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Ciapponi A, Berrueta M, P K Parker E, Bardach A, Mazzoni A, Anderson SA, Argento FJ, Ballivian J, Bok K, Comandé D, Goucher E, Kampmann B, Munoz FM, Rodriguez Cairoli F, Santa María V, Stergachis AS, Voss G, Xiong X, Zamora N, Zaraa S, Buekens PM. Safety of COVID-19 vaccines during pregnancy: A systematic review and meta-analysis. Vaccine 2023; 41:3688-3700. [PMID: 37012114 PMCID: PMC10040368 DOI: 10.1016/j.vaccine.2023.03.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Assessment of COVID-19 vaccines safety during pregnancy is urgently needed. METHODS We conducted a systematic review and meta-analysis to evaluate the safety of COVID-19 vaccines, including their components and technological platforms used in other vaccines during pregnancy and animal studies to complement direct evidence. We searched literature databases from its inception to September 2021 without language restriction, COVID-19 vaccine websites, and reference lists of other systematic reviews and the included studies. Pairs of reviewers independently selected, data extracted, and assessed the risk of bias of the studies. Discrepancies were resolved by consensus. (PROSPERO CRD42021234185). RESULTS We retrieved 8,837 records from the literature search; 71 studies were included, involving 17,719,495 pregnant persons and 389 pregnant animals. Most studies (94%) were conducted in high-income countries, were cohort studies (51%), and 15% were classified as high risk of bias. We identified nine COVID-19 vaccine studies, seven involving 309,164 pregnant persons, mostly exposed to mRNA vaccines. Among non-COVID-19 vaccines, the most frequent exposures were AS03 and aluminum-based adjuvants. A meta-analysis of studies that adjusted for potential confounders showed no association with adverse outcomes, regardless of the vaccine or the trimester of vaccination. Neither the reported rates of adverse pregnancy outcomes nor reactogenicity exceeded expected background rates, which was the case for ASO3- or aluminum-adjuvanted non-COVID-19 vaccines in the proportion meta-analyses of uncontrolled studies/arms. The only exception was postpartum hemorrhage after COVID-19 vaccination (10.40%; 95% CI: 6.49-15.10%), reported by two studies; however, the comparison with non-exposed pregnant persons, available for one study, found non-statistically significant differences (adjusted OR 1.09; 95% CI 0.56-2.12). Animal studies showed consistent results with studies in pregnant persons. CONCLUSION We found no safety concerns for currently administered COVID-19 vaccines during pregnancy. Additional experimental and real-world evidence could enhance vaccination coverage. Robust safety data for non-mRNA-based COVID-19 vaccines are still needed.
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Affiliation(s)
- Agustín Ciapponi
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Mabel Berrueta
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Edward P K Parker
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Ariel Bardach
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Agustina Mazzoni
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Steven A Anderson
- US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Fernando J Argento
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Jamile Ballivian
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina
| | - Karin Bok
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
| | - Daniel Comandé
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Erin Goucher
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
| | - Beate Kampmann
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Vaccines & Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, the Gambia; Charité Centre for Global Health, Universitätsmedizin Charité Berlin, Germany.
| | - Flor M Munoz
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Federico Rodriguez Cairoli
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina.
| | - Victoria Santa María
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina
| | - Andy S Stergachis
- School of Pharmacy and School of Public Health, University of Washington, 1959 NE Pacific St, BOX 357631, Seattle, WA, USA.
| | - Gerald Voss
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway.
| | - Xu Xiong
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
| | - Natalia Zamora
- Centro de Investigación de Epidemiología y Salud Pública (CIESP) - Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Argentina
| | - Sabra Zaraa
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030, USA.
| | - Pierre M Buekens
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
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Sarna M, Pereira GF, Foo D, Baynam GS, Regan AK. The risk of major structural birth defects associated with seasonal influenza vaccination during pregnancy: A population-based cohort study. Birth Defects Res 2022; 114:1244-1256. [PMID: 35678518 PMCID: PMC9796878 DOI: 10.1002/bdr2.2049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Seasonal inactivated influenza vaccine (IIV) is routinely recommended during pregnancy to protect both mothers and infants from complications following influenza infection. While previous studies have evaluated the risk of major structural birth defects in infants associated with prenatal administration of monovalent pandemic IIV, fewer studies have evaluated the risk associated with prenatal seasonal IIV. METHODS We conducted a population-based cohort study of 125,866 singleton births between 2012 and 2016 in Western Australia. Birth registrations were linked to the state's registers for congenital anomalies and a state prenatal vaccination database. We estimated prevalence ratios (PR) of any major structural birth defect and defects by organ system. Vaccinated pregnancies were defined as those with a record of IIV in the first trimester. Inverse probability treatment weighting factored for baseline probability for vaccination. A Bonferroni correction was applied to account for multiple comparisons. RESULTS About 3.9% of births had a major structural birth defect. Seasonal IIV exposure during the first trimester was not associated with diagnosis of any major structural birth defect diagnosed within 1 month of birth (PR 0.98, 95% CI: 0.77, 1.28) or within 6 years of life (PR 1.02, 95% CI: 0.78, 1.35). We identified no increased risk in specific birth defects associated with seasonal IIV. CONCLUSION Based on registry data for up to 6 years of follow-up, results suggest there is no association between maternal influenza vaccination and risk of major structural birth defects. These results support the safety of seasonal IIV administration during pregnancy.
