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Kristinsdottir I, Haraldsson A, Thors V. Influenza vaccination in pregnant women in Iceland 2010-2020 and the burden of influenza in pregnant women and their infants. Vaccine 2024; 42:2051-2058. [PMID: 38413277 DOI: 10.1016/j.vaccine.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Influenza vaccinations are recommended in pregnancy to protect both the pregnant woman and the unborn baby. The aim of this study was to assess the influenza vaccine uptake among pregnant women in Iceland in ten influenza seasons and to estimate the influenza disease burden on pregnant women and their infants. METHODS This was a retrospective, descriptive study on influenza vaccine uptake among pregnant women and the burden of influenza and influenza-like illness (ILI) among pregnant women and their infants in ten influenza seasons. All women attending a 20-week ultrasound at Landspitali University Hospital in Reykjavik in August-April each influenza season 2010-2020 were included in the study. Data on influenza vaccinations and influenza/ILI diagnoses was collected from central national databases. RESULTS The influenza vaccine uptake increased from 6.2 % in 2011-2012 to 37.5 % in 2019-2020. The incidence rate of influenza/ILI among pregnant women ranged from 5.5 to 22.1/1000 person-years. The estimated vaccine effectiveness in the ten influenza seasons was 34-100 %. The incidence rate of influenza/ILI among infants < 12 months of age was 0-13.4/1000 person-years. Influenza vaccinations in pregnancy are protective against influenza/ILI in pregnant women (IRR 0.36, 95 % CI 0.22-0.58), infants in the season of vaccination (IRR 0.40, 95 % CI 0.17-0.97) and probably for infants < 6 months of age (IRR 0.51, 95 % CI 0.22-1.21). CONCLUSIONS Influenza vaccine coverage in pregnancy is suboptimal. Influenza vaccinations in pregnancy provide significant protection against influenza/ILI for pregnant women and infants in the season of vaccination. Initiatives to improve maternal vaccination coverage are needed.
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Affiliation(s)
- Iris Kristinsdottir
- Faculty of Medicine, University of Iceland, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Iceland
| | - Asgeir Haraldsson
- Faculty of Medicine, University of Iceland, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Iceland
| | - Valtyr Thors
- Faculty of Medicine, University of Iceland, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Iceland.
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Brown K, Cotaru C, Binks M. A retrospective, longitudinal cohort study of trends and risk factors for preterm birth in the Northern Territory, Australia. BMC Pregnancy Childbirth 2024; 24:33. [PMID: 38182975 PMCID: PMC10768210 DOI: 10.1186/s12884-023-06164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Preterm birth (PTB) is the single most important cause of perinatal mortality and morbidity in high income countries. In Australia, 8.6% of babies are born preterm but substantial variability exists between States and Territories. Previous reports suggest PTB rates are highest in the Northern Territory (NT), but comprehensive analysis of trends and risk factors are lacking in this region. The objective of this study was to characterise temporal trends in PTB among First Nations and non-First Nations mothers in the Top End of the NT over a 10-year period and to identify perinatal factors associated with the risk of PTB. METHODS This was a retrospective population-based cohort study of all births in the Top End of the NT over the 10-year period from January 1st, 2008, to December 31st, 2017. We described maternal characteristics, obstetric complications, birth characteristics and annual trends in PTB. The association between the characteristics and the risk of PTB was determined using univariate and multivariate generalised linear models producing crude risk ratios (cRR) and adjusted risk ratios (aRR). Data were analysed overall, in First Nations and non-First Nations women. RESULTS During the decade ending in 2017, annual rates of PTB in the Top End of the NT remained consistently close to 10% of all live births. However, First Nations women experienced more than twice the risk of PTB (16%) compared to other women (7%). Leading risk factors for PTB among First Nations women as compared to other women included premature rupture of membranes (RR 12.33; 95% CI 11.78, 12.90), multiple pregnancy (RR 7.24; 95% CI 6.68, 7.83), antepartum haemorrhage (RR 4.36; 95% CI 3.93, 4.84) and pre-existing diabetes (RR 4.18; 95% CI 3.67, 4.76). CONCLUSIONS First Nations women experience some of the highest PTB rates globally. Addressing specific pregnancy complications provides avenues for intervention, but the story is complex and deeper exploration is warranted. A holistic approach that also acknowledges the influence of socio-demographic influences, such as remote dwelling and disadvantage on disease burden, will be required to improve perinatal outcomes.
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Affiliation(s)
- Kiarna Brown
- Menzies School of Health Research, Royal Darwin Hospital, Building 58, John Matthews Building, Tiwi, NT, 0810, Australia.
