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Figueroa-Romero A, Atchadé A, Yadouleton A, Fiogbe M, Bonnet E, Yovo E, Accrombessi M, Hounsa S, Paper T, Dupont R, Gaudart J, Le Hesran JY, Massougbodji A, Cottrell G, González R. SARS-CoV-2 seroprevalence among Beninese pregnant women in the third year of the pandemic. BMC Public Health 2024; 24:1762. [PMID: 38956517 PMCID: PMC11221113 DOI: 10.1186/s12889-024-19087-4] [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: 01/03/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Pregnant women are a vulnerable population to COVID-19 given an increased susceptibility to severe SARS-CoV-2 infection and pregnancy complications. However, few SARS-CoV-2 serological surveys have been performed among this population to assess the extent of the infection in sub-Saharan countries. The objectives of this study were to determine SARS-CoV-2 seroprevalence among Beninese pregnant women, to identify spatial seropositivity clusters and to analyse factors associated with the infection. METHODS A cross-sectional study including women in their third trimester of pregnancy attending the antenatal care (ANC) clinics at Allada (south Benin) and Natitingou (north Benin) was conducted. Rapid diagnostic tests (RDT) for detection of IgG/IgM against the SARS-CoV-2 spike protein were performed using capillary blood. Seroprevalence of SARS-CoV-2 antibodies and associations between SARS-CoV-2 serostatus and maternal characteristics were analyzed by multivariate logistic regression. Spatial analyses were performed using the spatial scan statistics to identify spatial clusters of SARS-CoV-2 infection. RESULTS A total of 861 pregnant women were enrolled between May 4 and June 29, 2022. 58/861 (6.7%) participants reported having received COVID-19 vaccine. None of the participants had been diagnosed with COVID-19 during their pregnancy. SARS-CoV-2 antibodies were detected in 607/802 (75.7%; 95% CI 72.56%-78.62%) of unvaccinated participants. Several urban and rural spatial clusters of SARS-CoV-2 cases were identified in Allada and one urban spatial cluster was identified in Natitingou. Unvaccinated participants from Allada with at least one previous morbidity were at a three-times higher risk of presenting SARS-CoV-2 antibodies (OR = 2.89; 95%CI 1.19%-7.00%). CONCLUSION Three out of four pregnant women had SARS-CoV-2 antibodies, suggesting a high virus circulation among pregnant women in Benin, while COVID-19 vaccination coverage was low. Pregnant women with comorbidities may be at increased risk of SARS-CoV-2 infection. This population should be prioritized for COVID-19 diagnosis and vaccination in order to prevent its deleterious effects. TRIAL REGISTRATION NCT06170320 (retrospectively registered on December 21, 2023).
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Affiliation(s)
- Antía Figueroa-Romero
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain.
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
| | - Aurore Atchadé
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Anges Yadouleton
- Laboratoire des fièvres hémorragiques virales du Bénin, Ministère de la Santé du Bénin, Cotonou, 01BP918, Bénin
| | - Marc Fiogbe
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Emmanuel Bonnet
- Institut de recherche pour le développement PRODIG UMR 215, CNRS Université Paris 1 Panthéon- Sorbonne, AgroParisTech 5, cours des Humanités, Aubervilliers, Île-de-France, F-93 322, France
| | - Emmanuel Yovo
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Manfred Accrombessi
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
- Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene & Tropical Medicine, London, UK
- Population Services International, Malaria Department, Country-Based Global Employee, Cotonou, Benin
| | - Sandrine Hounsa
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Thierry Paper
- Biosynex S.A, 22 boulevard Sebastien Brant, Illkirch Graffenstaden, Strasbourg, F-67400, France
| | - Raphael Dupont
- Biosynex S.A, 22 boulevard Sebastien Brant, Illkirch Graffenstaden, Strasbourg, F-67400, France
| | - Jean Gaudart
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, AP-HM, Hop La Timone, BioSTIC, Biostatistic and ICT, Marseille, France
| | - Jean-Yves Le Hesran
- Institut de Recherche pour le Développement, MERIT UMR216, Université Paris-Cité, Faculté de pharmacie, laboratoire de parasitologie, Paris, France
| | | | - Gilles Cottrell
- Institut de Recherche pour le Développement, MERIT UMR216, Université Paris-Cité, Faculté de pharmacie, laboratoire de parasitologie, Paris, France
| | - Raquel González
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
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To T, Zhu J, Terebessy E, Borkhoff CM, Gershon AS, Kendzerska T, Pakhale SS, Vozoris NT, Zhang K, Licskai C. Mode of delivery and birth outcomes before and during COVID-19 -A population-based study in Ontario, Canada. PLoS One 2024; 19:e0303175. [PMID: 38728292 PMCID: PMC11086824 DOI: 10.1371/journal.pone.0303175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
