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Davies HG, Thorley EV, Al-Bahadili R, Sutton N, Burt J, Hookham L, Karampatsas K, Lambach P, Muñoz F, Cutland CL, Omer S, Le Doare K. Defining and reporting adverse events of special interest in comparative maternal vaccine studies: a systematic review. Vaccine X 2024; 18:100464. [PMID: 38495929 PMCID: PMC10943481 DOI: 10.1016/j.jvacx.2024.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction The GAIA (Global Alignment on Immunisation Safety Assessment in Pregnancy) consortium was established in 2014 with the aim of creating a standardised, globally coordinated approach to monitoring the safety of vaccines administered in pregnancy. The consortium developed twenty-six standardised definitions for classifying obstetric and infant adverse events. This systematic review sought to evaluate the current state of adverse event reporting in maternal vaccine trials following the publication of the case definitions by GAIA, and the extent to which these case definitions have been adopted in maternal vaccine safety research. Methods A comprehensive search of published literature was undertaken to identify maternal vaccine research studies. PubMed, EMBASE, Web of Science, and Cochrane were searched using a combination of MeSH terms and keyword searches to identify observational or interventional studies that examined vaccine safety in pregnant women with a comparator group. A two-reviewer screening process was undertaken, and a narrative synthesis of the results presented. Results 14,737 titles were identified from database searches, 435 titles were selected as potentially relevant, 256 were excluded, the remaining 116 papers were included. Influenza vaccine was the most studied (25.0%), followed by TDaP (20.7%) and SARS-CoV-2 (12.9%).Ninety-one studies (78.4%) were conducted in high-income settings. Forty-eight (41.4%) utilised electronic health-records. The majority focused on reporting adverse events of special interest (AESI) in pregnancy (65.0%) alone or in addition to reactogenicity (27.6%). The most frequently reported AESI were preterm birth, small for gestational age and hypertensive disorders. Fewer than 10 studies reported use of GAIA definitions. Gestational age assessment was poorly described; of 39 studies reporting stillbirths 30.8% provided no description of the gestational age threshold. Conclusions Low-income settings remain under-represented in comparative maternal vaccine safety research. There has been poor uptake of GAIA case definitions. A lack of harmonisation and standardisation persists limiting comparability of the generated safety data.
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Affiliation(s)
- Hannah G Davies
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
- MRC, UVRI & LSHTM Uganda Research Centre, Entebbe, Uganda
- Makerere University John Hopkins Research Unit, Kampala, Uganda
| | - Emma V Thorley
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Rossul Al-Bahadili
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Natalina Sutton
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Jessica Burt
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Lauren Hookham
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Kostas Karampatsas
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | | | - Flor Muñoz
- Paediatric Infectious Diseases Department, Baylor College of Medicine, Houston, TX, USA
| | - Clare L Cutland
- Wits African Leadership in Vaccinology Expertise (Wits-Alive), School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Saad Omer
- O’Donnell School of Public Health, UT Southwestern Medical Center, Texas, USA
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
- Makerere University John Hopkins Research Unit, Kampala, Uganda
- World Health Organization, Geneva, Switzerland
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2
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Olson-Chen C, Swamy GK, Gonik B, Forsyth K, Heininger U, Hozbor D, von König CHW, Chitkara AJ, Top KA, Muloiwa R, van der Schyff M, Tan TQ. The current state of pertussis vaccination in pregnancy around the world, with recommendations for improved care: Consensus statements from the Global Pertussis Initiative. Int J Gynaecol Obstet 2024; 165:860-869. [PMID: 38251722 DOI: 10.1002/ijgo.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024]
Abstract
Bordetella pertussis, which causes a respiratory disease known as pertussis ("whooping cough") remains an important global challenge, with the incidence in pertussis cases increasing in recent years. Newborns and infants are at increased risk for severe morbidity and mortality from this bacterium. Vaccination in pregnancy has become an important strategy to both passively transfer immunity as well as prevent infection in pregnant persons, who are a major source of newborn infection, thus attempting to decrease the impact of this serious disease. It is considered safe for the pregnant person, the developing fetus, and the infant, and during the first 3 months of life it has been shown to be highly effective in preventing pertussis. There are a variety of strategies, recommendations, and adherence rates associated with pertussis vaccination in pregnancy around the world. We summarize the 2021 Global Pertussis Initiative Annual Meeting that reviewed the current global status of pertussis vaccination in pregnancy and remaining medical and scientific questions, with a focus on vaccination challenges and strategies for obstetric and gynecologic healthcare providers.
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Affiliation(s)
- Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Geeta K Swamy
- Division of Maternal-Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bernard Gonik
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kevin Forsyth
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ulrich Heininger
- Division of Pediatric Infectious Diseases and Vaccinology, Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Daniela Hozbor
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CONICET, La Plata, Argentina
| | | | - Amar J Chitkara
- Department of Pediatrics, Max Super Speciality Hospital, New Delhi, India
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rudzani Muloiwa
- Department of Paediatrics and Child health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Malikah van der Schyff
- Department of Obstetrics and Gynaecology, Constantiaberg Mediclinic, Cape Town, South Africa
| | - Tina Q Tan
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Clark LR, Johnson DR. Safety and Clinical Benefits of Adacel ® and Adacel ®-Polio Vaccination in Pregnancy: A Structured Literature Review. Infect Dis Ther 2023; 12:1955-2003. [PMID: 37653123 PMCID: PMC10505126 DOI: 10.1007/s40121-023-00847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 09/02/2023] Open
Abstract
Vaccination in pregnancy using a tetanus toxoid, reduced dose diphtheria toxoid, and reduced dose acellular pertussis (Tdap) vaccine is important for prevention of severe pertussis disease in young infants. The objectives of this systematic literature review were to search for original research studies evaluating the vaccine effectiveness, immunogenicity, and safety of Adacel®/Adacel-Polio® used during pregnancy to prevent pertussis disease in young infants. Medical databases used included EMBASE, BIOSIS Previews, and Chemical Abstracts, with search terms related to pregnancy, vaccines/immunization, safety, pertussis, effectiveness/efficacy, and immune response; other potentially eligible reports were included where applicable. Search results were restricted to literature published from 1 January 1995 to 26 July 2021. A total of 2021 articles and 4 other reports were identified for primary review. A total of 49 publications qualified for inclusion after primary and secondary reviews. Effectiveness studies of Adacel or Adacel-Polio given in pregnancy consistently showed high levels of protection from pertussis disease in the newborn (vaccine effectiveness: 91-93%). In immunogenicity studies, the response in pregnant women was consistent with that of non-pregnant women. Infants of mothers vaccinated with Adacel or Adacel-Polio in pregnancy had higher anti-pertussis antibody levels at birth and at 2 months of age compared to infants born to women vaccinated with comparator vaccines, placebo, or those not vaccinated during pregnancy. There was evidence of a slightly decreased response to primary pertussis vaccination in infants of mothers vaccinated with Adacel or Adacel-Polio, but this was not thought to be clinically significant. In safety studies, Adacel or Adacel-Polio vaccination was well tolerated by pregnant woman and not associated with pregnancy, postpartum, or neonatal complications. In conclusion, Adacel or Adacel-Polio vaccination in pregnancy is highly effective in protecting young infants from pertussis disease, with a favorable safety profile for both pregnant women and their infants.
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Affiliation(s)
- Liana R Clark
- Global Medical, Sanofi, 1 Discovery Drive, Swiftwater, PA, 18370, USA.
| | - David R Johnson
- Global Medical, Sanofi, 1 Discovery Drive, Swiftwater, PA, 18370, USA
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4
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Hong EY, Kulkarni K, Gosavi A, Wong HC, Singh K, Kale AS. Assessment of knowledge and attitude towards influenza and pertussis vaccination in pregnancy and factors affecting vaccine uptake rates: a cross-sectional survey. Singapore Med J 2023; 64:513-516. [PMID: 34544209 PMCID: PMC10476924 DOI: 10.11622/smedj.2021097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Eliane Yuting Hong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Kanaka Kulkarni
- School of Medicine, University of Leeds, Leeds, England, United Kingdom
| | - Arundhati Gosavi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Hung Chew Wong
- Biostatistics Unit, Research Support Unit, National University Health System, Singapore
| | - Kuldip Singh
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Anita Sugam Kale
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
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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:S0264-410X(23)00332-8. [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] [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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Isenhour CJ, Skoff TH, Lindley MC, Zhou F, Hariri S. Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage Among Publicly Insured Pregnant Women, U.S., 2016-2019. AJPM FOCUS 2023; 2:100060. [PMID: 37789941 PMCID: PMC10546573 DOI: 10.1016/j.focus.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine during pregnancy is highly effective against Bordetella pertussis in young infants. We aimed to evaluate the uptake of maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination during the recommended gestation period of 27 through 36 weeks among women enrolled in a public medical insurance plan in the U.S. Methods In this analysis using Centers for Medicare and Medicaid Services insurance claims data, we identified women aged 15 through 49 years who delivered a live-born infant from 2016 through 2019. We identified claims for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination to calculate the proportion of women who were vaccinated during Weeks 27 through 36 of gestation in each calendar year. We also assessed the average annual maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis coverage by age group, race and ethnicity, U.S. Census region of residence, and plan type. Data were analyzed in 2021. Results Among 4,318,823 deliveries, the 4-year national average for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccination was 26%, improving from 22% in 2016 to 31% in 2019 (p<0.001). Within subgroups, the lowest 4-year average coverage was among women aged 15 through 18 years (22%); Black, non-Hispanic (23%) and Hispanic women (24%); those residing in the South (18%); those enrolled in a Children's Health Insurance Program plan (22%); and those covered by a fee-for-service plan (19%). Coverage increased across all subgroups from 2016 through 2019. Conclusions Although maternal tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis coverage among publicly insured women in the U.S. increased from 2016 through 2019, it remained considerably lower than estimated national coverage, with notable differences by race and ethnicity.