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Carina Cotaru
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Michael Binks
- Menzies School of Health Research, Royal Darwin Hospital, Building 58, John Matthews Building, Tiwi, NT, 0810, Australia
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Bansal A, Trieu MC, Mohn KGI, Cox RJ. Safety, Immunogenicity, Efficacy and Effectiveness of Inactivated Influenza Vaccines in Healthy Pregnant Women and Children Under 5 Years: An Evidence-Based Clinical Review. Front Immunol 2021; 12:744774. [PMID: 34691051 PMCID: PMC8526930 DOI: 10.3389/fimmu.2021.744774] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023] Open
Abstract
Annual influenza vaccination is often recommended for pregnant women and young children to reduce the risk of severe influenza. However, most studies investigating the safety, immunogenicity, and efficacy or effectiveness of influenza vaccines are conducted in healthy adults. In this evidence-based clinical review, we provide an update on the safety profile, immunogenicity, and efficacy/effectiveness of inactivated influenza vaccines (IIVs) in healthy pregnant women and children <5 years old. Six electronic databases were searched until May 27, 2021. We identified 3,731 articles, of which 93 met the eligibility criteria and were included. The IIVs were generally well tolerated in pregnant women and young children, with low frequencies of adverse events following IIV administration; however, continuous vaccine safety monitoring systems are necessary to detect rare adverse events. IIVs generated good antibody responses, and the seroprotection rates after IIVs were moderate to high in pregnant women (range = 65%-96%) and young children (range = 50%-100%), varying between the different influenza types/subtypes and seasons. Studies show vaccine efficacy/effectiveness values of 50%-70% in pregnant women and 20%-90% in young children against lab-confirmed influenza, although the efficacy/effectiveness depended on the study design, host factors, vaccine type, manufacturing practices, and the antigenic match/mismatch between the influenza vaccine strains and the circulating strains. Current evidence suggests that the benefits of IIVs far outweigh the potential risks and that IIVs should be recommended for pregnant women and young children.
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Affiliation(s)
- Amit Bansal
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mai-Chi Trieu
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Kristin G I Mohn
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rebecca Jane Cox
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Helse Bergen, Bergen, Norway
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Smith SE, Gum L, Thornton C. An exploration of midwives' role in the promotion and provision of antenatal influenza immunisation: A mixed methods inquiry. Women Birth 2021; 34:e7-e13. [PMID: 32418653 PMCID: PMC7211614 DOI: 10.1016/j.wombi.2020.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/05/2022]
Abstract
PROBLEM No South Australian study has previously investigated the role of midwives in the promotion and provision of antenatal influenza immunisation. BACKGROUND Influenza acquired in pregnancy can have serious sequalae for both mother and foetus. Recent studies have demonstrated that influenza vaccine in pregnancy is both safe and effective. Despite this, evidence suggests that vaccine uptake in pregnancy is suboptimal in both Australia and worldwide. AIM The aim of this study was to investigate the role of midwives in the promotion and provision of antenatal influenza vaccine and, to provide a statistical and thematic description of the barriers and enablers midwives encounter. METHODS This mixed method study incorporated a cross sectional on-line survey and in-depth interviews conducted with midwives, employed in urban and regional South Australia. FINDINGS Quantitative data were available for 137 midwives and 10 midwives participated in the interviews. Recruitment for the interview phase was through the last question on the survey. Whilst all midwives indicated that education and vaccine promotion were part of their role, immunisation knowledge varied between Registered Nurse/Midwives (RM/RN) 80% and Registered Midwives (RM) 48.90% (p = 0.001). Quantitative data showed that only 43% of midwives felt sufficiently educated to provide the vaccine. Midwives who had received formal immunisation training were more likely to recommend the vaccine 93.7% (p = 0.001). Qualitative data confirmed these results and identified the lack of immunisation education as a barrier to practise. CONCLUSION Midwives identified an immunisation knowledge deficit. Midwives who had received immunisation education were more likely to actively promote and provide the vaccine to pregnant women. These findings indicate the need for more immunisation education of midwives in both tertiary and practice settings.
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Affiliation(s)
- Susan Elizabeth Smith
- Flinders University, College of Nursing and Health Science, Sturt Street, Bedford Park, Adelaide, SA 5154, Australia.
