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Jobarteh ML, Saxena DB, Kulkarni B, Shah K, Banjara SK, Shah PA, Memon F, Chilumula M, Palepu DP, Selvaraj K, Dasi T, Madhari R, Calvo-Urbano B, Dockrell J, Antalek C, Davies-Kershaw H, Ferguson E, Heffernan C. Impact of SARS-CoV-2 infection and mitigation strategy during pregnancy on prenatal outcome, growth and development in early childhood in India: a UKRI GCRF Action Against Stunting Hub protocol paper. BMJ Paediatr Open 2024; 8:e001900. [PMID: 38417925 PMCID: PMC10900341 DOI: 10.1136/bmjpo-2023-001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/11/2023] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has offset some of the gains achieved in global health, particularly in relation to maternal, child health and nutrition. As pregnancy is a period of plasticity where insults acting on maternal environment have far-reaching consequences, the pandemic has had a significant impact on prenatal outcomes, intrauterine and postnatal development of infants. This research will investigate both the direct and indirect impacts of the COVID-19 pandemic during pregnancy on prenatal outcomes, growth and development in early childhood. METHODS AND ANALYSIS Community and hospital data in Hyderabad and Gujarat, India will be used to recruit women who were pregnant during the COVID-19 pandemic and contracted SARS-CoV-2 infection. In comparison with women who were pregnant around the same time and did not contract the virus, the study will investigate the impact of the pandemic on access to healthcare, diet, nutrition, mental health and prenatal outcomes in 712 women (356 per study arm). Children born to the women will be followed prospectively for an 18-month period to investigate the impact of the pandemic on nutrition, health, growth and neurocognition in early childhood. ETHICS AND DISSEMINATION Ethics approval was granted from the institutional ethics committees of the Indian Institute of Public Health Gandhinagar (SHSRC/2021/2185), Indian Council of Medical Research-National Institute of Nutrition (EC/NEW/INST/2021/1206), and London School of Hygiene and Tropical Medicine (72848). The findings of the study will be disseminated to policy and research communities through engagements, scientific conferences, seminars, and open-access, peer-reviewed publication.
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Affiliation(s)
- Modou Lamin Jobarteh
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Deepak B Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | - Bharati Kulkarni
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Komal Shah
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | | | - Priyanka Akshay Shah
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | - Farjana Memon
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | - Monica Chilumula
- Maternal and Child Health and Nutrition, National Institute of Nutrition, Hyderabad, India
| | | | - Kiruthika Selvaraj
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Teena Dasi
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Radhika Madhari
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Beatriz Calvo-Urbano
- Department of Pathobiology and Population Sciences, University of London, London, UK
| | - Julie Dockrell
- Faculty of Children and Learning, University of London Institute of Education, London, UK
| | - Catherine Antalek
- Faculty of Children and Health, University of London Institute of Education, London, UK
| | - Hilary Davies-Kershaw
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine Ferguson
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Claire Heffernan
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pathobiology and Population Sciences, London International Development Centre, London, UK
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2
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Razai MS, Mansour R, Goldsmith L, Freeman S, Mason-Apps C, Ravindran P, Kooner P, Berendes S, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott P. Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis. J Travel Med 2023; 30:taad138. [PMID: 37934788 PMCID: PMC10755181 DOI: 10.1093/jtm/taad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low. METHODS We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics. RESULTS From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations. CONCLUSIONS Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.