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Affiliation(s)
- Cheryl J. Isenhour
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tami H. Skoff
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fangjun Zhou
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hariri
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Vaccination in Pregnancy against Pertussis: A Consensus Statement on Behalf of the Global Pertussis Initiative. Vaccines (Basel) 2022; 10:vaccines10121990. [PMID: 36560400 PMCID: PMC9786323 DOI: 10.3390/vaccines10121990] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Infants are at high risk for severe morbidity and mortality from pertussis disease during early infancy. Vaccination against pertussis in pregnancy has emerged as the ideal strategy to protect infants during these early, vulnerable, first months of life. On 30 November and 1 December 2021, the Global Pertussis Initiative held a meeting that aimed to discuss and review the most up-to-date scientific literature supporting vaccination against pertussis in pregnancy and outstanding scientific questions. Herein, we review the current and historically published literature and summarize the findings as consensus statements on vaccination against pertussis in pregnancy on behalf of the Global Pertussis Initiative.
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Zhang C, Hu W, Ma Y, Li L, Si Y, Zhang S. Seroepidemiology of Tetanus among Healthy People Aged 1-59 Years Old in Shaanxi Province, China. Vaccines (Basel) 2022; 10:vaccines10111806. [PMID: 36366315 PMCID: PMC9698734 DOI: 10.3390/vaccines10111806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
The study aims to determine the seroprevalence of antibodies against tetanus among healthy people aged 1−59 years old in Shaanxi province. IgG against tetanus in serum samples were detected by ELISA. 6,439 subjects were enrolled. The positive rate (≥0.01 IU/mL) was 84.39% and GMC was 0.03 IU/mL. There were significant differences in positive rates (χ2 = 308.944, p < 0.01) and GMC (Z = 5,200,000, p < 0.01) among different age groups. The positive rates (χ2 = 304.3, p < 0.01) and GMCs (χ2 = 146.417, p < 0.01) showed regional differences. Both full protection rate (≥0.1 IU/mL) (χ2 = 36.834, p < 0.01) and GMC (Z = 688,000, p < 0.01) increased with the doses of tetanus-toxoid-containing vaccines (TTCVs) administered. The positive rate (χ2 = 54.136, p < 0.01) and GMC (Z = 140,200, p < 0.01) decreased gradually with the time interval after full immunization with TTCVs. The full protection rate (≥0.1 IU/mL) (χ2 = 176.201, p < 0.01) and GMC (Z = 629,900, p < 0.01) decreased with the interval (years) since the last dose of TTCVs. There were significant differences in the positive rates and GMCs for different ages, regions, immunization histories of TTCVs, and doses of TTCVs administered. The full protection rate and GMC decreased with the interval following full immunization with TTCVs and the interval since the last dose of TTCVs. The importance of using tetanus booster doses should be emphasized in adolescents and adults.
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Fakhraei R, Fung SG, Petrcich W, Crowcroft N, Bolotin S, Gaudet L, Amirthalingam G, Biringer A, Wilson K, Dubey V, Halperin SA, Jamieson F, Kwong JC, Sadarangani M, Cook J, Hawken S, Walker MC, Fell DB. Trends and characteristics of Tdap vaccination during pregnancy in Ontario, Canada: a retrospective cohort study. CMAJ Open 2022; 10:E1017-E1026. [PMID: 36735222 PMCID: PMC9744266 DOI: 10.9778/cmajo.20220058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In February 2018, Canada's National Advisory Committee on Immunization (NACI) recommended tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination during pregnancy to protect newborns against pertussis infection. We sought to describe pre- and postrecommendation trends in Tdap vaccination coverage among pregnant Ontario residents. METHODS Using linked health administrative databases, we conducted a population-based retrospective cohort study of all pregnant individuals who gave birth in Ontario hospitals between April 2012 and March 2020. We described Tdap vaccination patterns in pregnancy for the entire study period and before and after the NACI recommendation. We used log-binomial regression to identify characteristics associated with Tdap vaccination during pregnancy. RESULTS Among the 991 850 deliveries included, 7.0% of pregnant individuals received the Tdap vaccination during pregnancy. Vaccine coverage increased from 0.4% in 2011/12 to 29.2% in 2019/20. Coverage was highest among individuals who were older, had no previous live births, had adequate prenatal care and received maternity care primarily from a family physician. After adjustment, characteristics associated with lower coverage included younger maternal age, having a multiple birth, residing in a rural location and higher area material deprivation. In 2019/20, 71.0% of vaccinated individuals received the Tdap vaccination during the recommended gestational window (27-32 wk). Stratified analyses of the pre- and postrecommendation cohorts yielded similar findings to the main analyses with a few gradient differences after adjustment. INTERPRETATION During pregnancy, Tdap vaccination coverage increased substantially in Ontario between 2011/12 and 2019/20, most notably after recommendations for universal Tdap vaccination during pregnancy began in Canada. To further improve vaccine coverage in the obstetric setting, public health strategies should consider tailoring their programs to reach subpopulations with lower vaccine coverage.
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Affiliation(s)
- Romina Fakhraei
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Stephen G Fung
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - William Petrcich
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Natasha Crowcroft
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Shelly Bolotin
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Laura Gaudet
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Gayatri Amirthalingam
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Anne Biringer
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Kumanan Wilson
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Vinita Dubey
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Scott A Halperin
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Frances Jamieson
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Jeffrey C Kwong
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Manish Sadarangani
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Jocelynn Cook
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Steven Hawken
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Mark C Walker
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.
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10
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Tallarek AC, Hollwitz B, Diemert A. Einmalige Möglichkeit für doppelten Nutzen: Impfungen in der Schwangerschaft. DIE GYNÄKOLOGIE 2022. [PMCID: PMC9411844 DOI: 10.1007/s00129-022-04978-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Impfungen sind eine der größten Errungenschaften zum Schutz der öffentlichen Gesundheit. Impfstoffe, die schwangeren Frauen verabreicht werden, schützen dabei nicht nur die Schwangere selbst, sondern auch das Neugeborene. Schwangere Frauen sind von Infektionen unverhältnismäßig stark beeinträchtigt. Die widersprüchlichen Anforderungen an das mütterliche Immunsystem während der Schwangerschaft, mit dem Ziel, die fetale Immuntoleranz aufrechtzuerhalten, erschweren eine schnelle und effektive Immunantwort gegen Krankheitserreger. Dieser dynamische Zustand der Immunadaptation prädisponiert Schwangere für schwerere Krankheitsverläufe. Durch eine Impfung kann einer Infektion oder einem schweren Krankheitsverlauf vorgebeugt werden. In der Folge sinkt auch das Risiko einer Frühgeburt und anderer schwerer Schwangerschaftskomplikationen, die lebenslange Folgen für Mutter und Kind haben können. Nach der Geburt muss das Neugeborene zunächst ein adaptives Gedächtnis für eine bis dahin unbekannte, antigenreiche Umgebung entwickeln; es ist für Infektionen und die daraus resultierenden Komplikationen besonders vulnerabel. Durch den Transfer maternaler Antikörper über die Plazenta werden Säuglinge geschützt, die zu jung sind, um geimpft zu werden. Beim Stillen setzt sich dies durch die Muttermilch fort. Für die von der Ständigen Impfkommission (STIKO) empfohlenen Impfungen in der Schwangerschaft (Influenza, Pertussis, COVID[„coronavirus disease“]-19), gibt es eindeutige Hinweise aus verschiedenen prospektiven und observationellen Studien, dass sie Mutter und Kind entweder vor einer Infektion oder einem schweren Krankheitsverlauf effektiv schützen. Im Beitrag geben wir einen Überblick über die Impfstrategie rund um die Schwangerschaft und fassen die wissenschaftlichen Daten zur Wirksamkeit der empfohlenen Impfungen zusammen.