| | - Lyn Gum
- Flinders University, College of Nursing and Health Science, Sturt Street, Bedford Park, Adelaide, SA 5154, Australia
| | - Charlene Thornton
- Flinders University, College of Nursing and Health Science, Sturt Street, Bedford Park, Adelaide, SA 5154, Australia
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Glover C, Crawford N, Leeb A, Wood N, Macartney K. Active SMS-based surveillance of adverse events following immunisation with influenza and pertussis-containing vaccines in Australian pregnant women using AusVaxSafety. Vaccine 2020; 38:4892-4900. [PMID: 32499067 DOI: 10.1016/j.vaccine.2020.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Maternal immunisation is important to protect both mother and baby, but safety concerns can lead to low uptake. AusVaxSafety participant-based surveillance actively monitors adverse events following immunisation (AEFI) in Australia. We aimed to analyse AEFI in the days following vaccination with seasonal inactivated influenza vaccine (IIV) and/or reduced antigen diphtheria-tetanus-acellular pertussis vaccine (dTpa) in pregnant women in Australia. METHODS De-identified AEFI reports were solicited from vaccine recipients via automated SMS survey (using SmartVax software) following routine vaccination with IIV and/or dTpa at 219 national sentinel surveillance sites from 2015 to 2018. AEFI rates were compared by vaccine group (IIV alone, dTpa alone, or IIV and dTpa together), vaccine brand, trimester (IIV only) and vaccination period (April to August 2016-2018; IIV only). Women who had two vaccination encounters during surveillance were identified and AEFI rates compared for each dose. RESULTS Among 13,758 participants, overall AEFI rates were lower following IIV (4.9%) than dTpa (6.4%) or IIV and dTpa given concomitantly (7.4%). The AEFI profile was similar for both vaccines, with injection site reactions, tiredness, and headache most commonly reported. Injection site pain and swelling/redness were significantly more common in women who received dTpa than IIV. Reports of medical attendance following immunisation were similar (0.3%) for each vaccine group. AEFI rates did not differ by IIV brand (FluQuadri®, Fluarix® Tetra), dTpa brand (Boostrix®, Adacel®), or by trimester. Among women with sequential dTpa vaccinations, 6.0% (7/116) had an AEFI following their second dTpa dose. CONCLUSIONS Self-reported AEFI rates did not differ by trimester (IIV), or by vaccine brand (IIV or dTpa). Concomitant influenza and pertussis vaccination was associated with more frequent, but low rates of minor, expected AEFI. These real world 'citizen science-based' data provide further reassuring evidence of the safety of maternal vaccination.
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Affiliation(s)
- Catherine Glover
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| | - Nigel Crawford
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Alan Leeb
- SmartVax, Illawarra Medical Centre, Ballajura, Western Australia, Australia; Illawarra Medical Centre, Ballajura, Western Australia, Australia.
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia; Department of Microbiology and Infectious Disease, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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McHugh L, Marshall HS, Perrett KP, Nolan T, Wood N, Lambert SB, Richmond P, Ware RS, Binks P, Binks MJ, Andrews RM. The Safety of Influenza and Pertussis Vaccination in Pregnancy in a Cohort of Australian Mother-Infant Pairs, 2012-2015: The FluMum Study. Clin Infect Dis 2020; 68:402-408. [PMID: 30475988 DOI: 10.1093/cid/ciy517] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/17/2018] [Indexed: 01/22/2023] Open
Abstract
Background Inactivated influenza vaccine (IIV) and pertussis vaccination are recommended in pregnancy. Limited safety data exist for women who received IIV vaccine during the first trimester of pregnancy or received both vaccines in pregnancy. We assessed adverse birth outcomes between vaccinated and unvaccinated pregnancies. Methods Among prospectively enrolled Australian "FluMum" participants (2012-2015), primary exposure was receipt and timing of IIV during pregnancy. Primary outcomes included preterm birth, low birthweight at term (LBWT), and small for gestational age (SGA). We compared birth outcomes for IIV in pregnancy with women unvaccinated in pregnancy using Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs). Adjusted HRs (aHRs) controlled for potential confounding variables. Sensitivity analyses were conducted in a subgroup of women who received pertussis vaccination during pregnancy to assess whether associations between IIV and adverse outcomes were maintained after adjusting for pertussis vaccination. Results Among 8827 participants in our study, women who received IIV in pregnancy did not have an elevated risk of an adverse birth outcome compared with unvaccinated pregnant women: preterm births (HR, 1.10 [95% CI, .92-1.31]; P = .28); LBWT (HR, 1.05 [95% CI, .76-1.44]; P = .77); or SGA (HR, 0.99 [95% CI, .86-1.15]; P = .94). Adjustment for pertussis vaccination during pregnancy yielded similar results: preterm births (aHR, 1.05 [95% CI, .82-1.34]; P = .69); LBWT (aHR, 0.81 [95% CI, .50-1.29]; P = .37); SGA (aHR, 0.92 [95% CI, .74-1.14]; P = .43). There was no evidence of elevated risk by trimester of IIV. Conclusions No significant associations were found between maternal IIV or pertussis vaccination in pregnancy and adverse birth outcomes, regardless of the trimester of pregnancy a vaccination was given compared to unvaccinated pregnancies.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory
| | - Helen S Marshall
- Women's and Children's Health Network, Robinson Research Institute and Adelaide Medical School, University of Adelaide, South Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Royal Children's Hospital and School of Population and Global Health, University of Melbourne, Victoria
| | - Terry Nolan
- Murdoch Children's Research Institute, Royal Children's Hospital and School of Population and Global Health, University of Melbourne, Victoria
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospitals Network, Discipline of Child and Adolescent Health, University of Sydney, New South Wales
| | - Stephen B Lambert
- Child Health Research Centre, School of Medicine, University of Queensland, Brisbane
| | - Peter Richmond
- University of Western Australia, Division of Paediatrics and Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane
| | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Giles ML, Cheng AC. Regulatory agencies have a role to play in maintaining consumer confidence in vaccine safety for pregnant women. Hum Vaccin Immunother 2020; 16:2573-2576. [PMID: 32078437 PMCID: PMC7644227 DOI: 10.1080/21645515.2020.1718976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University , Melbourne, Australia.,Infectious Diseases Unit, Alfred Health , Melbourne, Australia
| | - Allen C Cheng
- Central Clinical School, Monash University , Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
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Ohfuji S, Deguchi M, Tachibana D, Koyama M, Takagi T, Yoshioka T, Urae A, Ito K, Kase T, Maeda A, Kondo K, Fukushima W, Hirota Y. Safety of influenza vaccination on adverse birth outcomes among pregnant women: A prospective cohort study in Japan. Int J Infect Dis 2020; 93:68-76. [PMID: 31982621 DOI: 10.1016/j.ijid.2020.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pregnant women are in the highest priority group for receiving influenza vaccination. However, they may be reluctant to receive the vaccination due to concerns about the influence of vaccination on the fetuses. METHODS This prospective cohort study of 10 330 pregnant women examined the safety of influenza vaccination in terms of adverse birth outcomes. Influenza vaccination during pregnancy was determined from questionnaires before and after the 2013/2014 influenza season. All subjects were followed until the end of their pregnancy. Adverse birth outcomes, including miscarriage, stillbirth, preterm birth, low birth weight, and malformation, were assessed by obstetrician reports. RESULTS Adverse birth outcomes were reported for 641 (10%) of the 6387 unvaccinated pregnant women and 356 (9%) of the 3943 vaccinated pregnant women. Even after adjusting for potential confounders, vaccination during pregnancy showed no association with the risk of adverse birth outcomes (odds ratio 0.90, 95% confidence interval 0.76-1.07). Vaccination during the first or second trimester displayed no association with adverse birth outcomes, whereas vaccination during the third trimester was associated with a decreased risk of adverse birth outcomes (odds ratio 0.70, 95% confidence interval 0.51-0.98). CONCLUSIONS Influenza vaccination during pregnancy did not increase the risk of adverse birth outcomes, regardless of the trimester in which vaccination was performed, when compared to unvaccinated pregnant women.
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Affiliation(s)
- Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan; Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan.
| | - Masaaki Deguchi
- Department of Obstetrics and Gynecology, Kishiwada City Hospital, 1001, Gakuhara-cho, Kishiwada-shi, Osaka 596-8501, Japan
| | - Daisuke Tachibana
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan
| | - Tetsu Takagi
- Takagi Ladies Clinic, 1-13-44, Kamihigashi, Hirano-ku, Osaka-shi, Osaka 547-0002, Japan
| | - Takayuki Yoshioka
- Osaka Branch, Mediscience Planning Inc., 3-6-1, Hiranomachi, Chuo-ku, Osaka-shi, Osaka 541-0052, Japan
| | - Akinori Urae
- Head Office, Mediscience Planning Inc., 1-11-44, Akasaka, Minato-ku, Tokyo 107-0052, Japan
| | - Kazuya Ito
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan; College of Healthcare Management, 960-4, Takayanagi, Setaka-machi, Miyama-shi, Fukuoka, 835-0018, Japan
| | - Tetsuo Kase
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan; Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan
| | - Akiko Maeda
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan
| | - Kyoko Kondo
- Osaka City University Hospital, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan; Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan
| | - Yoshio Hirota
- Department of Public Health, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka 545-8585, Japan; College of Healthcare Management, 960-4, Takayanagi, Setaka-machi, Miyama-shi, Fukuoka, 835-0018, Japan; Clinical Epidemiology Research Center, SOUSEIKAI, 3-5-1, Kashii-Teriha, Higashi-ku, Fukuoka-shi, Fukuoka 813-0017, Japan
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Regan AK, Håberg SE, Fell DB. Current Perspectives on Maternal Influenza Immunization. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00188-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Rolfes MA, Vonglokham P, Khanthamaly V, Chitry B, Pholsena V, Chitranondh V, Mirza SA, Moen A, Bresee JS, Xeuatvongsa A, Olsen SJ. Measurement of birth outcomes in analyses of the impact of maternal influenza vaccination. Influenza Other Respir Viruses 2019; 13:547-555. [PMID: 31424627 PMCID: PMC6800304 DOI: 10.1111/irv.12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022] Open
Abstract
Background The estimated association of maternal influenza vaccination and birth outcomes may be sensitive to methods used to define preterm birth or small‐for‐gestational age (SGA). Methods In a cohort of pregnant women in Lao People's Democratic Republic, we estimated gestational age from: (a) date of last menstrual period (LMP), (b) any prenatal ultrasound, (c) first trimester ultrasound, (d) Ballard Score at delivery, and (e) an algorithm combining LMP and ultrasound. Infants were classified as SGA at birth using a Canadian, global, and equation‐based growth reference. We estimated the association of maternal influenza vaccination and birth outcomes, by influenza activity, using multivariable log‐binomial regression and Cox proportional hazards regression with vaccination as a time‐varying exposure. Results The frequency of preterm birth in the cohort varied by method to estimate gestational age, from 5% using Ballard Score to 15% using any ultrasound. Using LMP, any ultrasound, or the algorithm, we found statistically significant reductions in preterm birth among vaccinated women during periods of high influenza activity and statistically significant increases in SGA, using a Canadian growth reference. We did not find statistically significant associations with SGA when using global or equation‐based growth references. Conclusions The association of maternal influenza vaccination and birth outcomes was most affected by the choice of a growth reference used to define SGA at birth. The association with pre‐term birth was present and consistent across multiple statistical approaches. Future studies of birth outcomes, specifically SGA, should carefully consider the potential for bias introduced by measurement choice.