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Affiliation(s)
- Mohinder Sarna
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Gavin F. Pereira
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia,Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Damien Foo
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Gareth S. Baynam
- King Edward Memorial Hospital, Western Australian Department of HealthSubiacoWestern AustraliaAustralia,Faculty of Health and Medical Sciences, Division of PediatricsThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Annette K. Regan
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia,School of Nursing and Health ProfessionsUniversity of San FranciscoSan FranciscoCaliforniaUSA
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Campbell F, Salam S, Sutton A, Jayasooriya SM, Mitchell C, Amabebe E, Balen J, Gillespie BM, Parris K, Soma-Pillay P, Chauke L, Narice B, Anumba DO. Interventions for the prevention of spontaneous preterm birth: a scoping review of systematic reviews. BMJ Open 2022; 12:e052576. [PMID: 35568487 PMCID: PMC9109033 DOI: 10.1136/bmjopen-2021-052576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/04/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Globally, 11% of babies are born preterm each year. Preterm birth (PTB) is a leading cause of neonatal death and under-five mortality and morbidity, with lifelong sequelae in those who survive. PTB disproportionately impacts low/middle-income countries (LMICs) where the burden is highest. OBJECTIVES This scoping review sought to the evidence for interventions that reduce the risk of PTB, focusing on the evidence from LMICs and describing how context is considered in evidence synthesis. DESIGN We conducted a scoping review, to describe this wide topic area. We searched five electronic databases (2009-2020) and contacted experts to identify relevant systematic reviews of interventions to reduce the risk of PTB. We included published systematic reviews that examined the effectiveness of interventions and their effect on reducing the risk of PTB. Data were extracted and is described narratively. RESULTS 139 published systematic reviews were included in the review. Interventions were categorised as primary or secondary. The interventions where the results showed a greater effect size and consistency across review findings included treatment of syphilis and vaginal candidiasis, vitamin D supplementation and cervical cerclage. Included in the 139 reviews were 1372 unique primary source studies. 28% primary studies were undertaken in LMIC contexts and only 4.5% undertaken in a low-income country (LIC) Only 10.8% of the reviews sought to explore the impact of context on findings, and 19.4% reviews did not report the settings or the primary studies. CONCLUSION This scoping review highlights the lack of research evidence derived from contexts where the burden of PTB globally is greatest. The lack of rigour in addressing contextual applicability within systematic review methods is also highlighted. This presents a risk of inappropriate and unsafe recommendations for practice within these contexts. It also highlights a need for primary research, developing and testing interventions in LIC settings.
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Affiliation(s)
| | - Shumona Salam
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | | | | | - Caroline Mitchell
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Emmanuel Amabebe
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Julie Balen
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Bronwen M Gillespie
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Kerry Parris
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Lawrence Chauke
- Department of Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg, South Africa
| | - Brenda Narice
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Dilichukwu O Anumba
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Prenatal influenza vaccination and allergic and autoimmune diseases in childhood: A longitudinal, population-based linked cohort study. PLoS Med 2022; 19:e1003963. [PMID: 35381006 PMCID: PMC9017895 DOI: 10.1371/journal.pmed.1003963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/19/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have evaluated the effect of maternal influenza vaccination on the development of allergic and autoimmune diseases in children beyond 6 months of age. We aimed to investigate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and subsequent diagnosis of allergic and autoimmune diseases. METHODS AND FINDINGS This longitudinal, population-based linked cohort study included 124,760 singleton, live-born children from 106,206 mothers in Western Australia (WA) born between April 2012 and July 2016, with up to 5 years of follow-up from birth. In our study cohort, 64,169 (51.4%) were male, 6,566 (5.3%) were Aboriginal and/or Torres Strait Islander children, and the mean age at the end of follow-up was 3.0 (standard deviation, 1.3) years. The exposure was receipt of seasonal IIV during pregnancy. The outcomes were diagnosis of an allergic or autoimmune disease, including asthma and anaphylaxis, identified from hospital and/or emergency department (ED) records. Inverse probability of treatment weights (IPTWs) accounted for baseline probability of vaccination by maternal age, Aboriginal and/or Torres Strait Islander status, socioeconomic status, body mass index, parity, medical conditions, pregnancy complications, prenatal smoking, and prenatal care. The models additionally adjusted for the Aboriginal and/or Torres Strait Islander status of the child. There were 14,396 (11.5%) maternally vaccinated children; 913 (6.3%) maternally vaccinated and 7,655 (6.9%) maternally unvaccinated children had a diagnosis of allergic or autoimmune disease, respectively. Overall, maternal influenza vaccination was not associated with diagnosis of an allergic or autoimmune disease (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.95 to 1.09). In trimester-specific analyses, we identified a negative association between third trimester influenza vaccination and the diagnosis of asthma (n = 40; aHR, 0.70; 95% CI, 0.50 to 0.97) and anaphylaxis (n = 36; aHR, 0.67; 95% CI, 0.47 to 0.95).We did not capture outcomes diagnosed in a primary care setting; therefore, our findings are only generalizable to more severe events requiring hospitalization or presentation to the ED. Due to small cell sizes (i.e., <5), estimates could not be determined for all outcomes after stratification. CONCLUSIONS In this study, we observed no association between in utero exposure to influenza vaccine and diagnosis of allergic or autoimmune diseases. Although we identified a negative association of asthma and anaphylaxis diagnosis when seasonal IIV was administered later in pregnancy, additional studies are needed to confirm this. Overall, our findings support the safety of seasonal inactivated influenza vaccine during pregnancy in relation to allergic and autoimmune diseases in early childhood and support the continuation of current global maternal vaccine programs and policies.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C. Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K. Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States of America