There is lack of clarity on whether pregnancies during COVID-19 resulted in poorer mode of delivery and birth outcomes in Ontario, Canada. We aimed to compare mode of delivery (C-section), birth (low birthweight, preterm birth, NICU admission), and health services use (HSU, hospitalizations, ED visits, physician visits) outcomes in pregnant Ontario women before and during COVID-19 (pandemic periods). We further stratified for pre-existing chronic diseases (asthma, eczema, allergic rhinitis, diabetes, hypertension). Deliveries before (Jun 2018-Feb 2020) and during (Jul 2020-Mar 2022) pandemic were from health administrative data. We used multivariable logistic regression analyses to estimate adjusted odds ratios (aOR) of delivery and birth outcomes, and negative binomial regression for adjusted rate ratios (aRR) of HSU. We compared outcomes between pre-pandemic and pandemic periods. Possible interactions between study periods and covariates were also examined. 323,359 deliveries were included (50% during pandemic). One in 5 (18.3%) women who delivered during the pandemic had not received any COVID-19 vaccine, while one in 20 women (5.2%) lab-tested positive for COVID-19. The odds of C-section delivery during the pandemic was 9% higher (aOR = 1.09, 95% CI: 1.08-1.11) than pre-pandemic. The odds of preterm birth and NICU admission were 15% (aOR = 0.85, 95% CI: 0.82-0.87) and 10% lower (aOR = 0.90, 95% CI: 0.88-0.92), respectively, during COVID-19. There was a 17% reduction in ED visits but a 16% increase in physician visits during the pandemic (aRR = 0.83, 95% CI: 0.81-0.84 and aRR = 1.16, 95% CI: 1.16-1.17, respectively). These aORs and aRRs were significantly higher in women with pre-existing chronic conditions. During the pandemic, healthcare utilization, especially ED visits (aRR = 0.83), in pregnant women was lower compared to before. Ensuring ongoing prenatal care during the pandemic may reduce risks of adverse mode of delivery and the need for acute care during pregnancy.
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Affiliation(s)
- Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
| | - Jingqin Zhu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
| | - Emilie Terebessy
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea S. Gershon
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- ICES, Ontario, Canada
- Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Smita S. Pakhale
- Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas T. Vozoris
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kimball Zhang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
| | - Christopher Licskai
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Bednarek A, Laskowska M. Vaccination Guidelines for Pregnant Women: Addressing COVID-19 and the Omicron Variant. Med Sci Monit 2024; 30:e942799. [PMID: 38229424 PMCID: PMC10802082 DOI: 10.12659/msm.942799] [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: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 01/18/2024] Open
Abstract
Vaccinations are an essential element of public health programs around the world, which have a major impact on morbidity, mortality, and costs of the health care system. In recent years, with a better understanding of the effectiveness and safety of vaccinations, many recommendations have been developed for administering vaccines to adults. Countless physiological changes occur during pregnancy, including those affecting the immune system. Pregnant women are at increased risk of developing infections and resulting complications. According to research, vaccines are immunogenic and safe for pregnant women. Pregnancy is not an absolute contraindication to vaccination. After administration of vaccines to pregnant women, the concentration of antibodies increases, which can be transferred to the child in the second and third trimesters of pregnancy and provide protection in the first months of life. The Advisory Committee on Immunization Practices (ACIP), guidelines of the Centers for Disease Control and Prevention (CDC), and the American College of Obstetrics and Gynecology (ACOG) unanimously recommend vaccination of pregnant women if a safe vaccine is available and there is a risk of exposure of the woman to a disease that threatens herself or her developing baby. In everyday clinical practice, medical professionals should provide their patients with the necessary information on vaccinations, which may contribute to greater awareness and implementation of vaccinations. This article aims to review current global recommendations for the vaccination of pregnant and breastfeeding women, including against the Omicron variants of SARS-CoV-2.