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Affiliation(s)
- Melissa A Rolfes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Viengphone Khanthamaly
- Influenza Program, U.S. CDC-Lao PDR, American Embassy, Vientiane, Lao People's Democratic Republic
| | - Bounlap Chitry
- Mother and Child Hospital, Vientiane, Lao People's Democratic Republic
| | | | - Visith Chitranondh
- Luang Prabang Provincial Hospital, Luang Prabang, Lao People's Democratic Republic
| | - Sara A Mirza
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann Moen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph S Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jeong S, Jang EJ, Jo J, Jang S. Effects of maternal influenza vaccination on adverse birth outcomes: A systematic review and Bayesian meta-analysis. PLoS One 2019; 14:e0220910. [PMID: 31412058 PMCID: PMC6693758 DOI: 10.1371/journal.pone.0220910] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background Although pregnant women are a priority group for influenza vaccination, its effect on birth outcomes has long been debated. Numerous observational studies and a few randomized controlled studies have been conducted, with inconsistent results. Objectives To evaluate the association of influenza vaccination in pregnancy with adverse birth outcomes. Data source The Cochrane Library, PubMed, EMBASE, Web of Science, and Scopus were searched. Study eligibility criteria This analysis included randomized placebo-controlled studies, cohort studies, and case-control studies, in which inactivated influenza vaccination was given during pregnancy and fetal adverse birth outcomes were assessed. Participants & intervention Women who received inactivated influenza vaccine during pregnancy and their offspring. Study appraisal and synthesis Two independent reviewers and a third reviewer collaborated in study selection and data extraction. A Bayesian 3-level random-effects model was utilized to assess the impact of maternal influenza vaccination on birth outcomes, which were presented as odds ratios (ORs) with 95% credible interval (CrIs). Bayesian outcome probabilities (P) of an OR<1 were calculated, and values of at least 90% (0.9) were deemed to indicate a significant result. Results Among the 6,249 identified publications, 48 studies were eligible for the meta-analysis, including 2 randomized controlled trials, 41 cohort studies, and 5 case-control studies. The risk of none of the following adverse birth outcomes decreased significantly: preterm birth (OR = 0.945, 95% CrI: 0.736–1.345, P = 73.3%), low birth weight (OR = 0.928, 95% CrI: 0.432–2.112, P = 76.7%), small for gestational age (OR = 0.971, 95% CrI: 0.249–4.217,P = 63.3%), congenital malformation (OR = 1.026, 95% CrI: 0.687–1.600, P = 38.0%), and fetal death (OR = 0.942, 95% CrI: 0.560–1.954, P = 61.6%). Summary estimates including only cohort studies showed significantly decreased risks for preterm birth, small for gestational age and fetal death. However, after adjusting for season at the time of vaccination and countries’ income level, only fetal death remained significant. Conclusion This Bayesian meta-analysis did not find a protective effect of maternal influenza vaccination against adverse birth outcomes, as reported in previous studies. In fact, our results showed evidence of null associations between maternal influenza vaccination and adverse birth outcomes.