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Affiliation(s)
- Mohammad S Razai
- Population Health Research Institute, St George’s University of London, London, UK
| | - Rania Mansour
- Population Health Research Institute, St George’s University of London, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George’s University of London, London, UK
| | - Samuel Freeman
- Primary Care Unit, University Hospitals Sussex NHS Foundation Trust, Sussex, UK
| | - Charlotte Mason-Apps
- Population Health Research Institute, St George’s University of London, London, UK
| | - Pahalavi Ravindran
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | | | - Sima Berendes
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joan Morris
- Population Health Research Institute, St George’s University of London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sally Hargreaves
- Population Health Research Institute, St George’s University of London, London, UK
- The Migrant Health Research Unit, Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s University of London, London, UK
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3
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Lu L, Wang L, Feng T, Du X. Safety evaluation of COVID-19 vaccination during early pregnancy: A single-center prospective cohort study of Chinese pregnant women. Hum Vaccin Immunother 2023; 19:2226995. [PMID: 37462023 PMCID: PMC10355675 DOI: 10.1080/21645515.2023.2226995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
This prospective cohort study aimed to evaluate the safety of an inactivated coronavirus disease 2019 (COVID-19) vaccine in pregnant women at a tertiary hospital in Hubei, China. Pregnancy outcomes were compared between pregnant vaccinated and unvaccinated women. Composite adverse pregnancy outcomes were defined as one or more of maternal adverse outcomes (prenatal pyrexia, postpartum hemorrhage, maternal intensive care unit admission, and a prethrombotic state) and adverse neonatal outcomes (premature delivery, intrauterine fetal death or induction of labor, fetal macrosomia, fetal growth restriction, small-for-gestational age, fetal abnormalities, neonatal admission to the neonatal intensive care unit, and birth asphyxia). Of a total of 845 participants in the delivery cohort, 41.2% (348/845) received at least one dose of the COVID-19 vaccination, and 33.6% (284/845) received two doses. In total, 25.3% (88/348) of the vaccinated group were vaccinated at 0-4 weeks of pregnancy. No significant difference was found in the composite adverse outcomes between the vaccinated and unvaccinated participants, regardless of whether vaccination occurred before (44/243 [18.1%] vs. 71/497 [14.3%]; P = .17) or during early pregnancy (14/105 [13.3%] vs. 71/497[14.3%]; P = .79). These findings indicate that the pregnancy outcomes of women who received the COVID-19 vaccination, even if they were vaccinated early in pregnancy, were comparable to those of unvaccinated women. This study was registered with the Chinese Clinical Trial Center (ChiCTR2100051756).
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Affiliation(s)
- Ling Lu
- Department of Graduate School, Hubei University of Medicine, Shiyan, Hubei, P. R. China
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, P. R. China
| | - Lu Wang
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, P. R. China
| | - Tongfu Feng
- Department of School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, P. R. China
| | - Xin Du
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, P. R. China
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Bosworth ML, Schofield R, Ayoubkhani D, Charlton L, Nafilyan V, Khunti K, Zaccardi F, Gillies C, Akbari A, Knight M, Wood R, Hardelid P, Zuccolo L, Harrison C. Vaccine effectiveness for prevention of covid-19 related hospital admission during pregnancy in England during the alpha and delta variant dominant periods of the SARS-CoV-2 pandemic: population based cohort study. BMJ MEDICINE 2023; 2:e000403. [PMID: 37564827 PMCID: PMC10410807 DOI: 10.1136/bmjmed-2022-000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/18/2023] [Indexed: 08/12/2023]
Abstract
Objective To estimate vaccine effectiveness for preventing covid-19 related hospital admission in individuals first infected with the SARS-CoV-2 virus during pregnancy compared with those of reproductive age who were not pregnant when first infected with the virus. Design Population based cohort study. Setting Office for National Statistics Public Health Data Asset linked dataset, providing national linked census and administrative data in England, 8 December 2020 to 31 August 2021. Participants 815 477 females aged 18-45 years (mean age 30.4 years) who had documented evidence of a first SARS-CoV-2 infection in the NHS Test and Trace or Hospital Episode Statistics data. Main outcome measures Hospital admission where covid-19 was recorded as the primary diagnosis. Cox proportional hazards models, adjusted for calendar time of infection, sociodemographic factors, and pre-existing health conditions related to uptake of the covid-19 vaccine and risk of severe covid-19 outcomes, were used to estimate vaccine effectiveness as the complement of the hazard ratio for hospital admission for covid-19. Results Compared with pregnant individuals who were not vaccinated, the adjusted rate of hospital admission for covid-19 was 77% (95% confidence interval 70% to 82%) lower for pregnant individuals who had received one dose and 83% (76% to 89%) lower for those who had received two doses of vaccine. These estimates were similar to those found in the non-pregnant group: 79% (77% to 81%) for one dose and 83% (82% to 85%) for two doses of vaccine. Among those who were vaccinated >90 days before infection, having two doses of vaccine was associated with a greater reduction in risk than one dose. Conclusions Covid-19 vaccination was associated with reduced rates of hospital admission in pregnant individuals infected with the SARS-CoV-2 virus, and the reduction in risk was similar to that in non-pregnant individuals. Waning of vaccine effectiveness occurred more quickly after one than after two doses of vaccine.