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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5
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Juvet LK, Robertson AH, Laake I, Mjaaland S, Trogstad L. Safety of Influenza A H1N1pdm09 Vaccines: An Overview of Systematic Reviews. Front Immunol 2021; 12:740048. [PMID: 34777351 PMCID: PMC8581668 DOI: 10.3389/fimmu.2021.740048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background In 2009, a new influenza A H1N1 virus emerged causing a global pandemic. A range of monovalent influenza A H1N1pdm09 vaccines with or without adjuvants were developed. After the mass vaccination campaigns safety concerns related to H1N1pdm09 vaccines were reported. More than a decade later, reported AEFIs are still under scrutiny. We performed a systematic review aiming to synthesize the evidence on the safety of the H1N1pdm09 vaccines on reported outcomes from existing systematic reviews. Methods Four electronic databases, PubMed, EMBASE, Epistimonikos and the Cochrane Database of Systematic Reviews were searched for articles on H1N1pdm09 vaccination published from 2009 to January 2021. Systematic reviews assessing short- or long-term adverse events after H1N1pdm09 vaccination were considered for inclusion. Data was extracted from all selected reviews. Outcomes were grouped and results from each included review were presented narratively and in tables. Results 16 systematic reviews met the inclusion criteria. Reported outcomes were short-term events (3 reviews), fetal/pregnancy outcomes (8 reviews), Guillain-Barré syndrome (GBS) (4 reviews), narcolepsy (2 reviews) demyelinating diseases (1 review based on one study only) and inflammatory bowel disease (IBD) (1 review). Short-term serious adverse events were rare, 3 cases amongst 16725 subjects in 18 randomized controlled trials (0.018%). No deaths were reported. The risks of local events were generally higher for adjuvanted vaccines as compared to unadjuvanted vaccines. Maternal H1N1pdm09 vaccination in any trimester was not associated with an increase in preterm birth, small for gestational age, congenital malformations or fetal death. For GBS, results were conflicting. The main systematic review on narcolepsy found a 5-14-fold increased risk in children, and a 2-7- fold increased risk in adults after vaccination with Pandemrix. The attributable risk of narcolepsy one year after vaccination was 1 case per 18 400 vaccine doses in children/adolescents, and 1 case per 181 000 vaccine doses in adults. Conclusion Adjuvanted vaccines had more local but not serious adverse events compared to unadjuvanted vaccines. Vaccination with Pandemrix was strongly associated with narcolepsy, particularly in children. No increased risks of pregnancy outcomes were seen after pandemic vaccination. The findings on GBS were inconclusive.
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Affiliation(s)
- Lene Kristine Juvet
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Ciapponi A, Bardach A, Mazzoni A, Alconada T, Anderson SA, Argento FJ, Ballivian J, Bok K, Comandé D, Erbelding E, Goucher E, Kampmann B, Karron R, Munoz FM, Palermo MC, Parker EPK, Rodriguez Cairoli F, Santa María V, Stergachis AS, Voss G, Xiong X, Zamora N, Zaraa S, Berrueta M, Buekens PM. Safety of components and platforms of COVID-19 vaccines considered for use in pregnancy: A rapid review. Vaccine 2021; 39:5891-5908. [PMID: 34489131 PMCID: PMC8360993 DOI: 10.1016/j.vaccine.2021.08.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Rapid assessment of COVID-19 vaccine safety during pregnancy is urgently needed. METHODS We conducted a rapid systematic review, to evaluate the safety of COVID-19 vaccines selected by the COVID-19 Vaccines Global Access-Maternal Immunization Working Group in August 2020, including their components and their technological platforms used in other vaccines for pregnant persons. We searched literature databases, COVID-19 vaccine pregnancy registries, and explored reference lists from the inception date to February 2021 without language restriction. Pairs of reviewers independently selected studies through COVIDENCE, and performed the data extraction and the risk of bias assessment. Discrepancies were resolved by consensus. Registered on PROSPERO (CRD42021234185). RESULTS We retrieved 6757 records and 12 COVID-19 pregnancy registries from the search strategy; 38 clinical and non-clinical studies (involving 2,398,855 pregnant persons and 56 pregnant animals) were included. Most studies (89%) were conducted in high-income countries and were cohort studies (57%). Most studies (76%) compared vaccine exposures with no exposure during the three trimesters of pregnancy. The most frequent exposure was to AS03 adjuvant, in the context of A/H1N1 pandemic influenza vaccines, (n = 24) and aluminum-based adjuvants (n = 11). Only one study reported exposure to messenger RNA in lipid nanoparticles COVID-19 vaccines. Except for one preliminary report about A/H1N1 influenza vaccination (adjuvant AS03), corrected by the authors in a more thorough analysis, all studies concluded that there were no safety concerns. CONCLUSION This rapid review found no evidence of pregnancy-associated safety concerns of COVID-19 vaccines or of their components or platforms when used in other vaccines. However, the need for further data on several vaccine platforms and components is warranted, given their novelty. Our findings support current WHO guidelines recommending that pregnant persons may consider receiving COVID-19 vaccines, particularly if they are at high risk of exposure or have comorbidities that enhance the risk of severe disease.