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Affiliation(s)
- Ann-Christin Tallarek
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Deutschland
| | - Bettina Hollwitz
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Deutschland
| | - Anke Diemert
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Deutschland
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11
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Tseng HF, Sy LS, Ackerson BK, Lee GS, Luo Y, Florea A, Becerra-Culqui T, Tartof SY, Tian Y, Taylor C, Campora L, Ceregido MA, Kuznetsova A, Poirrier JE, Rosillon D, Valdes L, Cheuvart B, Mesaros N, Meyer N, Guignard A, Qian L. Safety of tetanus, diphtheria, acellular pertussis (Tdap) vaccination during pregnancy. Vaccine 2022; 40:4503-4512. [PMID: 35717267 DOI: 10.1016/j.vaccine.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
The objective of this study was to evaluate the safety of prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination. This cohort study was conducted among pregnant members at Kaiser Permanente Southern California (KPSC). The exposed cohort consisted of women who received Tdap vaccine on or after the 27th week of pregnancy between January 2018 and January 2019. The unexposed cohort consisted of matched women who were pregnant between January 2012 and December 2014 and were not vaccinated with any Tdap vaccine throughout their pregnancy. Maternal and infant characteristics and pre-specified endpoints were collected through automated data and review of the electronic health records. Unadjusted and adjusted relative risks (aRRs) with confidence intervals (CIs) were estimated by Poisson regression. Non-inferiority testing (i.e., to rule out a two-fold increase) was conducted for primary endpoints with adjustment for multiplicity. Superiority testing was conducted without multiplicity adjustment for secondary endpoints. The analysis consisted of 16,606 pairs of Tdap recipients and unexposed pregnant women. For the primary endpoints, the aRR for preeclampsia/eclampsia was 1.38 (98.75% CI:1.21-1.58) and the aRR for intrauterine infection was 1.28 (98.75% CI:1.12-1.47). These increases were consistent with the background increasing trend of these diagnoses among all pregnant women at KPSC since 2011, and the upper limit of the 98.75% CI of both aRRs did not exceed the pre-specified threshold of 2. No increased risks of small for gestational age (aRR = 1.04, 98.75% CI:0.94-1.16) or preterm delivery (aRR = 0.71, 98.75% CI:0.64-0.78) were observed. No evidence of increased risks for secondary endpoints, including poor fetal growth, preterm pre-labor rupture of membranes, stillbirth/fetal death, placental abruption, transfusion during delivery hospitalization, and neonatal death, was observed. Prenatal Tdap vaccination after the 27th week of pregnancy was not associated with increased risks of pre-specified maternal and infant outcomes, supporting the safety of Tdap vaccination during pregnancy.
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Affiliation(s)
- Hung Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
| | - Bradley K Ackerson
- Pediatrics and Pediatric Infectious Diseases, Southern California Permanente Medical Group, Harbor City, CA, USA
| | - Gina S Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ana Florea
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Tracy Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Yun Tian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Christine Taylor
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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12
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Hattabi H, Bouchez C, Dubos F, Martinot A, Faure K, Dessein R, Bartolo S, Subtil D. [Should French pregnant women be vaccinated against pertussis during pregnancy?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:486-493. [PMID: 35483610 DOI: 10.1016/j.gofs.2022.02.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
Many countries with a high perinatal level have started a policy of vaccination of pregnant women against pertussis. To date, France has not chosen this policy. The objective was to review knowledge on pertussis mortality in infants. Compare the strategies available to protect the infant before his first vaccination, scheduled for two months of age. We proceeded to a litterature analysis, from January 1998 to 2021. Search by the following keywords used ; "Whooping cough, vaccination, pregnancy, strategy, cocooning", on the scientific basis of "Pubmed", as well as French and foreign vaccination recommendations. Currently 90% of whooping cough deaths are concerning infants under six months of age and this mortality represents 2% of mortality in the first year of life. Vaccination at birth is not effective. The cocooning strategy, which consists of vaccinating those around the child, is expensive and difficult to implement. A systematic vaccination policy for pregnant women is effective and reasonably expensive when compared to the cocooning strategy. In England, it was recently accompanied by a 78% reduction in confirmed cases of pertussis in infants under six months of age. In conclusion, compared to cocooning strategy, pertussis vaccination of pregnant women appears more effective and cost-effective, and this with each pregnancy.
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Affiliation(s)
- H Hattabi
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France.
| | - C Bouchez
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France
| | - F Dubos
- University Lille, CHU Lille, pôle enfant, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
| | - A Martinot
- University Lille, CHU Lille, pôle enfant, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
| | - K Faure
- University Lille, CHU Lille, service de maladies infectieuses, rue Michel Polonowski, 59000 Lille, France; University Lille, EA7366, recherche translationnelle relation hôte-pathogènes, faculté de médecine pôle recherche, 59045 Lille, France
| | - R Dessein
- University Lille, EA7366, recherche translationnelle relation hôte-pathogènes, faculté de médecine pôle recherche, 59045 Lille, France
| | - S Bartolo
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
| | - D Subtil
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
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González-López JJ, Álvarez Aldeán J, Álvarez García FJ, Campins M, Garcés-Sánchez M, Gil-Prieto R, Grande-Tejada AM. Epidemiology, prevention and control of pertussis in Spain: New vaccination strategies for lifelong protection. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:195-203. [PMID: 35473991 DOI: 10.1016/j.eimce.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/22/2021] [Indexed: 06/14/2023]
Abstract
Pertussis is a highly contagious, vaccine-preventable respiratory tract infection, with high morbidity and mortality and a particularly severe effect on newborns and infants under 2 months. The first pertussis vaccines were introduced in the 1940s. Since 1980, however, the incidence of cases has risen despite the extensive vaccination programmes and antibiotic adjuvant treatments available. Transition from the use of whole-cell vaccines to acellular vaccines and the antigenic modifications of Bordetella pertussis have contributed, among other factors, to a reduction in vaccine-acquired immunity and reemergence of the disease. Today, there are still unmet needs not covered by conventional prevention measures and existing antibiotic treatments. This review aims to update the available data, and to discuss which vaccine strategies might contribute to better disease control and prevention.
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Affiliation(s)
- Juan José González-López
- Department of Clinical Microbiology, Hospital Vall d'Hebron, Barcelona, Spain; Department of Microbiology and Genetics, Universitat Autònoma de Barcelona, Spain.
| | | | - Francisco José Álvarez García
- Pediatrics, Centro de Salud de Llanera, Asturias, Spain; Department of Medicine, Universidad de Oviedo, Asturias, Spain
| | - Magda Campins
- Department of Preventive Medicine and Epidemiology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Ruth Gil-Prieto
- Department of Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
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Bonito B, Balzi D, Boccalini S, Bonanni P, Mereu G, Santini MG, Bechini A. Descriptive Observational Study of Tdap Vaccination Adhesion in Pregnant Women in the Florentine Area (Tuscany, Italy) in 2019 and 2020. Vaccines (Basel) 2021; 9:vaccines9090955. [PMID: 34579192 PMCID: PMC8473358 DOI: 10.3390/vaccines9090955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Tdap (Tetanus-Diphtheria-acellular Pertussis) vaccination is nowadays a worldwide-recommended practice to immunize pregnant women. The vaccine administration at the third trimester of pregnancy (as recommended by the WHO) would ensure antibody protection to both the mother and the newborn and has contributed to the significant drop of pertussis cases in infants. The aim of this observational study was to describe for the first time the socio-demographic characteristics and determinants of Tdap vaccination adhesion of pregnant women in the Florentine area. Methods: Information about parents’ vaccination status, their citizenship, employment type and mothers’ previous pregnancies and/or abortions were collected at the time of birth through the assistance birth certificates (CedAP) both for the years 2019 and 2020. This archive and the regional SISPC (Collective Prevention Healthcare Information System) linked using an anonymous unique personal identifier to retrieve the mother’s vaccination status. Results: We found an overall Tdap vaccination adhesion of 43% in 2019 and 47.3% in 2020. Several socio-demographic parameters would determine an increased vaccination adhesion, including parents’ geographical origin, mothers’ age and educational background, as well as the number of previous deliveries, abortions or voluntary termination of pregnancy. Conclusions: Since not much data are available on this topic in Italy, this study may constitute the baseline information for Tdap vaccination adhesion in pregnant women in the Florentine area (Italy). Thus, future successful vaccination strategies may be designed accordingly.
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Affiliation(s)
- Benedetta Bonito
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.B.); (S.B.); (P.B.)
| | - Daniela Balzi
- AUSL Toscana Centro, 50122 Florence, Italy; (D.B.); (G.M.); (M.G.S.)
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.B.); (S.B.); (P.B.)
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.B.); (S.B.); (P.B.)
| | - Giovanna Mereu
- AUSL Toscana Centro, 50122 Florence, Italy; (D.B.); (G.M.); (M.G.S.)
| | | | - Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (B.B.); (S.B.); (P.B.)
- Correspondence: ; Tel.: +39-055-2751-081
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15
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Saini J, Ellingson MK, Beigi RH, MacDonald NE, Top KA, Carroll S, Omer SB. Vaccine package inserts and prescribing habits of obstetricians-gynecologists for maternal vaccination. Hum Vaccin Immunother 2021; 17:3761-3770. [PMID: 34236947 DOI: 10.1080/21645515.2021.1942714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Despite ample evidence of the safety and efficacy of the influenza vaccine and the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy, two-thirds of pregnant women do not receive these vaccines. Providers have a significant role in increasing prenatal vaccine uptake. It is important to understand how different sources of vaccine prescribing information, such as Food and Drug Administration package inserts, influence provider recommendations. We aimed to examine the role of vaccine package inserts in provider recommendations and perceptions of safety and effectiveness of vaccines during pregnancy. A cross-sectional survey was mailed to a random, weighted sample of American College of Obstetricians and Gynecologists Fellows living in the United States in March 2019. Providers were asked about their attitudes toward package inserts, and to evaluate sample package insert statements following two different labeling rules. Their evaluations of each rule were then compared. Of the 321 respondents, the majority (90%, 288/321) recommended and/or administered maternal vaccinations. Few respondents (7.8%, 25/321) read package inserts for information regarding vaccination. Respondents were less likely to recommend sample vaccines with Pregnancy and Lactation Labeling Rule-complying inserts (46.1%, 148/321) than vaccines with Pregnancy Category inserts (87.5%, 282/321). Although most providers did not actively utilize vaccine package inserts to inform recommendations, the previous Pregnancy Categories rule was preferred compared to the Pregnancy and Lactation Labeling Rule. Collaborative efforts to update inserts with current clinical practices for pregnancy would be valuable in reducing apprehensiveness around package inserts to generate safer and more cogent recommendations for pregnant women.