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Affiliation(s)
- Anna Bednarek
- Department of Health Promotion, Chair of Nursing Development, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Marzena Laskowska
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland
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Wei CR, Kamande S, Lang'at GC. Vaccine inequity: a threat to Africa's recovery from COVID-19. Trop Med Health 2023; 51:69. [PMID: 38111032 PMCID: PMC10729430 DOI: 10.1186/s41182-023-00564-2] [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: 08/09/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Vaccine inequity is a reality facing the Sub-Saharan Africa region as vaccine nationalism from high-income countries (HICs) leads to limited access to the lifesaving vaccines needed to end the pandemic. In Africa, a significant portion of the population has yet to be vaccinated against Covid-19; however, the barriers to accessing such vaccines, including capacity challenges, still persist despite the implementation of the COVAX facility meant to support the lower- and middle-income countries (LMICs) to boost vaccination. METHODS This study involved a systemic narrative review where literature search was conducted using the NCBI's PMC and BMC databases based on defined keywords. Three authors were involved in the literature search and consensus was applied to settle disagreements and validate the findings. RESULTS In this systematic narrative review, we report that vaccine nationalism remains a challenge for LMICs as HICs still hoard vaccines and even bypass COVAX to procure doses directly from the manufacturers. Factors that promote vaccine hesitancy in Africa include misinformation regarding the Covid-19 vaccine, a lack of trust in politicians and the pharmaceutical industry, and concerns about vaccine safety and efficacy. The policies implemented to enhance vaccine coverage in Africa, such as mandates, community engagement, and partnerships, all seek to promote equity of vaccination and ending Covid-19. CONCLUSION Covid-19 vaccine inequity persists and contributes to prolonged pandemic in LMICs. In response, African governments have taken certain measures to enhance vaccine uptake but more needs to be done to address resistance to vaccines.
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Affiliation(s)
- Calvin R Wei
- Department of Research and Development, Shing Huei Group, Taipei, Taiwan
| | | | - Godwin C Lang'at
- Department of Public and Global Health, University of Nairobi, Nairobi, Kenya.
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Limaye RJ, Fesshaye B, Singh P, Zavala E, Akter S, Siddiqua TJ, Rahman H, Ali H, Karron R. COVID-19 vaccine eligibility of pregnant and lactating women in Bangladesh: Gap between policy and policy interpretation among policymakers and healthcare workers. Vaccine X 2023; 15:100370. [PMID: 37589020 PMCID: PMC10425672 DOI: 10.1016/j.jvacx.2023.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
SARS-CoV-2 infection in pregnancy is associated with a greater risk of maternal and newborn morbidity and maternal death. Bangladesh confirmed its first COVID-19 case in March of 2020, and vaccination rollout started in January of 2021. In Bangladesh, pregnant women are allowed to receive COVID-19 vaccines during pregnancy with qualifications while lactating women are permitted to receive COVID-19 vaccines with no qualifications as of October 2021. There is limited evidence on how vaccine policies are disseminated, interpreted, and implemented from the national level to the community level in Bangladesh. We conducted in-depth interviews from April-August 2022 with policymakers and healthcare workers in Bangladesh to understand how different stakeholders understood and implemented COVID-19 vaccination policies related to pregnant and lactating women. We interviewed policymakers at three levels: national, divisional, and district, and interviewed healthcare workers from one one urban and three rural communities within one division. We found a gap between policies related to COVID-19 vaccination for pregnant and lactating women and policy interpretation among policymakers and healthcare workers. Policymakers and healthcare workers' perceptions differed related to policy dissemination, attitudes toward policies related to pregnant and lactating women, and eligibility of pregnant and lactating women. Our findings indicate the need for effective dissemination of and understanding of policies. Within the context of vaccine uptake and vaccine acceptance, policymakers play a critical role as they are charged with developing and disseminating policy related to vaccine eligibility. Healthcare workers rely on timely and accurate communication related to vaccine eligibility, including populations, timing, and locations. Efforts are needed to narrow the policy and policy implementation gap as doing so is crucial to controlling vaccine preventable disease.