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Affiliation(s)
- Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Steven A Anderson
- US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.
| | - Fernando J Argento
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Jamile Ballivian
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Karin Bok
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 31 Center Dr # 7A03, Bethesda, MD 20892, USA.
| | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Emily Erbelding
- National Institute of Allergy and Infectious Diseases, 1 Center Dr # 7A03, Bethesda, USA.
| | - Erin Goucher
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA 70112, USA.
| | - Beate Kampmann
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Vaccines & Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia.
| | - Ruth Karron
- Bloomberg School of Public Health, Johns Hopkins University, 7CX5+8W Baltimore, MD, USA.
| | - Flor M Munoz
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX 77030, USA.
| | - María Carolina Palermo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Edward P K Parker
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Victoria Santa María
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Andy S Stergachis
- School of Pharmacy and School of Public Health, University of Washington, MM2R+78 Seattle, WA, USA.
| | - Gerald Voss
- TuBerculosis Vaccine Initiative (TBVI), GHF4+6W Lelystad, the Netherlands.
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA 70112, USA.
| | - Natalia Zamora
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina
| | - Sabra Zaraa
- School of Pharmacy, University of Washington, MM2R+78 Seattle, WA, USA.
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Dr. Emilio Ravignani 2024 C1014CPV, Argentina.
| | - Pierre M Buekens
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA 70112, USA.
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Barger MK. Current Resources for Evidence-Based Practice, January/February 2021. J Midwifery Womens Health 2021; 66:118-126. [PMID: 33599098 DOI: 10.1111/jmwh.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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Ciapponi A, Bardach A, Mazzoni A, Alconada T, Anderson S, Argento FJ, Ballivian J, Bok K, Comandé D, Erbelding E, Goucher E, Kampmann B, Karron R, Munoz FM, Palermo MC, Parker EPK, Cairoli FR, Santa MV, Stergachis A, Voss G, Xiong X, Zamora N, Zaraa S, Berrueta M, Buekens PM. Safety of COVID-19 vaccines, their components or their platforms for pregnant women: A rapid review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.03.21258283. [PMID: 34127978 PMCID: PMC8202435 DOI: 10.1101/2021.06.03.21258283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women with COVID-19 are at an increased risk of severe COVID-19 illness as well as adverse pregnancy and birth outcomes. Many countries are vaccinating or considering vaccinating pregnant women with limited available data about the safety of this strategy. Early identification of safety concerns of COVID-19 vaccines, including their components, or their technological platforms is therefore urgently needed. METHODS We conducted a rapid systematic review, as the first phase of an ongoing full systematic review, to evaluate the safety of COVID-19 vaccines in pregnant women, including their components, and their technological platforms (whole virus, protein, viral vector or nucleic acid) used in other vaccines, following the Cochrane methods and the PRISMA statement for reporting (PROSPERO-CRD42021234185).We searched literature databases, COVID-19 and pregnancy registries from inception February 2021 without time or language restriction and explored the reference lists of relevant systematic reviews retrieved. We selected studies of any methodological design that included at least 50 pregnant women or pregnant animals exposed to the vaccines that were selected for review by the COVAX MIWG in August 2020 or their components or platforms included in the COVID-19 vaccines, and evaluated adverse events during pregnancy and the neonatal period.Pairs of reviewers independently selected studies through the COVIDENCE web software and performed the data extraction through a previously piloted online extraction form. Discrepancies were resolved by consensus. RESULTS We identified 6768 records, 256 potentially eligible studies were assessed by full-text, and 37 clinical and non-clinical studies (38 reports, involving 2,397,715 pregnant women and 56 pregnant animals) and 12 pregnancy registries were included.Most studies (89%) were conducted in high-income countries. The most frequent study design was cohort studies (n=21), followed by surveillance studies, randomized controlled trials, and registry analyses. Most studies (76%) allowed comparisons between vaccinated and unvaccinated pregnant women (n=25) or animals (n=3) and reported exposures during the three trimesters of pregnancy.The most frequent exposure was to AS03 adjuvant in the context of A/H1N1 pandemic influenza vaccines (n=24), followed by aluminum-based adjuvants (n=11). Aluminum phosphate was used in Respiratory Syncytial Virus Fusion candidate vaccines (n=3) and Tdap vaccines (n=3). Different aluminum-based adjuvants were used in hepatitis vaccines. The replication-deficient simian adenovirus ChAdOx1 was used for a Rift Valley fever vaccine. Only one study reported exposure to messenger RNA (mRNA) COVID-19 vaccines that also used lipid nanoparticles. Except for one preliminary report about A/H1N1 influenza vaccination (adjuvant AS03) - corrected by the authors in a more thorough analysis, all studies concluded that there were no safety concerns. CONCLUSION This rapid review found no evidence of pregnancy-associated safety concerns of COVID-19 vaccines that were selected for review by the COVAX MIWG or of their components or platforms when used in other vaccines. However, the need for further data on several vaccine platforms and components is warranted given their novelty. Our findings support current WHO guidelines recommending that pregnant women may consider receiving COVID-19 vaccines, particularly if they are at high risk of exposure or have comorbidities that enhance the risk of severe disease.