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Affiliation(s)
- Jannat Saini
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, MD, USA
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Richard H Beigi
- UPMC Magee-Women's Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Carroll
- Immunization, Infectious Disease and Public Health Preparedness, American College of Obstetricians and Gynecologists, Washington, DC, USA
| | - Saad B Omer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Yale Institute for Global Health, New Haven, CT, USA.,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
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González-López JJ, Álvarez Aldeán J, Álvarez García FJ, Campins M, Garcés-Sánchez M, Gil-Prieto R, Grande-Tejada AM. Epidemiology, prevention and control of pertussis in Spain: New vaccination strategies for lifelong protection. Enferm Infecc Microbiol Clin 2021:S0213-005X(21)00185-3. [PMID: 34154858 DOI: 10.1016/j.eimc.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 11/03/2022]
Abstract
Pertussis is a highly contagious, vaccine-preventable respiratory tract infection, with high morbidity and mortality and a particularly severe effect on newborns and infants under 2 months. The first pertussis vaccines were introduced in the 1940s. Since 1980, however, the incidence of cases has risen despite the extensive vaccination programmes and antibiotic adjuvant treatments available. Transition from the use of whole-cell vaccines to acellular vaccines and the antigenic modifications of Bordetella pertussis have contributed, among other factors, to a reduction in vaccine-acquired immunity and reemergence of the disease. Today, there are still unmet needs not covered by conventional prevention measures and existing antibiotic treatments. This review aims to update the available data, and to discuss which vaccine strategies might contribute to better disease control and prevention.
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Affiliation(s)
- Juan José González-López
- Department of Clinical Microbiology, Hospital Vall d'Hebron, Barcelona, Spain; Department of Microbiology and Genetics, Universitat Autònoma de Barcelona, Spain.
| | | | - Francisco José Álvarez García
- Pediatrics, Centro de Salud de Llanera, Asturias, Spain; Department of Medicine, Universidad de Oviedo, Asturias, Spain
| | - Magda Campins
- Department of Preventive Medicine and Epidemiology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Ruth Gil-Prieto
- Department of Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
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Naleway AL, Crane B, Irving SA, Bachman D, Vesco KK, Daley MF, Getahun D, Glenn SC, Hambidge SJ, Jackson LA, Klein NP, McCarthy NL, McClure DL, Panagiotakopoulos L, Panozzo CA, Vazquez-Benitez G, Weintraub ES, Zerbo O, Kharbanda EO. Vaccine Safety Datalink infrastructure enhancements for evaluating the safety of maternal vaccination. Ther Adv Drug Saf 2021; 12:20420986211021233. [PMID: 34178302 PMCID: PMC8207278 DOI: 10.1177/20420986211021233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/06/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Identifying pregnancy episodes and accurately estimating their beginning and end dates are imperative for observational maternal vaccine safety studies using electronic health record (EHR) data. METHODS We modified the Vaccine Safety Datalink (VSD) Pregnancy Episode Algorithm (PEA) to include both the International Classification of Disease, ninth revision (ICD-9 system) and ICD-10 diagnosis codes, incorporated additional gestational age data, and validated this enhanced algorithm with manual medical record review. We also developed the new Dynamic Pregnancy Algorithm (DPA) to identify pregnancy episodes in real time. RESULTS Around 75% of the pregnancy episodes identified by the enhanced VSD PEA were live births, 12% were spontaneous abortions (SABs), 10% were induced abortions (IABs), and 0.4% were stillbirths (SBs). Gestational age was identified for 99% of live births, 89% of SBs, 69% of SABs, and 42% of IABs. Agreement between the PEA-assigned and abstractor-identified pregnancy outcome and outcome date was 100% for live births, but was lower for pregnancy losses. When gestational age was available in the medical record, the agreement was higher for live births (97%), but lower for pregnancy losses (75%). The DPA demonstrated strong concordance with the PEA and identified pregnancy episodes ⩾6 months prior to the outcome date for 89% of live births. CONCLUSION The enhanced VSD PEA is a useful tool for identifying pregnancy episodes in EHR databases. The DPA improves the timeliness of pregnancy identification and can be used for near real-time maternal vaccine safety studies. PLAIN LANGUAGE SUMMARY Improving identification of pregnancies in the Vaccine Safety Datalink electronic medical record databases to allow for better and faster monitoring of vaccination safety during pregnancy Introduction: It is important to monitor of the safety of vaccines after they have been approved and licensed by the Food and Drug Administration, especially among women vaccinated during pregnancy. The Vaccine Safety Datalink (VSD) monitors vaccine safety through observational studies within large databases of electronic medical records. Since 2012, VSD researchers have used an algorithm called the Pregnancy Episode Algorithm (PEA) to identify the medical records of women who have been pregnant. Researchers then use these medical records to study whether receiving a particular vaccine is linked to any negative outcomes for the woman or her child.Methods: The goal of this study was to update and enhance the PEA to include the full set of medical record diagnostic codes [both from the older International Classification of Disease, ninth revision (ICD-9 system) and the newer ICD-10 system] and to incorporate additional sources of data about gestational age. To ensure the validity of the PEA following these enhancements, we manually reviewed medical records and compared the results with the algorithm. We also developed a new algorithm, the Dynamic Pregnancy Algorithm (DPA), to identify women earlier in pregnancy, allowing us to conduct more timely vaccine safety assessments.Results: The new version of the PEA identified 2,485,410 pregnancies in the VSD database. The enhanced algorithm more precisely estimated the beginning of pregnancies, especially those that did not result in live births, due to the new sources of gestational age data.Conclusion: Our new algorithm, the DPA, was successful at identifying pregnancies earlier in gestation than the PEA. The enhanced PEA and the new DPA will allow us to better evaluate the safety of current and future vaccinations administered during or around the time of pregnancy.
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Affiliation(s)
- Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Bradley Crane
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Don Bachman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Kimberly K. Vesco
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Darios Getahun
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - Lisa A. Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
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18
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Gidengil C, Goetz MB, Newberry S, Maglione M, Hall O, Larkin J, Motala A, Hempel S. Safety of vaccines used for routine immunization in the United States: An updated systematic review and meta-analysis. Vaccine 2021; 39:3696-3716. [PMID: 34049735 DOI: 10.1016/j.vaccine.2021.03.079] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Understanding the safety of vaccines is critical to inform decisions about vaccination. Our objective was to conduct a systematic review of the safety of vaccines recommended for children, adults, and pregnant women in the United States. METHODS We searched the literature in November 2020 to update a 2014 Agency for Healthcare Research and Quality review by integrating newly available data. Studies of vaccines that used a comparator and reported the presence or absence of key adverse events were eligible. Adhering to Evidence-based Practice Center methodology, we assessed the strength of evidence (SoE) for all evidence statements. The systematic review is registered in PROSPERO (CRD42020180089). RESULTS Of 56,603 reviewed citations, 338 studies reported in 518 publications met inclusion criteria. For children, SoE was high for no increased risk of autism following measles, mumps, and rubella (MMR) vaccine. SoE was high for increased risk of febrile seizures with MMR. There was no evidence of increased risk of intussusception with rotavirus vaccine at the latest follow-up (moderate SoE), nor of diabetes (high SoE). There was no evidence of increased risk or insufficient evidence for key adverse events for newer vaccines such as 9-valent human papillomavirus and meningococcal B vaccines. For adults, there was no evidence of increased risk (varied SoE) or insufficient evidence for key adverse events for the new adjuvanted inactivated influenza vaccine and recombinant adjuvanted zoster vaccine. We found no evidence of increased risk (varied SoE) for key adverse events among pregnant women following tetanus, diphtheria, and acellular pertussis vaccine, including stillbirth (moderate SoE). CONCLUSIONS Across a large body of research we found few associations of vaccines and serious key adverse events; however, rare events are challenging to study. Any adverse events should be weighed against the protective benefits that vaccines provide.
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Affiliation(s)
- Courtney Gidengil
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90073, United States
| | - Sydne Newberry
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Margaret Maglione
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Owen Hall
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Jody Larkin
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Aneesa Motala
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; Southern California Evidence Review Center, University of Southern California, Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA 90033, United States
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; Southern California Evidence Review Center, University of Southern California, Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA 90033, United States
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Scatigna M, Appetiti A, Pasanisi M, D'Eugenio S, Fabiani L, Giuliani AR. Experience and attitudes on vaccinations recommended during pregnancy: survey on an Italian sample of women and consultant gynecologists. Hum Vaccin Immunother 2021; 18:1-8. [PMID: 33956557 PMCID: PMC8920149 DOI: 10.1080/21645515.2021.1894061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Active immunization in pregnancy is recommended for the influenza and the tetanus, diphtheria, and acellular pertussis (Tdap) vaccines. Evidence indicates vaccine effectiveness in preventing influenza-related hospitalizations and pertussis in early infancy. We investigate vaccine uptake in pregnant and non-pregnant women through a sample of young women and consultant gynecologists, along with the potential predisposing and/or enabling factors affecting attitudes to vaccination (knowledge, beliefs, barriers). A cross-sectional study was conducted between June and September 2019, with a sample of 251 women and 14 consultant gynecologists at the Local Health Authority (ASL01) of the Abruzzo Region (Italy), using an anonymous, self-report questionnaire survey. Among the participants, 5.6% of women had received influenza vaccination, 16.4% had received Tdap during pregnancy and only 1.2% had received both vaccines. The assessment of the psychometric attitudinal variables has suggested a more positive willingness to receive Tdap than influenza vaccine among women, as the former is considered more important for the maternal and neonatal health. Health care workers have reported vaccine safety concerns, lack of information, and misconceptions about the need for vaccination as barriers to immunization in pregnant women. The results of this study will contribute to defining the goals and strategies to increase vaccine uptake under the current recommendations, through promoting effective training programs for all health care workers involved (gynecologists, obstetricians, public health physicians).