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Affiliation(s)
| | | | - Daniel Ayoubkhani
- Office for National Statistics, Newport, UK
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kamlesh Khunti
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Clare Gillies
- Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Pia Hardelid
- NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Luisa Zuccolo
- Health Data Science Centre, Fondazione Human Technopole, Milan, Italy
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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5
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Zayyan S, Frise C. COVID-19 in pregnancy: A UK perspective. Obstet Med 2022; 15:216-219. [PMID: 36514793 PMCID: PMC8943486 DOI: 10.1177/1753495x221083134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 infection in pregnancy can cause respiratory and obstetric complications,1 however emerging evidence on its impact in pregnancy is limited. This article aims to review data collected and analysed so far over the course of the coronavirus pandemic, that examine demographic associations, patterns of disease, severity and outcomes of COVID-19 in pregnancy in the UK. Hospital admission, for which black and minority ethnic background and raised body mass index are risk factors, is associated with maternal mortality and admission to intensive care and is more likely in the late second or third trimester.2 Vaccination is safe in pregnancy3 and is protective against severe COVID-19 and admission to intensive care,4, 5 Maternal SARS CoV-2 is associated with a greater risk of stillbirth, preterm birth, small for gestational age (SGA) and preeclampsia.6 Efforts to reduce the incidence of COVID-19 in pregnancy, including vaccination, are therefore likely to reduce preventable complications from this disease.
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Affiliation(s)
- Sanaa Zayyan
- Oxford University Hospitals NHS Foundation
Trust, Oxford, UK,Sanaa Zayyan, John Radcliffe Hospital, Oxford, UK.
| | - Charlotte Frise
- Fetal Maternal Medicine Unit and Department of Acute and General Medicine,
Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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6
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Davies D, McDougall A, Prophete A, Sivashanmugarajan V, Yoong W. COVID-19 vaccination: patient uptake and attitudes in a multi-ethnic North London maternity unit. Postgrad Med J 2022; 98:750-755. [PMID: 37062992 DOI: 10.1136/pmj-2022-141829] [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: 04/10/2022] [Accepted: 08/07/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE COVID-19 vaccine uptake among pregnant women has been low, particularly in younger and ethnic minority mothers. We performed a 'snapshot' survey to explore vaccine uptake and factors which influence this, as well as underlying beliefs regarding COVID-19 vaccination among pregnant women in a North London hospital. STUDY DESIGN Pregnant women were invited to complete an anonymised survey, where data were collected on demographics, personal and household vaccination status, and beliefs about the vaccine. Free-text comments were analysed thematically. RESULTS Two hundred and two women completed the survey, of whom 56.9% (n=115) were unvaccinated and 43.1% (n=87) had received at least one dose of COVID-19 vaccine, with 35.6% (n=72) having received two doses. Factors associated with acceptance of vaccination included: (a) age over 25 years (57.6% vaccinated vs 17.2% under 25 years); (b) Asian ethnicity (69.4% vaccinated vs 41.2% white ethnicity, 27.5% black/Caribbean/African/black-British ethnicity and 12.5% mixed ethnicity) and (c) living in a vaccinated household (63.7% vaccinated vs 9.7% living in an unvaccinated household) (all p<0.001). Vaccine uptake was higher in women who had relied on formal medical advice as their main source of information compared with other sources (59.0% vs 37.5% friends and family, 30.4% news and 21.4% social media). Qualitative data revealed concerns about a lack of information regarding the safety of COVID-19 vaccination in pregnancy. CONCLUSION Age, ethnicity, household vaccination status and information source influenced vaccination status in our pregnant population. These findings highlight the urgent need to tackle vaccine mistrust and disseminate pregnancy-specific vaccine safety data to pregnant women. TRIAL REGISTRATION NUMBER 5467.