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9
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Maltezou HC, Rodolakis A. Vaccination of pregnant women against influenza: what is the optimal timing? Hum Vaccin Immunother 2021; 17:2723-2727. [PMID: 33599569 DOI: 10.1080/21645515.2021.1889934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Pregnant women and young infants are at increased risk for severe influenza and its complications. Influenza vaccination during pregnancy is increasingly implemented as a strategy aiming to protect the pregnant woman, the fetus and the young infant. In clinical practice, the achievement of satisfactory protection for the pregnant woman without compromising the protection of her infant during the first months of life remains a challenge. Determinants that are implicated in the optimal timing of influenza vaccination in pregnancy include influenza season, trimester of pregnancy, maternal host factors and infant factors. This article addresses influenza vaccination in pregnancy and presents recent published evidence on issues that affect the optimization of the timing of maternal vaccination.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynecology, University of Athens, Alexandra General Hospital, Athens, Greece
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10
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Foo DYP, Sarna M, Pereira G, Moore HC, Fell DB, Regan AK. Early Childhood Health Outcomes Following In Utero Exposure to Influenza Vaccines: A Systematic Review. Pediatrics 2020; 146:peds.2020-0375. [PMID: 32719088 DOI: 10.1542/peds.2020-0375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Vaccination during pregnancy is an effective strategy for preventing infant disease; however, little is known about early childhood health after maternal vaccination. OBJECTIVES To systematically review the literature on early childhood health associated with exposure to influenza vaccines in utero. DATA SOURCES We searched CINAHL Plus, Embase, Medline, Scopus, and Web of Science for relevant articles published from inception to July 24, 2019. STUDY SELECTION We included studies published in English reporting original data with measurement of in utero exposure to influenza vaccines and health outcomes among children <5 years of age. DATA EXTRACTION Two authors independently assessed eligibility and extracted data on study design, setting, population, vaccines, outcomes, and results. RESULTS The search yielded 3647 records, of which 9 studies met the inclusion criteria. Studies examined infectious, atopic, autoimmune, and neurodevelopmental outcomes, and all-cause morbidity and mortality. Authors of 2 studies reported an inverse association between pandemic influenza vaccination and upper respiratory tract infections, gastrointestinal infections, and all-cause hospitalizations; and authors of 2 studies reported modest increased association between several childhood disorders and pandemic or seasonal influenza vaccination, which, after adjusting for confounding and multiple comparisons, were not statistically significant. LIMITATIONS Given the small number of studies addressing similarly defined outcomes, meta-analyses were deemed not possible. CONCLUSIONS Results from the few studies in which researchers have examined outcomes in children older than 6 months of age did not identify an association between exposure to influenza vaccines in utero and adverse childhood health outcomes.
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Affiliation(s)
- Damien Y P Foo
- School of Public Health, Curtin University, Perth, Western Australia, Australia; .,Wesfarmers Centre of Vaccines & Infectious Diseases
| | - Mohinder Sarna
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; and
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases.,School of Public Health, Texas A&M University, College Station, Texas
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11
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Quach THT, Mallis NA, Cordero JF. Influenza Vaccine Efficacy and Effectiveness in Pregnant Women: Systematic Review and Meta-analysis. Matern Child Health J 2019; 24:229-240. [DOI: 10.1007/s10995-019-02844-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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12
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Buchy P, Badur S, Kassianos G, Preiss S, Tam JS. Vaccinating pregnant women against influenza needs to be a priority for all countries: An expert commentary. Int J Infect Dis 2019; 92:1-12. [PMID: 31863875 DOI: 10.1016/j.ijid.2019.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In 2012, the World Health Organization recommended influenza vaccination for all pregnant women worldwide and the prioritisation of pregnant women in national influenza vaccination programmes. Nevertheless, vaccination rates in pregnant women often remain much lower than national targets. OBJECTIVES To assess the benefits and risks associated with influenza infection and vaccination during pregnancy, and to consider obstacles that work against influenza vaccine uptake during pregnancy. RESULTS There is strong evidence that maternal and foetal outcomes can be compromised if women develop influenza infections during pregnancy. Influenza vaccines have been administered to millions of pregnant women and have demonstrated benefits in terms of disease prevention in mothers and their infants. There is a consensus amongst several recommending authorities that influenza vaccines may be safely administered during all stages of pregnancy. Healthcare professionals are recognised as the most important influencers of vaccine uptake, being well placed to recommend vaccination and directly address safety concerns. CONCLUSIONS Despite data supporting the value of influenza vaccination during pregnancy, vaccine uptake remains low globally. Low uptake appears to be largely due to ineffective communication with pregnant women about the risks and benefits of influenza vaccination. A graphical abstract is available online.