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Affiliation(s)
- Maria Scatigna
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Appetiti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Silvia D'Eugenio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Leila Fabiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Rita Giuliani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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VISALLI GIUSEPPA, FACCIOLÀ ALESSIO, MAZZITELLI FRANCESCO, LAGANÀ PASQUALINA, DI PIETRO ANGELA. Health education intervention to improve vaccination knowledge and attitudes in a cohort of obstetrics students. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E110-E116. [PMID: 34322625 PMCID: PMC8283633 DOI: 10.15167/2421-4248/jpmh2021.62.1.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
Introduction To improve the vaccination coverage in pregnant women it is important to increase their knowledge of vaccines and related preventable diseases. Midwifes can play an important role because they are often the first contact for woman during her pregnancy. This study aimed to explore the vaccination knowledge and attitudes in a cohort of Obstetrics students in Italy and improve their knowledge through an informative health education intervention. Methods The study consisted in the administration of a first questionnaire followed by a health education intervention concerning all aspects of vaccinations. Then, a second questionnaire to evaluate the efficacy of the educational program was administered. Results From the pre-intervention questionnaire resulted that almost the whole sample (97.1%) were favorable to vaccines in general. Moreover, 65.7% of the participants declared a sufficient level of vaccination knowledge but 62.9% found herself unprepared to answer questions and provide information about vaccinations. Concerning the answers about vaccination in pregnancy, the correct answers went from 17.1 to 68.6% respectively before and after educational intervention. The training intervention obtained a total consensus (100%). The most part of the students (85.7%) declared that the received information changed some of their beliefs and the entire sample (100%) stated that it improved their preparation. Conclusions Our results revealed some critical issues in the preparation of midwifes about vaccinations and confirm the necessity to carry out health intervention campaigns to these health professionals that, for the role they play, they must necessarily be well prepared.
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Affiliation(s)
- GIUSEPPA VISALLI
- Correspondence: Giuseppa Visalli, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via C. Valeria, Gazzi 98100, Messina Italy - Tel.: +39 090 221 3349 - Fax: +39 090221 3351 - E-mail:
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21
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Fakhraei R, Crowcroft N, Bolotin S, Sucha E, Hawken S, Wilson K, Gaudet L, Amirthalingam G, Biringer A, Cook J, Dubey V, Halperin SA, Jamieson F, Kwong JC, Sadarangani M, Walker MC, Laverty M, Fell DB. Obstetric and perinatal health outcomes after pertussis vaccination during pregnancy in Ontario, Canada: a retrospective cohort study. CMAJ Open 2021; 9:E349. [PMID: 33849984 PMCID: PMC8084546 DOI: 10.9778/cmajo.20200239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In February 2018, Canada's National Advisory Committee on Immunization recommended maternal vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy to prevent severe pertussis infection in young infants. This study assessed the relation between maternal Tdap vaccination and obstetric and perinatal outcomes in Ontario. METHODS We performed a population-based cohort study of all births from April 2012 to March 2017 using multiple linked health administrative databases. We used Cox regression with a time-dependent exposure variable to estimate adjusted hazard ratios (HRs) for preterm birth (< 37 wk), very preterm birth (< 32 wk) and stillbirth. We assessed remaining outcomes (gestational hypertension, chorioamnionitis, postpartum hemorrhage, severe postpartum hemorrhage, being small for gestational age, neonatal intensive care unit stay > 24 h, composite neonatal morbidity) using log-binomial regression to generate adjusted risk ratios (RRs). We adjusted estimates for potential confounding using propensity score weighting. RESULTS Of 615 213 infants (live births and stillbirths), 11 519 were exposed to Tdap vaccination in utero. There was no increased risk for preterm birth (adjusted HR 0.98, 95% confidence interval [CI] 0.91-1.06), very preterm birth (adjusted HR 1.10, 95% CI 0.86-1.41), stillbirth (adjusted HR 1.15, 95% CI 0.82-1.60) or being small for gestational age (adjusted RR 0.96, 95% CI 0.90-1.02). The risks of a neonatal intensive care unit stay exceeding 24 hours (adjusted RR 0.82, 95% CI 0.76-0.88) and neonatal morbidity (adjusted RR 0.81, 95% CI 0.75-0.87) were decreased. There was no association with chorioamnionitis (adjusted RR 1.17, 95% CI 0.99-1.39), postpartum hemorrhage (adjusted RR 1.01, 95% CI 0.91-1.13) or severe postpartum hemorrhage (adjusted RR 0.79, 95% CI 0.55-1.13), but we observed a reduced risk of gestational hypertension (adjusted RR 0.87, 95% CI 0.78-0.96). INTERPRETATION Our results complement evidence that maternal Tdap vaccination is not associated with adverse outcomes in mothers or infants. Ongoing evaluation in Canada is needed as maternal Tdap vaccination coverage increases in coming years.
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Affiliation(s)
- Romina Fakhraei
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Natasha Crowcroft
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Shelly Bolotin
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Steven Hawken
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Kumanan Wilson
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Laura Gaudet
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Gayatri Amirthalingam
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Anne Biringer
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Jocelynn Cook
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Vinita Dubey
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Scott A Halperin
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Frances Jamieson
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Jeffrey C Kwong
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Manish Sadarangani
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Mark C Walker
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Meghan Laverty
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute (Fakhraei, Sucha, Fell); Ottawa Hospital Research Institute (Fakhraei, Hawken, Wilson, Walker), Ottawa, Ont.; ICES Central (Crowcroft, Hawken, Kwong, Fell); University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; ICES uOttawa (Sucha); University of Ottawa (Hawken, Cook, Walker, Laverty, Fell); Bruyère Research Institute (Wilson), Ottawa, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; Public Health England (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Centre for Vaccinology (Halperin), Dalhousie University and IWK Health Centre, Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC
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22
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Andersen AR, Kolmos SK, Flanagan KL, Benn CS. Systematic review and meta-analysis of the effect of pertussis vaccine in pregnancy on the risk of chorioamnionitis, non-pertussis infectious diseases and other adverse pregnancy outcomes. Vaccine 2021; 40:1572-1582. [PMID: 33642162 DOI: 10.1016/j.vaccine.2021.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several countries have introduced maternal immunisation with pertussis vaccine to provide protection against pertussis in early infancy. There is increasing interest in non-specific effects of vaccines including that non-live vaccines may enhance susceptibility to non-targeted infections in females. Some studies have shown increased risk of chorioamnionitis among women receiving pertussis vaccine during pregnancy. We aimed to conduct a systematic review and meta-analysis of the effect of maternal pertussis immunisation on the risk of chorioamnionitis, as well as the secondary outcomes of non-pertussis infections in women, non-pertussis infections in infants, spontaneous abortion or stillbirth, maternal death and infant death. METHODS We searched PubMed and Embase for articles published until January 14, 2021. We screened articles for eligibility and extracted data using Covidence. Quality was assessed using Cochrane RoB tool and Newcastle-Ottawa Scale. Data were imported into RevMan for pooling and conduction of a meta-analysis stratified by study type. Outcomes are presented as risk ratios. RESULTS We identified 13 observational studies and six randomized controlled trials eligible for inclusion. We pooled data on chorioamnionitis from six observational studies and found maternal pertussis vaccine (mostly compared with other maternal immunizations with non-live vaccines) to be associated with an increased risk among the pertussis vaccinated women, RR = 1.27 [CI 95%: 1.14-1.42]. We found no difference in the analysis of our secondary outcomes of non-pertussis infections, spontaneous abortion or stillbirth and death. CONCLUSION We found an increased risk of chorioamnionitis among women who received pertussis vaccine in pregnancy. The large number of women receiving pertussis vaccine during pregnancy, as well as the growing evidence of non-live vaccines causing increased susceptibility to infections, indicates a need for further randomised trials to assess potential adverse effects of maternal immunisation with pertussis-containing vaccines.
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Affiliation(s)
- A R Andersen
- Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - S K Kolmos
- Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - K L Flanagan
- Tasmanian Vaccine Trial Centre, Launceston General Hospital, Launceston, TAS, Australia; School of Medicine, Faculty of Health Sciences, 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
| | - C S Benn
- OPEN, Odense Patient Data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark, Denmark; Danish Institute of Advanced Science, University of Southern Denmark, Denmark.