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Affiliation(s)
- Dorothy Davies
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - Anna McDougall
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
| | - Amelia Prophete
- St George's International School of Medicine, St George's, Grenada
| | | | - Wai Yoong
- Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UK
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7
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Briller JE, Aggarwal NR, Davis MB, Hameed AB, Malhamé I, Mahmoud Z, McDonald EG, Moraes de Oliveira G, Quesada O, Scott NS, Sharma J. Cardiovascular Complications of Pregnancy-Associated COVID-19 Infections. JACC: ADVANCES 2022; 1:100057. [PMID: 35967591 PMCID: PMC9364954 DOI: 10.1016/j.jacadv.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
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Bianchi FP, Stefanizzi P, Di Gioia MC, Brescia N, Lattanzio S, Tafuri S. COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines 2022; 21:1443-1454. [PMID: 35818804 DOI: 10.1080/14760584.2022.2100766] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pregnant and breastfeeding women are at an increased risk of severe illness from COVID-19. Despite this, low vaccination coverages are reported in this population sub-group. AREAS COVERED The purpose of this study is to estimate the proportion of pregnant and breastfeeding women expressing hesitation to the COVID-19 vaccine worldwide. Forty-six studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar, and Scopus databases between January 1, 2020 and February 6, 2022. The vaccine hesitation rate among pregnant and breastfeeding women was 48.4% (95%CI= 43.4-53.4%). In a sub analysis by study period, it was 40.0% (95%CI=31.6-46.6%) considering surveys administered in 2020, 58.0% (95%CI=48.9-66.9%) considering surveys administered in the first semester of 2021, and 38.1% (95%CI=25.9-51.2%) considering surveys administered in the second semester of 2021. The main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events. EXPERT OPINION Available evidence in the literature has shown that fighting vaccine resistance is harsh and too slow as a process, considering the rapidity and unpredictability of a pandemic. Health education should be provided in order to improve the willingness of the community, especially for those with lower levels of education.
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Affiliation(s)
| | | | | | - Nazario Brescia
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
| | - Sabrina Lattanzio
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari
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Ameratunga R. SARS-CoV-2 the ASIA virus (autoimmune/autoinflammatory syndrome induced by adjuvants), the risk of infertility and vaccine hesitancy. Expert Rev Vaccines 2022; 21:1177-1184. [PMID: 35695410 DOI: 10.1080/14760584.2022.2089120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION COVID-19 has had a calamitous impact on the global community. The current death toll far exceeds 6 million and large numbers of patients are experiencing long-term medical and psychiatric morbidity from the infection. The immunopathology of severe COVID-19 is now better understood. In severely affected patients, there is a chaotic, destructive immune response triggered by SARS-CoV-2, where autoimmunity features prominently. AREAS COVERED COVID-19 vaccines ensure a coordinated, balanced immune response to future SARS-CoV-2 infection. The rapid global deployment of effective COVID-19 vaccines has been hindered by financial, logistical and political barriers. Of concern is increasing vaccine hesitancy caused by unfounded conspiracy theories of vaccine adverse effects, often fueled by misinformation and disinformation on social media. EXPERT OPINION This perspective discusses the potential impact of the so-called autoimmune/autoinflammatory syndrome caused by adjuvants (ASIA) on COVID-19 vaccine uptake. Proponents of the ASIA syndrome have inappropriately linked infertility to HPV vaccines and have recently suggested antigenic cross-reactivity between SARS-CoV-2 and ovarian follicles. COVID-19 vaccines have also been linked to ASIA and unfounded fear of infertility is a leading cause of vaccine hesitancy. Vaccine hesitancy caused by spurious disorders such as ASIA are likely to harm individuals and delay global vaccination efforts leading to emergence of vaccine and monoclonal antibody resistant mutants, thereby prolonging the COVID-19 pandemic.