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Affiliation(s)
- Sohyun Jeong
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts, United States of America
- School of Pharmacy, Sungkyunkwan University, Jangan-gu, Suwon, Gyeonggi-do, Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Gyeongsangbuk-do, Korea
| | - Junwoo Jo
- Department of Statistics, Kyungpook National University, Bukgu, Daegu, Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
- * E-mail:
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12
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Munoz FM, Jackson LA, Swamy GK, Edwards KM, Frey SE, Stephens I, Ault K, Winokur P, Petrie CR, Wolff M, Patel SM, Keitel WA. Safety and immunogenicity of seasonal trivalent inactivated influenza vaccines in pregnant women. Vaccine 2018; 36:8054-8061. [DOI: 10.1016/j.vaccine.2018.10.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/14/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
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13
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Giles ML, Krishnaswamy S, Macartney K, Cheng A. The safety of inactivated influenza vaccines in pregnancy for birth outcomes: a systematic review. Hum Vaccin Immunother 2018; 15:687-699. [PMID: 30380986 PMCID: PMC6605784 DOI: 10.1080/21645515.2018.1540807] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pregnant women are at increased risk of morbidity and mortality from influenza and are recognized as a priority group for influenza vaccination. Despite this, uptake is often poor and one reason cited for this is concerns about safety. The objective of this study was to perform a systematic review of the safety of inactivated influenza vaccination (IIV) in pregnancy. Studies were included if they were: (i) observational or experimental design; (ii) included a comparator group comprising of unvaccinated pregnant women; (iii) comprised of either seasonal IIV or monovalent H1N1 IIV (including adjuvanted vaccines); and (iv) addressed one of the following outcomes: preterm birth (PTB), small for gestational age (SGA), fetal death (including stillbirth or spontaneous abortion), low birth weight (LBW) or congenital abnormalities. Two reviewers screened abstracts and titles and selected full texts for retrieval. Crude odds ratios were calculated from reported event rates, using binomial standard errors. Adjusted odds ratios, hazard ratios and relative rates were extracted as reported in each paper. After removal of duplicates and full text eligibility assessment, 40 studies remained. The aOR for PTB was 0.87 (0.78–0.96), for LBW 0.82 (0.76–0.89), congenital abnormality 1.03 (0.99–1.07), SGA 0.99 (0.94–1.04) and stillbirth 0.84 (0.65–1.08). This study contributes to the increasing body of safety data for IIV in pregnancy and reports a protective effect on PTB and LBW.
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Affiliation(s)
- Michelle L Giles
- a Department of Obstetrics and Gynaecology and Department of Infectious Diseases , Monash University and Alfred Health , Melbourne , Australia
| | - Sushena Krishnaswamy
- b Department of Obstetrics and Gynaecology and Department of Infectious Diseases , Monash University and Monash Health , Melbourne , Australia
| | - Kristine Macartney
- c National Centre for Immunisation Research and Surveillance , University of Sydney , Sydney , Australia
| | - Allen Cheng
- d Department of Epidemiology and Infectious Diseases , Monash University and Alfred Health , Melbourne , Australia
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14
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Giles ML, Krishnaswamy S, Wallace EM. Maternal immunisation: What have been the gains? Where are the gaps? What does the future hold? F1000Res 2018; 7:F1000 Faculty Rev-1733. [PMID: 30443339 PMCID: PMC6213781 DOI: 10.12688/f1000research.15475.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 12/22/2022] Open
Abstract
The vaccination of pregnant women has enormous potential to protect not only mothers from vaccine-preventable diseases but also their infants through the passive acquisition of protective antibodies before they are able to themselves acquire protection through active childhood immunisations. Maternal tetanus programmes have been in place since 1989, and as of March 2018, only 14 countries in the world were still to reach maternal neonatal tetanus elimination status. This has saved hundreds of thousands of lives. Building on this success, influenza- and pertussis-containing vaccines have been recommended for pregnant women and introduced into immunisation programmes, albeit predominantly in resource-rich settings. These have highlighted some important challenges when additional immunisations are introduced into the antenatal context. With new vaccine candidates, such as respiratory syncytial virus (RSV) and group B streptococcus (GBS), on the horizon, it is important that we learn from these experiences, identify the information gaps, and close these to ensure safe and successful implementation of maternal vaccines in the future, particularly in low- and middle-income countries with a high burden of disease.
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Affiliation(s)
- Michelle L. Giles
- Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Sushena Krishnaswamy
- Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Monash Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Euan M. Wallace
- Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Safer Care Victoria, Victorian Government, Melbourne, VIC, Australia
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15
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McHugh L, Andrews RM, Ware RS. Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy 2012-2014: The FluMum study. Vaccine 2018; 35:4492-4493. [PMID: 28818441 DOI: 10.1016/j.vaccine.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa McHugh
- Centre for Child Development and Education, Menzies School of Health Research, Spring Hill, Brisbane 4000, Queensland, Australia. http://www.menzies.edu.au
| | - Ross M Andrews
- Centre for Child Development and Education, Menzies School of Health Research, Spring Hill, Brisbane 4000, Queensland, Australia
| | - Robert S Ware
- Centre for Child Development and Education, Menzies School of Health Research, Spring Hill, Brisbane 4000, Queensland, Australia
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16
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Krishnaswamy S, Cheng AC, Wallace EM, Buttery J, Giles ML. Understanding the barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds: A cross-sectional study. Hum Vaccin Immunother 2018; 14:1591-1598. [PMID: 29494274 DOI: 10.1080/21645515.2018.1445455] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The role of maternal vaccination in reducing neonatal morbidity and mortality is expanding but uptake remains suboptimal. While the barriers to uptake have been well described, women from minority groups have not been well represented in previous studies. In this study we examine the facilitators and barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds in Melbourne, Australia. 537 women attending antenatal care completed a survey; 69% were born overseas. 63% had or intended to receive pertussis vaccine and 57% had or intended to receive influenza vaccine during their pregnancy. On multivariable analysis, predictors of uptake of pertussis vaccine were healthcare provider recommendation (OR 10, 95% CI 5-21, p < 0.001) and belief maternal pertussis vaccination is safe (OR 36, 95% CI 18-70, p < 0.001). For influenza vaccine, predictors of uptake were previous receipt of influenza vaccine (OR 8, 95% CI 5-15, p < 0.001) and healthcare provider recommendation (OR 30, 95% CI 16-56, p < 0.001). Lack of healthcare provider recommendation was the main reason for non-vaccination (17/46, 37%). While most women were aware of and intended to receive recommended vaccinations, recently arrived migrant women (resident in Australia for less than two years) were less likely to be aware of pertussis vaccine (15/22, 68% vs 452/513, 88%, p = 0.01) and less likely to believe it to be safe during pregnancy (4/22, 18% vs 299/514, 58%, p < 0.001). This highlights the important role of healthcare providers in recommending and educating women, particularly newly arrived migrant women, in their decisions about vaccination during pregnancy.