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23
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Abu-Raya B, Maertens K. Protection of the Newborn Through Vaccination in Pregnancy. Neoreviews 2021; 22:e25-e39. [PMID: 33386312 DOI: 10.1542/neo.22-1-e25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Newborns and infants are at risk for severe infections with some pathogens (eg, Bordetella pertussis, influenza, respiratory syncytial virus, group B Streptococcus) during early life. To decrease this window of high susceptibility to some infections during early life and protect young infants, vaccination in pregnancy against some vaccine-preventable diseases (eg, influenza, pertussis, tetanus) has been recommended in an increasing number of countries with notable success. In addition, recent advances have been made in developing vaccines for pregnant women with the aim of reducing the respiratory syncytial virus and group B Streptococcus burden in infancy. In this article, we review the vaccines currently recommended during pregnancy and their benefits to newborns and infants. We also discuss progress made in the development of other vaccines that are expected to be evaluated in pregnant women in the near future.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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24
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Brewer SE, Cataldi JR, Fisher M, Glasgow RE, Garrett K, O'Leary ST. Motivational Interviewing for Maternal Immunisation (MI4MI) study: a protocol for an implementation study of a clinician vaccine communication intervention for prenatal care settings. BMJ Open 2020; 10:e040226. [PMID: 33203635 PMCID: PMC7674098 DOI: 10.1136/bmjopen-2020-040226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Vaccination against influenza and pertussis in pregnancy offers a 'two-for-one' opportunity to protect mother and child. Pregnant patients have increased risk of severe disease from influenza and newborns have increased risk of severe disease from both influenza and pertussis. Obstetricians need communication tools to support their self-efficacy and effectiveness in communicating the importance of immunisation during pregnancy and ultimately improving maternal vaccination rates. METHODS AND ANALYSIS We describe the protocol for a pragmatic study testing the feasibility and potential impact of a clinician communication strategy on maternal vaccination uptake. This study will be conducted in five prenatal care settings in Colorado, USA. The Motivational Interviewing for Maternal Immunisation strategy involves training prenatal care providers to use motivational interviewing in the vaccine conversation with pregnant patients. Our primary outcomes will be the adoption and implementation of the intervention measured using the Enhanced RE-AIM/Practical Robust Implementation and Sustainability Model for dissemination and implementation. Secondary outcomes will include provider time spent, fidelity to Motivational Interviewing and self-efficacy measured through audio recorded visits and provider surveys, patients' visit experience based on audio recorded visits and follow-up interviews, and maternal vaccine uptake as measured through chart reviews. ETHICS AND DISSEMINATION This study is approved by the following institutional review boards: Colorado Multiple Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations. TRIAL REGISTRATION NUMBER NCT04302675.
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Affiliation(s)
- Sarah E Brewer
- Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica R Cataldi
- Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Fisher
- Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Russell E Glasgow
- Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kathleen Garrett
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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25
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Liu C, Yang L, Cheng Y, Xu H, Xu F. Risk factors associated with death in infants <120 days old with severe pertussis: a case-control study. BMC Infect Dis 2020; 20:852. [PMID: 33198647 PMCID: PMC7668018 DOI: 10.1186/s12879-020-05535-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Pertussis is a serious infectious disease in young infants, and severe cases frequently cause death. Our study explored risk factors for death from severe pertussis. Method A case-control study of infants with severe pertussis admitted to the paediatric intensive care unit (PICU) in the Children’s Hospital of Chongqing Medical University, China, from January 1, 2013, to June 30, 2019, was conducted. Pertussis was confirmed by clinical features and laboratory examinations. Severe pertussis was defined as patients with pertussis resulting in PICU admission or death. To understand the risk factors for death, we compared fatal and nonfatal cases of severe pertussis in infants aged < 120 days by collecting clinical and laboratory data. Results The participants included 63 infants < 120 days of age with severe pertussis. Fifteen fatal cases were confirmed and compared with 44 nonfatal severe pertussis cases, Four patients with termination of treatment were excluded. In the univariate analysis, the risk factors associated with death included apnoea (P = 0.001), leukocytosis (white blood cell (WBC) count≥30 × 109/L (P = 0.001) or ≥ 50 × 109/L (P = 0)), highest lymphocyte count (P = 0), pulmonary hypertension (P = 0.001), and length of PICU stay (P = 0.003). The multivariate analysis revealed that apnoea (OR 23.722, 95%CI 2.796–201.26, P = 0.004), leukocytosis (OR 63.708, 95%CI 3.574–1135.674, P = 0.005) and pulmonary hypertension (OR 26.109, 95%CI 1.800–378.809, P = 0.017) were significantly associated with death. Conclusion Leukocytosis and pulmonary hypertension exhibited the greatest associations with death in infants with severe pertussis admitted to the PICU. Vaccination is still the most effective protection method against pertussis.
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Affiliation(s)
- Cong Liu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Lin Yang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.,Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yuwei Cheng
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.,Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Hongmei Xu
- Department of Infectious Diseases, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Feng Xu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China. .,Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
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Carrasquilla G, Porras A, Martinez S, DeAntonio R, Devadiga R, Caceres DC, Juliao P. Incidence and mortality of pertussis disease in infants <12 months of age following introduction of pertussis maternal universal mass vaccination in Bogotá, Colombia. Vaccine 2020; 38:7384-7392. [DOI: 10.1016/j.vaccine.2020.07.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/31/2022]
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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: 63] [Impact Index Per Article: 15.8] [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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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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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: 82] [Impact Index Per Article: 20.5] [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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30
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Murthy NC, Black C, Kahn KE, Ding H, Ball S, Fink RV, Devlin R, D'Angelo D, Fiebelkorn AP. Tetanus, Diphtheria, and Acellular Pertussis and Influenza Vaccinations among Women With a Live Birth, Internet Panel Survey, 2017-2018. Infect Dis (Lond) 2020; 13:1178633720904099. [PMID: 32095076 PMCID: PMC7011328 DOI: 10.1177/1178633720904099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/11/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives Pregnant women are at increased risk of complications from influenza, and infants are at increased risk of pertussis. Maternal influenza and Tdap (tetanus, diphtheria, and acellular pertussis) vaccination can reduce risk of these infections and related complications. Our objective was to estimate vaccination coverage with influenza and Tdap vaccines during pregnancy among women with a recent live birth. Methods An opt-in Internet panel survey was conducted from March 28 to April 10, 2018 among pregnant and recently pregnant women. Respondents with a live birth from August 1, 2017 through the date in which the participant completed the survey were included in the analysis. Receipt of influenza vaccination since July 1, 2017 and Tdap vaccination during pregnancy were assessed by sociodemographic characteristics, receipt of a health care provider (HCP) recommendation and/or offer of vaccination, and vaccination-related knowledge, attitudes, and beliefs. Results Less than a third (30.3%) of women with a live birth were unvaccinated during their pregnancy with both Tdap and influenza vaccines. Almost a third (32.8%) of the women reported being vaccinated with both vaccines. The majority (73.0%) of women reported receiving an HCP recommendation for both vaccines, and 54.2% of women were offered both vaccines by an HCP. Reasons for nonvaccination included negative attitudes toward influenza vaccine and lack of awareness about Tdap vaccination during pregnancy. Conclusions Maternal Tdap and influenza vaccinations can prevent morbidity and mortality among infants and their mothers, yet many pregnant women are unvaccinated with either Tdap or influenza vaccines. Clinic-based education, along with interventions, such as standing orders and provider reminders, are strategies to increase maternal vaccination.
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Affiliation(s)
- Neil Chandra Murthy
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Carla Black
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Katherine E Kahn
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,Leidos, Atlanta, GA, USA
| | - Helen Ding
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | | | | - Denise D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Amy Parker Fiebelkorn
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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31
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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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32
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Kerr SM, Van Bennekom CM, Mitchell AA. Tetanus, diphtheria, and pertussis vaccine (Tdap) in pregnancy and risk of major birth defects in the offspring. Birth Defects Res 2020; 112:393-403. [DOI: 10.1002/bdr2.1642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/31/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Stephen M. Kerr
- Slone Epidemiology Center at Boston University Boston Massachusetts
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33
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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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34
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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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35
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O'Leary ST, Narwaney KJ, Wagner NM, Kraus CR, Omer SB, Glanz JM. Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT. Am J Prev Med 2019; 57:e125-e133. [PMID: 31471001 DOI: 10.1016/j.amepre.2019.05.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women. STUDY DESIGN RCT. SETTING/PARTICIPANTS This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013-July 2016, with data analysis in 2017-2018. INTERVENTION Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and "Ask a Question" portal. MAIN OUTCOME MEASURES Tdap and influenza vaccination. These outcomes were analyzed separately. RESULTS For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. CONCLUSIONS Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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Groom HC, Smith N, Irving SA, Koppolu P, Vazquez-Benitez G, Kharbanda EO, Daley MF, Donahue JG, Getahun D, Jackson LA, Klein NP, McCarthy NL, Nordin JD, Panagiotakopoulos L, Naleway AL. Uptake and safety of hepatitis A vaccination during pregnancy: A Vaccine Safety Datalink study. Vaccine 2019; 37:6648-6655. [PMID: 31548013 DOI: 10.1016/j.vaccine.2019.09.043] [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] [Received: 07/11/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Infection with hepatitis A virus (HAV) during pregnancy, although uncommon, is associated with gestational complications and pre-term labor. Hepatitis A vaccine (HepA) is recommended for anyone at increased risk for contracting hepatitis A, including women at risk who are also pregnant. Limited data are available on the safety of maternal HepA vaccination. OBJECTIVES Assess the frequency of maternal HepA receipt and evaluate the potential association between maternal vaccination and pre-specified maternal and infant safety outcomes. METHODS A retrospective cohort of pregnancies in the Vaccine Safety Datalink (VSD) resulting in live births from 2004 through 2015 was included. Pregnancies with HepA exposure were compared to those with other vaccine exposures, and to those with no vaccine exposures. Risk factors for contracting hepatitis A were identified up to one-year prior to or during the pregnancy using ICD-9 codes. Maternal and fetal adverse events were evaluated according to maternal HepA exposure status. Adjusted odds ratio (OR) were used to describe the association. RESULTS Among 666,233 pregnancies in the study period, HepA was administered at a rate of 1.7 per 1000 (n = 1140), most commonly within the first six weeks of pregnancy. Less than 3% of those exposed to HepA during pregnancy had an ICD-confirmed risk factor. There were no significant associations between HepA exposure during pregnancy and gestational hypertension, gestational diabetes, pre-eclampsia/eclampsia, cesarean delivery, pre-term delivery, and low birthweight. There was a statistically significant association between HepA exposure during pregnancy and small-for-gestational age (SGA) infants (aOR 1.32, [95% CI 1.09, 1.60], p = 0.004). CONCLUSIONS The rate of maternal HepA vaccination was low and rarely due to documented risk factors for vaccination. HepA vaccination during pregnancy was not associated with an increased risk for a range of adverse events examined among pregnancies resulting in live births, but an identified association between maternal HepA and SGA infant outcomes, while likely due to unmeasured confounding, warrants further exploration.