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Affiliation(s)
- Rohan Ameratunga
- Department of Clinical immunology, Auckland Hospital, Park Rd, Grafton, Auckland 1010, New Zealand.,Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland 1010, New Zealand.,Department of Molecular Medicine and Pathology, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland
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10
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Abstract
SARS-CoV-2 infection poses increased risks of poor outcomes during pregnancy, including preterm birth and stillbirth. There is also developing concern over the effects of SARS-CoV-2 infection on the placenta, and these effects seem to vary between different viral variants. Despite these risks, many pregnant individuals have been reluctant to be vaccinated against the virus owing to safety concerns. We now have extensive data confirming the safety and effectiveness of COVID-19 vaccination during pregnancy, although it will also be necessary to determine the effectiveness of these vaccines specifically against newly emerging viral variants, including Omicron. In this Progress article, I cover recent developments in our understanding of the risks of SARS-CoV-2 infection in pregnancy, and how vaccination can reduce these.
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Affiliation(s)
- Victoria Male
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
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11
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Stock SJ, Harmer C, Calvert C. Covid-19 variants of concern and pregnancy. BMJ MEDICINE 2022; 1:e000151. [PMID: 36936592 PMCID: PMC9951363 DOI: 10.1136/bmjmed-2022-000151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Sarah J Stock
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Clara Calvert
- University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
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12
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Engjom HM, Ramakrishnan R, Vousden N, Bunch K, Morris E, Simpson NAB, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Severity of maternal SARS-CoV-2 infection and perinatal outcomes of women admitted to hospital during the omicron variant dominant period using UK Obstetric Surveillance System data: prospective, national cohort study. BMJ MEDICINE 2022; 1:e000190. [PMID: 36936599 PMCID: PMC10012856 DOI: 10.1136/bmjmed-2022-000190] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
Objectives To describe the severity of maternal infection when the omicron SARS-CoV-2 variant (B.1.1.529) was dominant (15 December 2021 to 14 March 2022) and describe outcomes by symptoms and vaccination status. Design Prospective, national cohort study using the UK Obstetric Surveillance System. Setting 94 hospitals in the UK with a consultant led maternity unit. Participants Pregnant women admitted to hospital for any cause with a positive SARS-CoV-2 test. Main outcome measures Symptomatic or asymptomatic infection, vaccination status by doses before admission, and severity of maternal infection (moderate or severe infection according to modified World Health Organization's criteria). Results Of 3699 women who were admitted to hospital, 986 (26.7%, 95% confidence interval 25.3% to 28.1%) had symptoms; of these, 144 (14.6%, 12.5% to 17.0%) had a moderate to severe infection, 99 (10.4%, 8.6% to 12.5%) of 953 received respiratory support, and 30 (3.0%, 2.1% to 4.3%) were admitted to an intensive care unit. Covid-19 specific drug treatment was given to 13 (43.3%) of the 30 women in intensive care. Four women with symptoms died (0.4%, 0.1% to 1.1%). Vaccination status was known for 845 (85.6%) women with symptoms; 489 (58.9%) were unvaccinated and only 55 (6.5%) had three doses. Moderate to severe infection was reported for 93 (19.0%) of 489 unvaccinated women with symptoms, decreasing to three (5.5%) of 55 after three doses. Among the 30 women with symptoms who were admitted to intensive care, 23 (76.7%) were unvaccinated and none had received three doses. Conclusion Most women with severe covid-19 disease were unvaccinated and vaccine coverage among pregnant women admitted to hospital with SARS-CoV-2 was low. Ongoing action to prioritise and advocate for vaccine uptake in pregnancy is essential. A better understanding of the persistent low use of drug treatments is an urgent priority. Trial registration ISRCTN 40092247.
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Affiliation(s)
- Hilde M Engjom
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Bergen, Norway
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Eddie Morris
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- Royal College of Obstetricians and Gynaecologists, London, London, UK
| | - Nigel A B Simpson
- Department of Women’s & Children’s Health, University of Leeds, Leeds, West Yorkshire, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Patrick O'Brien
- Royal College of Obstetricians and Gynaecologists, London, London, UK
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, West Midlands, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK
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