in reducing infections in preterm and term infants. It explores the barriers to antenatal vaccinations and the optimisation of the immunisation uptake. This review also probes the part that maternal immunisation may hold in the reduction of perinatal antimicrobial resistance and the prevention of non-infectious diseases. Both healthcare providers and expectant mothers should continue to be educated on the importance and safety of the appropriate immunizations during pregnancy. Maternal vaccination merits its deserved priority in a life-course immunization approach and it is perhaps the only immunization whereby two generations benefit directly from a single input. We outline the current recommendations for antenatal vaccinations and highlight the potential advances in the field contributing to “preventive neonatology”.
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Affiliation(s)
- Naomi Bergin
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick V94 C566, Ireland.
| | - Janice Murtagh
- MSD Ireland Ltd., South County Business Park, Leopardstown, Dublin D18 X5K7, Ireland.
| | - Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick V94 C566, Ireland.
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99
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Pertussis epidemiology in Argentina: TRENDS after the introduction of maternal immunisation. Epidemiol Infect 2018; 146:858-866. [DOI: 10.1017/s0950268818000808] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractData on the impact of the recently recommended maternal pertussis vaccination are promising, but still insufficient to universalise this approach. We thus compared the epidemiological data prior to the implementation of this vaccination strategy in Argentina (2012) with the figures reported after 2012. During that 2010–2016 period, two outbreaks occurred, one in 2011 and another in 2016. In the former, the incidence was 6.9/100 000 inhabitants and the case-fatality rate 2.6%. Thereafter, a decline in incidence was detected until 2014. During 2015 and 2016 an increase in the incidence transpired, but this rise was fortunately not accompanied by one in the case fatality ratio. Indeed, in 2016 the case fatality ratio was the lowest (0.6%). Moreover, during the 2016 outbreak, the incidence (3.9/100 000 inhabitants) and the case severity detected in the most vulnerable population (infants 0–2 months) were both lower than those in 2011. Consistent with this pattern, in 2016, in the most populated province of Argentina (Buenos Aires), the case percentage with laboratory-positive results indicating a high number of symptoms (59.1% of the total cases) diminished compared with that detected in the 2011 outbreak without maternal immunisation (71.9%). Using the mathematical model of pertussis transmission we previously designed, we assessed the effect of vaccination during pregnancy on infant incidence. From comparisons between the epidemiological data made through calculations, emerged the possibility that vaccinating women during pregnancy would benefit the infants beyond age 2 months, specifically in the 2–12-month cohort.
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van der Lee S, van Rooijen DM, de Zeeuw-Brouwer ML, Bogaard MJM, van Gageldonk PGM, Marinovic AB, Sanders EAM, Berbers GAM, Buisman AM. Robust Humoral and Cellular Immune Responses to Pertussis in Adults After a First Acellular Booster Vaccination. Front Immunol 2018; 9:681. [PMID: 29670634 PMCID: PMC5893963 DOI: 10.3389/fimmu.2018.00681] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/20/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction To reduce the pertussis disease burden, nowadays several countries recommend acellular pertussis (aP) booster vaccinations for adults. We aimed to evaluate the immunogenicity of a first adult aP booster vaccination at childbearing age. Methods In 2014, healthy adults aged 25–29 years (n = 105), vaccinated during infancy with four doses of whole-cell pertussis (wP) vaccine, received a Tdap (tetanus, diphtheria, and aP) booster vaccination. Blood samples were collected longitudinally pre-booster, 2 and 4 weeks, and 1 year and 2 years post-booster. Tdap vaccine antigen-specific antibody levels and memory B- and T-cell responses were determined at all time points. Antibody persistence was calculated using a bi-exponential decay model. Results Upon booster vaccination, the IgG levels specific to all Tdap vaccine antigens were significantly increased. After an initial rapid decline in the first year, PT-IgG antibody decay was limited (15%) in the second year post-booster. The duration of a median level of PT-IgG ≥20 IU/mL was estimated to be approximately 9 years. Vaccine antigen-specific memory B- and T-cell numbers increased and remained at high levels although a significant decline was observed after 4 weeks post-booster. However, Th1, Th2, and Th17 cytokine production remained above pre-booster levels for 2 years. Conclusion The Tdap booster vaccination in wP-primed Dutch adults induced robust long-term humoral and cellular immune responses to pertussis antigens. Furthermore, PT-IgG levels are predicted to remain above the presumed protective cut-off for at least 9 years which might deserves further attention in evaluating the current recommendation to revaccinate women during every new pregnancy.
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Affiliation(s)
- Saskia van der Lee
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.,Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands
| | - Debbie M van Rooijen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Mary-Lène de Zeeuw-Brouwer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marjan J M Bogaard
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Pieter G M van Gageldonk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Axel Bonacic Marinovic
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.,Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Anne-Marie Buisman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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