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Affiliation(s)
| | - Selim Badur
- GSK, Büyükdere Caddesi No:173 1. Levent Plaza B Blok, 34394 Istanbul, Turkey
| | - George Kassianos
- President of the British Global & Travel Health Association, Chairman of RAISE Pan- European Committee on Influenza, National Immunisation Lead Royal College of General Practitioners, United Kingdom, Board Director of the European Working Group on Influenza
| | | | - John S Tam
- Chairman of the Asia Pacific Alliance for the control of influenza (APACI); Adjunct Professor, Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
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13
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Misra RS, Nayak JL. The Importance of Vaccinating Children and Pregnant Women against Influenza Virus Infection. Pathogens 2019; 8:pathogens8040265. [PMID: 31779153 PMCID: PMC6963306 DOI: 10.3390/pathogens8040265] [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] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022] Open
Abstract
Influenza virus infection is responsible for significant morbidity and mortality in the pediatric and pregnant women populations, with deaths frequently caused by severe influenza-associated lower respiratory tract infection and acute respiratory distress syndrome (ARDS). An appropriate immune response requires controlling the viral infection through activation of antiviral defenses, which involves cells of the lung and immune system. High levels of viral infection or high levels of inflammation in the lower airways can contribute to ARDS. Pregnant women and young children, especially those born prematurely, may develop serious complications if infected with influenza virus. Vaccination against influenza will lead to lower infection rates and fewer complications, even if the vaccine is poorly matched to circulating viral strains, with maternal vaccination offering infants protection via antibody transmission through the placenta and breast milk. Despite the health benefits of the influenza vaccine, vaccination rates around the world remain well below targets. Trust in the use of vaccines among the public must be restored in order to increase vaccination rates and decrease the public health burden of influenza.
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Affiliation(s)
- Ravi S Misra
- Department of Pediatrics Division of Neonatology, The University of Rochester Medical Center, Rochester, NY 14623, USA
- Correspondence:
| | - Jennifer L Nayak
- Department of Pediatrics Division of Pediatric Infectious Diseases, The University of Rochester Medical Center, Rochester, NY 14623, USA;
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14
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Brillo E, Tosto V, Giardina I, Buonomo E. Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization: an overview. J Matern Fetal Neonatal Med 2019; 34:3415-3444. [PMID: 31645152 DOI: 10.1080/14767058.2019.1680633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization for women during pregnancy (the so-called "maternal immunization") has been introduced in several countries, and recently also in Italy, to protect mother and fetus during pregnancy, infant in his first months of life and mother during postpartum period. However, very low vaccination coverage rates have been reached due to several variables. METHODS A literature search was conducted on PubMed and Embase, including any experimental or observational studies, to assesses existing evidence on the effectiveness, efficacy, safety and optimal timing of administration of Tdap and influenza immunization in pregnancy for mothers and their infants. The search was finalized in August 2019. RESULTS Reviewing the literature, we identified only a few studies that, among several maternal and infant outcomes, found sporadic significant associations with maternal influenza immunization and even less with Tdap immunization. Moreover, most of the authors of these studies explained these findings as a result of residual confounding effect. The effectiveness of maternal influenza immunization is more complicated to prove than the effectiveness of Tdap immunization because of several reasons. Not all nations recommend and offer vaccines in the same weeks of pregnancy and this one manifests the complexity in defining the best timing for Tdap or influenza immunization. CONCLUSIONS The safety of maternal Tdap or influenza immunization is supported by the evidence so far, however, regular surveillance should be maintained, especially with regard to the influenza vaccine that changes in formulation each year. There is a need to optimize the timing of vaccination in pregnancy and to have a national system of detection of maternal immunization in each country.