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Affiliation(s)
- Holly C Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States.
| | - Ning Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Padma Koppolu
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | | | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - James G Donahue
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Darios Getahun
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Natalie L McCarthy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James D Nordin
- HealthPartners Institute, Minneapolis, MN, United States
| | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
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Ghaswalla P, Poirrier JE, Packnett ER, Irwin DE, Gray SR, Buck PO. Maternal Immunization in the U.S.: A Nationwide Retrospective Cohort Study. Am J Prev Med 2019; 57:e87-e93. [PMID: 31427034 DOI: 10.1016/j.amepre.2019.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION At present, pregnant women in the U.S. are recommended to receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccines. This study assessed maternal coverage of these 2 vaccinations. METHODS Data for this retrospective cohort study were extracted from 2 large administrative claims databases, the MarketScan Commercial and Multi-State Medicaid Databases, for 2009-2017 and analyzed in 2018. Women aged 15-44 years on the date of pregnancy end were included. Pregnancies with gestational age of less than 23 weeks were excluded from the Tdap vaccination endpoint owing to the optimal recommended gestational age for Tdap vaccination. Multivariable logistic regression models identified predictors of vaccination. RESULTS The Tdap vaccination subpopulation included 1,421,452 Commercial and 523,635 Medicaid pregnancies; the influenza vaccination subpopulation included 1,862,705 Commercial and 628,079 Medicaid pregnancies. There were marked increases in vaccination coverage from 2010 to 2017: from 1.0% to 56.3% (Commercial) and from 0.5% to 31.4% (Medicaid) for Tdap, and from 14.7% to 31.3% (Commercial) and from 9.7% to 17.5% (Medicaid) for influenza. The likelihood of Tdap/influenza vaccination increased significantly with receipt of the other vaccine and more pregnancy-related healthcare visits. CONCLUSIONS Although maternal Tdap and influenza vaccination coverage increased substantially from 2010 to 2017 among large, geographically diverse U.S. cohorts, coverage remained suboptimal, potentially putting newborns at risk of pertussis and influenza. Strategies to increase maternal vaccination coverage could target women identified to have a reduced likelihood of vaccination: those who are younger, black, residing in rural areas, with multiple gestation, and a prepregnancy inpatient admission.
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Affiliation(s)
| | | | | | - Debra E Irwin
- Life Sciences, IBM Watson Health, Ann Arbor, Michigan
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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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Ricco' M, Vezzosi L, Gualerzi G, Balzarini F, Capozzi VA, Volpi L. Knowledge, attitudes, beliefs and practices of obstetrics-gynecologists on seasonal influenza and pertussis immunizations in pregnant women: preliminary results from North-Western Italy. ACTA ACUST UNITED AC 2019; 71:288-297. [DOI: 10.23736/s0026-4784.19.04294-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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O'Leary ST, Pyrzanowski J, Brewer SE, Sevick C, Miriam Dickinson L, Dempsey AF. Effectiveness of a multimodal intervention to increase vaccination in obstetrics/gynecology settings. Vaccine 2019; 37:3409-3418. [DOI: 10.1016/j.vaccine.2019.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 01/05/2023]
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Abstract
Maternal vaccination provides a method for protecting the pregnant woman, fetus and neonate during a period when there is increased susceptibility to infectious diseases. A dynamic state of immune tolerance during pregnancy and the need to develop adaptive memory to a new foreign antigen-rich environment lead to windows of vulnerability to infection for the mother and neonate, respectively. Passive transfer of humoral immunity through the placenta and breast milk from the mother can bridge the gap in immunity for the neonate. Studies on boosting this natural process of antibody transfer have led to the recommendation for administering inactivated influenza, diphtheria, tetanus toxoid and acellular pertussis vaccines during pregnancy. Several new maternal vaccine candidates are on the horizon.
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Disparities in Tdap Vaccination and Vaccine Information Needs Among Pregnant Women in the United States. Matern Child Health J 2019; 23:201-211. [PMID: 30288661 DOI: 10.1007/s10995-018-2633-8] [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: 01/05/2023]
Abstract
Objectives The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that pregnant women receive the Tdap vaccine during every pregnancy. The objectives of this paper are to evaluate disparities in Tdap vaccination among pregnant women in the U.S., and to assess whether race/ethnicity and other characteristics are associated with factors that inform pregnant women's decisions about Tdap vaccination. Methods We conducted a nationwide cross-sectional web-based survey of pregnant women in the U.S. during June-July 2014. The primary outcome was self-reported vaccination status with Tdap during pregnancy, categorized as vaccinated, unvaccinated with intent to be vaccinated during the current pregnancy, and unvaccinated with no intent to be vaccinated during the current pregnancy. Secondary outcomes included factors that influenced women's decisions about vaccination and information needs. We used multivariable logistic regression models to estimate odds ratios for associations between race/ethnicity and the outcomes. Results Among pregnant women who completed the survey, 41% (95% CI 36-45%) reported that they had received Tdap during the current pregnancy. Among those women in the third trimester at the time of survey, 52% (95% CI 43-60%) had received Tdap during the current pregnancy. Hispanic women had higher Tdap vaccination than white women and black women (53%, p < 0.05, compared with 38 and 36%, respectively). In logistic regression models adjusting for maternal age, geographic region, education, and income, Hispanic women were more likely to have been vaccinated with Tdap compared with white women (aOR 2.29, 95% CI 1.20-4.37). Higher income and residing in the western U.S. were also independently associated with Tdap vaccination during pregnancy. Twenty-six percent of surveyed women had not been vaccinated with Tdap yet but intended to receive the vaccine during the current pregnancy; this proportion did not differ significantly by race/ethnicity. The most common factor that influenced women to get vaccinated was a health care provider (HCP) recommendation. The most common reason for not getting vaccinated was a concern about safety of the vaccine. Conclusions This study found that some disparities exist in Tdap vaccination among pregnant women in the U.S., and HCPs have an important role in providing information and recommendations about the maternal Tdap recommendation to pregnant women so they can make informed vaccination decisions.
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O'Leary ST, Riley LE, Lindley MC, Allison MA, Crane LA, Hurley LP, Beaty BL, Brtnikova M, Collins M, Albert AP, Fisher AK, Jiles AJ, Kempe A. Vaccination Practices Among Obstetrician/Gynecologists for Non-pregnant Patients. Am J Prev Med 2019; 56:429-436. [PMID: 30777161 PMCID: PMC6383792 DOI: 10.1016/j.amepre.2018.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Many non-pregnant women see obstetrician-gynecologists as their sole source of medical care, yet little is known about vaccination practices of obstetrician-gynecologists for non-pregnant patients. The objectives were to assess, among a national sample of obstetrician-gynecologists, practices related to vaccine delivery in non-pregnant patients and factors associated with stocking and administering more than three different vaccines to non-pregnant patients. METHODS E-mail and mail surveys were administered July-October 2015, with analyses performed during October-November 2015 and April-June 2018. RESULTS The response rate was 73% (353/482). Human papillomavirus (92%); influenza (82%); and tetanus, diphtheria, acellular pertussis vaccines (50%) were the vaccines most commonly assessed, with the remaining vaccines assessed by <40% of respondents. Vaccines most commonly administered by obstetrician-gynecologists to non-pregnant patients included human papillomavirus (81%); influenza (70%); and tetanus, diphtheria, acellular pertussis (54%). The remaining vaccines were administered by <30% of obstetrician-gynecologists. Factors associated with routinely administering more than three vaccines to non-pregnant patients included working in a hospital-, public health-, or university-associated clinic (RR=1.87, 95% CI=1.35, 2.58, referent to private practice); a larger practice (more than five providers; RR=1.54, 95% CI=1.05, 2.27); perceiving fewer financial barriers (RR=0.74, 95% CI=0.57, 0.96); fewer practice-associated barriers (RR=0.71, 95% CI=0.55, 0.92); and greater patient barriers (RR=1.62, 95% CI=1.33, 1.98). CONCLUSIONS Human papillomavirus; influenza; and tetanus, diphtheria, acellular pertussis vaccines are the only vaccines routinely assessed and administered to non-pregnant patients by most obstetrician-gynecologists. Given their role as the sole source of care for many women, obstetrician-gynecologists could make a positive impact on the vaccination status of their non-pregnant patients.