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Affiliation(s)
- Sushena Krishnaswamy
- a The Ritchie Centre, Department of Obstetrics and Gynaecology , Monash University , Clayton , Victoria , Australia.,b Monash Infectious Diseases, Monash Health , Clayton , Victoria , Australia
| | - Allen C Cheng
- c Department of Infectious Diseases , Alfred Health , Prahran , Victoria , Australia.,d Department of Epidemiology and Preventive Medicine , Monash University, The Alfred Centre , Melbourne , Victoria , Australia
| | - Euan M Wallace
- a The Ritchie Centre, Department of Obstetrics and Gynaecology , Monash University , Clayton , Victoria , Australia.,e Safer Care Victoria , Victorian Department of Health and Human Services , Melbourne , Victoria , Australia
| | - Jim Buttery
- f Infection and Immunity, Monash Children's Hospital , Clayton , Victoria , Australia.,g Monash Centre for Health Research and Implementation, Department of Epidemiology and Preventive Medicine , Monash University , Clayton , Victoria , Australia
| | - Michelle L Giles
- a The Ritchie Centre, Department of Obstetrics and Gynaecology , Monash University , Clayton , Victoria , Australia.,c Department of Infectious Diseases , Alfred Health , Prahran , Victoria , Australia
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17
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Somerville LK, Basile K, Dwyer DE, Kok J. The impact of influenza virus infection in pregnancy. Future Microbiol 2018; 13:263-274. [DOI: 10.2217/fmb-2017-0096] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Lucy K Somerville
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kerri Basile
- Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Dominic E Dwyer
- Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jen Kok
- Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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18
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McQuaid F, Jones C, Stevens Z, Meddaugh G, O'Sullivan C, Donaldson B, Hughes R, Ford C, Finn A, Faust SN, Gbesemete D, Bedford H, Hughes S, Varghese AS, Heath PT, Snape MD. Antenatal vaccination against Group B streptococcus: attitudes of pregnant women and healthcare professionals in the UK towards participation in clinical trials and routine implementation. Acta Obstet Gynecol Scand 2018; 97:330-340. [PMID: 29292509 DOI: 10.1111/aogs.13288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Maternal vaccination is increasingly part of antenatal care in the UK and worldwide. Trials of Group B streptococcus vaccines are ongoing. This study investigated the attitudes of pregnant women and healthcare professionals towards antenatal vaccination, both in routine care and a clinical trial setting. MATERIAL AND METHODS Survey of 269 pregnant women, 273 midwives/obstetricians and 97 neonatal doctors across seven sites in the UK assessing attitudes towards antenatal vaccinations, knowledge of Group B streptococcus, a hypothetical Group B streptococcus vaccine, and participation in clinical vaccine trials. RESULTS 68% of pregnant women intended to receive a vaccine during their current pregnancy (183/269) and 43% (of all respondents, 115/269) reported they would be very/fairly likely to accept a vaccine against Group B streptococcus despite only 29% (55/269) knowing what Group B streptococcus was. This increased to 69% after additional information about Group B streptococcus was provided. Twenty-four percent of pregnant women reported they would be likely to take part in a clinical trial of an unlicensed Group B streptococcus vaccine. Fifty-nine percent of maternity professionals and 74% of neonatologists would be likely to recommend participation in a Group B streptococcus vaccine trial to women, with the vast majority (>99%) willing to be involved in such a study. Incentives to take part cited by pregnant women included extra antenatal scans and the opportunity to be tested for Group B streptococcus. CONCLUSION Pregnant women and healthcare professionals were open to the idea of an antenatal Group B streptococcus vaccine and involvement in clinical trials of such a vaccine. Education and support from midwives would be key to successful implementation.