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Affiliation(s)
- Eleonora Brillo
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Valentina Tosto
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Irene Giardina
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
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15
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Wang A, Liu C, Wang Y, Yin A, Wu J, Zhang C, Luo M, Du L, Xiong Y, Zhao X, Huang Y. Pregnancy Outcomes After Human Papillomavirus Vaccination in Periconceptional Period or During Pregnancy: A Systematic Review and Meta-analysis. Hum Vaccin Immunother 2019; 16:581-589. [PMID: 31486334 DOI: 10.1080/21645515.2019.1662363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: National immunization schedules in many countries recommend HPV vaccination for females until the age of 26 years, and thus substantial numbers with reproductive age may be exposed to HPV vaccines. Objective: To assess whether inadvertent HPV vaccine exposures in the periconceptional period or during pregnancy were associated with increased risks for adverse pregnancy outcomes. Search strategy: A search of PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang databases (until March 31, 2019) was performed. Selection criteria: Studies that assess the risk of adverse pregnancy outcomes in HPV vaccine exposed/unexposed pregnancies were included. The adverse pregnancy outcomes included spontaneous abortion, stillbirth, small for sestational age, preterm birth, and birth defects. Data collection and analysis: The pooled relative risk (RR) was applied for the effect measure of the study. RRs and 95% confidence interval (CI) were measured when the paper did not report the effect. Heterogeneity between studies was assessed using the Cochrane's Q and I2 statistics. Main results: Of 374 identified citations, 8 met inclusion criteria. Compared with the unexposed pregnancies, HPV vaccine exposed pregnancies were associated with no higher risk for spontaneous abortion (RR, 0.99 [95% CI, 0.90 to 1.08]); stillbirth (RR, 1.16 [95% CI, 0.71 to 1.90]); small for gestational age (RR, 0.96 [95% CI, 0.86 to 1.07]); preterm birth (RR, 1.04 [95% CI, 0.91 to 1.18]); or birth defects (RR, 1.18 [95% CI, 0.97 to 1.43]). Conclusions: Inadvertent bivalent/quadrivalent HPV vaccination during pregnancy was not associated with significantly greater risks of adverse pregnancy outcomes.
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Affiliation(s)
- Anshi Wang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Chang Liu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yunan Wang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Aihua Yin
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jing Wu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Changbin Zhang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Mingyong Luo
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Li Du
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Ying Xiong
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xin Zhao
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yanlin Huang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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16
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Donahue JG, Kieke BA, King JP, Mascola MA, Shimabukuro TT, DeStefano F, Hanson KE, McClure DL, Olaiya O, Glanz JM, Hechter RC, Irving SA, Jackson LA, Klein NP, Naleway AL, Weintraub ES, Belongia EA. Inactivated influenza vaccine and spontaneous abortion in the Vaccine Safety Datalink in 2012-13, 2013-14, and 2014-15. Vaccine 2019; 37:6673-6681. [PMID: 31540812 PMCID: PMC6906603 DOI: 10.1016/j.vaccine.2019.09.035] [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: 06/11/2019] [Revised: 08/16/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023]
Abstract
Introduction: A recent study reported an association between inactivated influenza vaccine (IIV) and spontaneous abortion (SAB), but only among women who had also been vaccinated in the previous influenza season. We sought to estimate the association between IIV administered in three recent influenza seasons and SAB among women who were and were not vaccinated in the previous influenza season. Methods: We conducted a case-control study over three influenza seasons (2012–13, 2013–14, 2014–15) in the Vaccine Safety Datalink (VSD). Cases (women with SAB) and controls (women with live births) were matched on VSD site, date of last menstrual period, age group, and influenza vaccination status in the previous influenza season. Of 1908 presumptive cases identified from the electronic record, 1236 were included in the main analysis. Administration of IIV was documented in several risk windows, including 1–28, 29–56, and >56 days before the SAB date. Results: Among 627 matched pairs vaccinated in the previous season, no association was found between vaccination in the 1–28 day risk window and SAB (adjusted odds ratio (aOR) 0.9; 95% confidence interval (CI) 0.6–1.5). The season-specific aOR ranged from 0.5 to 1.7 with all CIs including the null value of 1.0. Similarly, no association was found among women who were not vaccinated in the previous season; the season-specific aOR in the 1–28 day risk window ranged from 0.6 to 0.7 and the 95% CI included 1.0 in each season. There was no association found between SAB and influenza vaccination in the other risk windows, or when vaccine receipt was analyzed relative to date of conception. Conclusion: During these seasons we found no association between IIV and SAB, including among women vaccinated in the previous season. These findings lend support to current recommendations for influenza vaccination at any time during pregnancy, including the first trimester.
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Affiliation(s)
- James G Donahue
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, United States.
| | - Burney A Kieke
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, United States.
| | - Jennifer P King
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, United States.
| | - Maria A Mascola
- Marshfield Clinic, Department of Obstetrics and Gynecology, 1000 N Oak Ave, Marshfield, WI 54449, United States.
| | - Tom T Shimabukuro
- Centers for Disease Control and Prevention, Immunization Safety Office, 1600 Clifton Road NE, MS V18-4 Atlanta, GA 30329, United States.
| | - Frank DeStefano
- Centers for Disease Control and Prevention, Immunization Safety Office, 1600 Clifton Road NE, MS V18-4 Atlanta, GA 30329, United States.
| | - Kayla E Hanson
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, United States.
| | - David L McClure
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, United States.
| | - Oluwatosin Olaiya
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, United States.
| | - Jason M Glanz
- Kaiser Permanente Colorado, 10065 E Harvard Ave, Suite 300, Denver, CO 80231, United States.
| | - Rulin C Hechter
- Kaiser Permanente Southern California, 100 S Los Robles Ave., 2nd Floor, Pasadena, CA 91101, United States.
| | - Stephanie A Irving
- Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, United States.
| | - Lisa A Jackson
- Kaiser Permanente Washington, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States.
| | - Nicola P Klein
- Kaiser Permanente Northern California, 1 Kaiser Plaza, 16th Floor, Oakland, CA 94612, United States.
| | - Allison L Naleway
- Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, United States.
| | - Eric S Weintraub
- Centers for Disease Control and Prevention, Immunization Safety Office, 1600 Clifton Road NE, MS V18-4 Atlanta, GA 30329, United States.
| | - Edward A Belongia
- Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449, United States.