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Affiliation(s)
- Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Laura E Riley
- The American College of Obstetricians and Gynecologists, Washington, District of Columbia
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mandy A Allison
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Division of General Internal Medicine, Denver Health, Denver, Colorado
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Collins
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Alison P Albert
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison K Fisher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela J Jiles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Zhou F, Xu J, Black CL, Ding H, Cho BH, Lu PJ, Lindley MC. Trends in Tdap vaccination among privately insured pregnant women in the United States, 2009-2016. Vaccine 2019; 37:1972-1977. [PMID: 30826146 DOI: 10.1016/j.vaccine.2019.02.042] [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] [Received: 10/25/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infants younger than 6 months are at increased risk of complications and mortality from pertussis infection. In October 2012, the Advisory Committee on Immunization Practices revised its recommendation to include a Tdap dose during each pregnancy, ideally between 27 and 36 weeks gestation. OBJECTIVE Assess trends in Tdap vaccination coverage among privately insured pregnant women from 2009 to 2016 including timing of Tdap vaccination (before, during, or after pregnancy), trimester of vaccination for women vaccinated during pregnancy, and missed vaccination opportunities for unvaccinated women. Identify factors associated with vaccination during the optimal period of 27-36 weeks gestation. STUDY DESIGN Retrospective analysis of privately insured women 15-49 years who delivered live births during 2009-2016 conducted using 2009-2016 MarketScan data. Tdap vaccination coverage and the timing of Tdap vaccine administration were assessed for women continuously enrolled from 6 months before pregnancy to 1 month after delivery. Multivariable logistic regression was performed to identify factors independently associated with receipt of Tdap vaccine at 27-36 weeks gestation. RESULTS Tdap vaccination coverage during pregnancy increased from 0.4% in 2009 to 6.2% in 2012 and to 53.2% in 2016. The proportion of vaccinated women receiving Tdap at 27-36 weeks gestation increased from <10% in 2009 to nearly 90% in 2016, with most vaccination occurring at 27-32 weeks gestation. Women of older age, residing in a metropolitan statistical area, residing outside the South, and having a capitated health insurance plan were more likely to receive Tdap at 27-36 weeks gestation than their counterparts. Among women not vaccinated during pregnancy, 77.7% had a pregnancy-related medical claim between 27 and 36 weeks gestation. CONCLUSION Tdap vaccination coverage during pregnancy increased significantly from 2009 to 2016, with the greatest increase occurring after the revised Advisory Committee on Immunization Practices recommendation. Most women who did not receive Tdap vaccine had a missed vaccination opportunity during pregnancy, indicating potential for much higher vaccination coverage and consequent infant protection against pertussis.
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Affiliation(s)
- Fangjun Zhou
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States.
| | - Jing Xu
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States
| | - Carla L Black
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States
| | - Helen Ding
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States; CFD Research Corporation, Huntsville, AL 35806, United States
| | - Bo-Hyun Cho
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States
| | - Peng-Jun Lu
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States
| | - Megan C Lindley
- Immunization Service Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, United States
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Cohen CC, Badger GJ, McLean KC. Provider group type and Tdap coverage in pregnancy. Vaccine 2019; 37:1188-1193. [PMID: 30665776 DOI: 10.1016/j.vaccine.2019.01.001] [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] [Received: 09/24/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The Advisory Committee on Immunization Practices (ACIP) has focused on maternal Tdap immunization as an important means to protect neonates from pertussis infections. There is little published data on provider and/or clinic characteristics as predictors of maternal Tdap uptake. This study examined differences in maternal Tdap coverage in women delivering at a single academic institution, but cared for prenatally in different clinical settings, in 2013, 2014, and 2015. Additionally, the accuracy and utilization of Vermont's immunization information system (IIS) was assessed. METHODS This was a retrospective, multiple time-point cross-sectional analysis of annual maternal Tdap coverage in women delivering at a single academic institution in the 3 years following a fundamental change in national maternal Tdap vaccination guidelines. Tdap administration was examined across different obstetric groups using chart review and data from the state's IIS. RESULTS All obstetric care groups except the resident-staffed clinic significantly increased maternal Tdap coverage in 2014, compared to 2013 coverage, with no further increase in 2015. In contrast, there was no increase in maternal Tdap coverage in 2014 in the resident-staffed clinics, but then a statistically significant increase in 2015. Overall Tdap coverage in 2014 was 80.4%, with variation in Tdap coverage between clinics types. In the subset of women who were cared for by the University-based groups, there was significant variation in Tdap coverage between clinics, despite racial homogeneity, which persisted after adjustment for maternal age and insurance type. The state's IIS was found to be highly accurate, using individual chart review as the "gold standard." DISCUSSION While we demonstrated high maternal Tdap coverage in women delivering at our institution, differences in clinic type and provider training appeared to impact immunization rates, as well as how quickly evolving national recommendations were adopted. Additionally, the fidelity of the state's IIS data was verified.
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Affiliation(s)
- Courtney C Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Gary J Badger
- Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Kelley C McLean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, United States.
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Desai S, Schanzer DL, Silva A, Rotondo J, Squires SG. Trends in Canadian infant pertussis hospitalizations in the pre- and post-acellular vaccine era, 1981-2016. Vaccine 2018; 36:7568-7573. [PMID: 30392765 DOI: 10.1016/j.vaccine.2018.10.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 09/06/2018] [Accepted: 10/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The acellular pertussis vaccine was introduced into the routine childhood immunization schedule across Canada in 1997-98 and adolescent booster doses were added between 1999 and 2005. We sought to assess the impact of these changes on infant pertussis hospitalizations and admissions to intensive care units (ICU) in Canada. METHODS Hospitalizations with a primary diagnosis of pertussis were extracted from the Canadian Discharge Abstract Database (DAD) for cases with hospital discharge dates between 1981 and 2016 using relevant ICD-9 and ICD-10 codes. Only cases with age less than one year at time of admission were included. Disease severity was assessed by admission to ICU. Cases were categorized into two periods: pre-program implementation period (1981-1995) and the post-program implementation period (2006-2016). Incidence rates, risk ratios, and rate differences were calculated for each period and comparisons for the two periods were done using chi-squared and t-tests. Quasi Poisson analysis was used to investigate trends. RESULTS When comparing the pre- and post-implementation periods, the average annual hospitalization rates for infants less than 1 year declined from 165.1 (95% CI 161.3, 168.9) to 33.6 (95% CI 31.6, 35.6) pertussis-related admissions per 100,000 population, with a corresponding reduction in the risk ratio of 4.9 (95% CI 4.6, 5.2). The risk of admission into an ICU was 1.58 times higher in the pre- versus post-implementation period while the highest reduction in average annual hospitalizations was 263.3 admissions per 100,000 population in infants 2 months of age. In the post-implementation period, infants less than 1 month of age had the highest average annual hospitalization rate at 126.6 (95% CI 113.1, 140.1) hospitalizations per 100,000 infants. CONCLUSION Infant pertussis hospitalizations have reduced greatly over time. Infants under 2 months of age remain the most at-risk age group for hospitalization and admission to ICU.
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Affiliation(s)
- Shalini Desai
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ontario K2E 7L9, Canada
| | - Dena L Schanzer
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ontario K2E 7L9, Canada
| | - Anada Silva
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ontario K2E 7L9, Canada
| | - Jenny Rotondo
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ontario K2E 7L9, Canada
| | - Susan G Squires
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ontario K2E 7L9, Canada.
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Janagaraj PD, Gurusamy PSR, Webby R. Current antenatal pertussis vaccination guidelines miss preterm infants: An epidemiological study from the Northern Territory. Aust N Z J Obstet Gynaecol 2018; 59:436-443. [PMID: 30255494 DOI: 10.1111/ajo.12896] [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] [Received: 05/23/2018] [Accepted: 08/12/2018] [Indexed: 12/01/2022]
Abstract
IMPORTANCE Assessing gaps in antenatal pertussis vaccination to increase coverage. INTRODUCTION Antenatal pertussis vaccination has been proven effective in reducing pertussis disease in infants. Current guidelines recommend maternal pertussis vaccination from 28 weeks gestation. The aim of this study is to determine antenatal pertussis vaccination coverage in the Northern Territory and potential socio-demographic factors affecting uptake, using validated birth and immunisation data. METHODS Cross-sectional population study including all viable births (from 24 weeks gestation) in Northern Territory public hospitals in 2016. RESULTS There were 3392 viable delivery episodes in 2016 with 48.9% coverage against maternal pertussis based on current guidelines. Mothers <35 years old were more likely to receive antenatal vaccination (adjusted odds ratio (aOR) = 1.26, CI 1.035-1.52, P = 0.021). Pertussis vaccination coverage for preterm births was low at 0% for extreme, 18.86% for very preterm and 39.8% for moderate preterm births, with an overall coverage of 33.5% for all preterm births. Term births were two times more likely than preterm births to have had mothers receive an antenatal diphtheria toxoid, tetanus toxoid and acellular pertussis vaccine (aOR = 1.957, CI 1.53-2.50, P < 0.001). CONCLUSIONS A significant proportion (66.5%) of preterm babies are not benefiting from protection against pertussis with the current pertussis vaccination policy from 28 weeks gestation. As timing of birth cannot be predetermined, a review of safety and acceptability of pertussis vaccine administration in the second trimester is needed. Implementation of pertussis vaccination from 20 weeks gestation will provide a wider vaccination period and maximise the protection of all infants including pre-term infants from pertussis.
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Affiliation(s)
| | | | - Rosalind Webby
- Centre for Disease Control (CDC), Tiwi, Northern Territory, Australia
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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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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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