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Affiliation(s)
- Fiona McQuaid
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
| | - Christine Jones
- Pediatric Infectious Diseases Research Group & Vaccine Institute, Institute for Infection and Immunity, St Georges, University of London & St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Zoe Stevens
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
| | - Gretchen Meddaugh
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
| | - Catherine O'Sullivan
- Pediatric Infectious Diseases Research Group & Vaccine Institute, Institute for Infection and Immunity, St Georges, University of London & St Georges University Hospitals NHS Foundation Trust, London, UK
| | | | - Rhona Hughes
- Simpson Center for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - Carolyn Ford
- Simpson Center for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - Adam Finn
- Bristol Children's Vaccine Center, University Hospitals Bristol NHS Foundation Trust & University of Bristol, Bristol, UK
| | - Saul N Faust
- Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust & Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Diane Gbesemete
- Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust & Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Helen Bedford
- Population, Policy and Practice Program, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stephen Hughes
- Department of Pediatric Allergy and Immunology, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Anu S Varghese
- Department of Pediatric Allergy and Immunology, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Paul T Heath
- Pediatric Infectious Diseases Research Group & Vaccine Institute, Institute for Infection and Immunity, St Georges, University of London & St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, UK
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Influenza immunization of pregnant women in resource-constrained countries: an update for funding and implementation decisions. Curr Opin Infect Dis 2018; 30:455-462. [PMID: 28777109 DOI: 10.1097/qco.0000000000000392] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW In 2018, Gavi, the Vaccine Alliance, is expected to review the strategy of maternal influenza immunization for potential investment in low-income countries. RECENT FINDINGS Clinical trial data confirm the efficacy of maternal influenza immunization to prevent influenza disease in both mothers and their infants during the first months of life. Trial and observational data indicate no significant adverse events in mothers or newborns. High-quality disease burden data, particularly for seasonal influenza in low-income and middle-income countries, are limited. Thus, the anticipated impact of maternal influenza immunization programs on severe illness is unclear. However, assessments of the public health value of investment in maternal influenza immunization should extend beyond calculations of disease prevention and include broader effects such as improving health systems for antenatal care delivery, preventing inappropriate antibacterial prescribing, building a platform for other vaccines to be used during pregnancy, and strengthening systems to regulate, procure, and distribute influenza vaccines in response to a future pandemic. SUMMARY A global investment in a maternal influenza immunization strategy would prevent influenza disease in pregnant women and their infants. It would also provide additional public health value by strengthening antenatal care systems and improving country pandemic preparedness.
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20
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Hutcheon J, Ortiz JR. Re: Birth outcomes for Australian mother-infant pairs who received an influenza vaccine during pregnancy 2012-2014: The FluMum study. Vaccine 2017; 35:4491. [PMID: 28818440 DOI: 10.1016/j.vaccine.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/02/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Jennifer Hutcheon
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
| | - Justin R Ortiz
- Initiative for Vaccine Research, Immunization, Vaccines and Biologicals, Family, Women's and Children's Health Cluster, World Health Organization, Geneva, Switzerland.
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Zerbo O, Modaressi S, Chan B, Goddard K, Lewis N, Bok K, Fireman B, Klein NP, Baxter R. No association between influenza vaccination during pregnancy and adverse birth outcomes. Vaccine 2017; 35:3186-3190. [PMID: 28483192 DOI: 10.1016/j.vaccine.2017.04.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pregnant women are recommended to receive inactivated influenza vaccination anytime during pregnancy. Studies have investigated the impact of influenza vaccination during pregnancy on birth outcomes and results on preterm birth have been inconsistent. METHODS We conducted a retrospective cohort study among children born at a gestational age≥24weeks from January 1, 2010 to December 31, 2015 at Kaiser Permanente Northern California facilities (KPNC). We evaluated the association between maternal influenza vaccination during pregnancy and risk of preterm birth, small and large for gestational age, admission to the neonatal intensive care unit (NICU), respiratory distress syndrome, low birth weight, and low Apgar score. We ascertained the dates of maternal influenza vaccination, conception, and delivery, as well as birth outcomes from KPNC inpatient and outpatient databases. Conditional multivariate Cox regression and logistic regression analyses were used to determine the association between maternal vaccination during pregnancy and risk of each birth outcome. RESULTS The study included 145,869 children. Maternal influenza vaccination during pregnancy was not associated with risk of small or large for gestational age births, preterm birth, need for mechanical ventilation at birth, respiratory distress syndrome, admission to the NICU, low birth weight, or low Apgar score. However, when we did not control for immortal time bias, the risk of preterm birth (odds ratio [OR]=0.69, 95% confidence interval [CI] 0.66-0.72) was lower among infants of vaccinated mothers. CONCLUSION We found no association between maternal influenza vaccination during pregnancy and adverse birth outcomes. When investigating preterm birth outcome in association with vaccination during pregnancy, immortal time bias should be taken into account in the analysis.
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Affiliation(s)
- Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA.
| | - Sharareh Modaressi
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA
| | - Berwick Chan
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA
| | - Karin Bok
- National Vaccine Program Office, Office of the Assistant Secretary for Health, US Department of Health and Human Services, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA
| | - Roger Baxter
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16B, Oakland, CA 94612, USA
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