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17
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Bovbjerg ML. Current Resources for Evidence-Based Practice, January 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:99-111. [DOI: 10.1016/j.jogn.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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18
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Ahmad SM, Alam MJ, Khanam A, Rashid M, Islam S, Kabir Y, Raqib R, Steinhoff MC. Vitamin A Supplementation during Pregnancy Enhances Pandemic H1N1 Vaccine Response in Mothers, but Enhancement of Transplacental Antibody Transfer May Depend on When Mothers Are Vaccinated during Pregnancy. J Nutr 2018; 148:1968-1975. [PMID: 30517724 DOI: 10.1093/jn/nxy228] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/17/2018] [Indexed: 12/29/2022] Open
Abstract
Background In the growing embryo, the vitamin A requirement is tightly regulated. Maternal vitamin A deficiency during pregnancy may alter maternal immune function to accommodate the fetus. Objective Our primary objective was to determine the effect of oral vitamin A supplementation (VAS) during pregnancy and until 6 mo postpartum on pandemic H1N1-vaccine responses in mothers and their infants at 6 mo of age. Methods In this randomized controlled clinical trial, pregnant women (n = 112) during the second trimester (mean ± SD: 14 ± 1 wk) were assigned to receive either an oral dose of 10,000 IU vitamin A or placebo weekly until 6 mo postpartum. During the third trimester, mothers received a single dose of inactivated pandemic H1N1-influenza vaccine. Hemagglutination-inhibition (HAI) titer was measured in cord, infant, and maternal blood samples. Multivariate regressions with adjustments were used for data analysis. Results Seventy-six percent of women had low plasma retinol concentrations (<1.05 μmol/L) in their second trimester. VAS of mothers increased vitamin A concentrations in cord blood by 21.4% and in colostrum by 40.7%. At 6 mo postpartum, women in the vitamin A group had 38.7% higher HAI titers and a higher proportion of HAI titer of ≥1:40 of the cutoff compared with the placebo group. A total of 54.5% of infants had an HAI titer ≥1:40 at 6 mo of age, but there was no difference in HAI titer in infants between groups. Overall, HAI in cord blood did not differ between groups, but in the placebo group, cord blood HAI was negatively associated with maternal "vaccination-to-delivery intervals" (rs = -0.401; P = 0.5), and maternal VAS increased cord blood HAI 6-fold if antenatal immunization was administered ≥10 wk before delivery. Conclusions In a community with low vitamin A status, weekly maternal VAS during pregnancy and postpartum increases the breast-milk vitamin A concentration and enhances prenatal H1N1-vaccine responses in mothers, but the benefits of maternal VAS in transplacental antibody transfer may depend on the time of gestation when mothers were vaccinated. This trial was registered at clinicaltrials.gov as NCT00817661.
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Affiliation(s)
- Shaikh M Ahmad
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Md J Alam
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Afsana Khanam
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mamunur Rashid
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Sharmin Islam
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Yearul Kabir
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Rubhana Raqib
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mark C Steinhoff
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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19
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Aldaz Herce P, Morató Agustí ML, Gómez Marco JJ, Javierre Miranda AP, Martín Martín S, Moreno Millán N, Sánchez Hernández C, Schwarz Chavarri G. Prevención de las enfermedades infecciosas. Actualización PAPPS en vacunas 2018. Aten Primaria 2018; 50 Suppl 1:66-82. [PMID: 29866359 PMCID: PMC6837052 DOI: 10.1016/s0212-6567(18)30363-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Pablo Aldaz Herce
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud San Juan, SNS, Pamplona
| | - M Luisa Morató Agustí
- Especialista en Medicina Familiar y Comunitaria, Consultor Senior del Grupo de Prevención en las Enfermedades Infecciosas PAPPS-semFyC
| | - José Javier Gómez Marco
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Las Calesas, SERMAS, Madrid
| | | | - Susana Martín Martín
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud de Balmaseda, OSI Ezkerraldea Enkarterri Cruces, Vizcaya
| | - Nemesio Moreno Millán
- Técnico de Salud, Máster en Salud Pública, Responsable de Sistemas de Información de la Dirección de Atención Primaria Metropolitana Nord (ICS-CAT)
| | - Coro Sánchez Hernández
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Virgen Peregrina, SERGAS, Pontevedra
| | - Germán Schwarz Chavarri
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud San Blas, Alicante, Conselleria de Sanitat, Generalitat Valenciana
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