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Affiliation(s)
- Rupali J. Limaye
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior & Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Berhaun Fesshaye
- International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prachi Singh
- International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eleonor Zavala
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shirina Akter
- JiVitA Project, Johns Hopkins University, Rangpur, Bangladesh
| | | | - Hafizur Rahman
- JiVitA Project, Johns Hopkins University, Rangpur, Bangladesh
| | - Hasmot Ali
- JiVitA Project, Johns Hopkins University, Rangpur, Bangladesh
| | - Ruth Karron
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Jorgensen SCJ, Drover SSM, Fell DB, Austin PC, D’Souza R, Guttmann A, Buchan SA, Wilson SE, Nasreen S, Schwartz KL, Tadrous M, Wilson K, Kwong JC. Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy. JAMA Pediatr 2023; 177:1314-1323. [PMID: 37870875 PMCID: PMC10594175 DOI: 10.1001/jamapediatrics.2023.4499] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/12/2023] [Indexed: 10/24/2023]
Abstract
Importance The study team previously showed that maternal mRNA COVID-19 vaccination during pregnancy confers protection against SARS-CoV-2 infection and COVID-19-related hospital admission in newborns and young infants. In this study, the study team evaluated newborn and early infant safety outcomes following maternal messenger RNA (mRNA) COVID-19 vaccination during pregnancy, for which there is limited comparative epidemiological evidence. Objective To determine if maternal mRNA COVID-19 vaccination during pregnancy is associated with adverse newborn and early infant outcomes. Design, Setting, and Participants This population-based retrospective cohort study took place in Ontario, Canada, using multiple linked health administrative databases. Singleton live births with an expected delivery date between May 1, 2021, and September 2, 2022, were included. Data were analyzed from January 2023 through March 2023. Exposure Maternal mRNA COVID-19 vaccination (1 or more doses) during pregnancy. Main Outcomes and Measures Severe neonatal morbidity (SNM), neonatal death, neonatal intensive care unit (NICU) admission, neonatal readmission, and hospital admission up to 6 months of age. The study team calculated inverse probability of treatment weighted risk ratios (RRs) and fit weighted Cox proportional hazards regression models comparing outcomes in infants of mothers who received COVID-19 vaccination during pregnancy with those who received no COVID-19 vaccine doses before delivery. Results In total, 142 006 infants (72 595 male [51%]; mean [SD] gestational age at birth, 38.7 [1.7] weeks) were included; 85 670 were exposed to 1 or more COVID-19 vaccine doses in utero (60%). Infants of vaccinated mothers had lower risks of SNM (vaccine exposed 7.3% vs vaccine unexposed 8.3%; adjusted RR [aRR], 0.86; 95% CI, 0.83-0.90), neonatal death (0.09% vs 0.16%; aRR, 0.47; 95% CI, 0.33-0.65), and NICU admission (11.4% vs 13.1%; aRR, 0.86; 95% CI, 0.83-0.89). There was no association between maternal vaccination during pregnancy and neonatal readmission (5.5% vs 5.1%; adjusted hazard ratio, 1.03; 95% CI, 0.98-1.09) or 6-month hospital admission (8.4% vs 8.1%; adjusted hazard ratio, 1.01; 95% CI, 0.96-1.05). Conclusions and Relevance In this population-based cohort study in Ontario, Canada, maternal mRNA COVID-19 vaccination during pregnancy was associated with lower risks of SNM, neonatal death, and NICU admission. In addition, neonatal and 6-month readmissions were not increased in infants of mothers vaccinated during pregnancy.
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Affiliation(s)
- Sarah C. J. Jorgensen
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deshayne B. Fell
- ICES, Toronto, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Peter C. Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D’Souza
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
- The Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah A. Buchan
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E. Wilson
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Sharifa Nasreen
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kevin L. Schwartz
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Mina Tadrous
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Hospital Research Institutes, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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Gwak E, Kim T, Shin JY, Choi NK, Han S, Lee JY, Choe YJ, Choe SA. Effectiveness and Safety of COVID-19 Vaccination During Preconceptional and Preclinical Pregnancy Period: A National Population Study. J Korean Med Sci 2023; 38:e314. [PMID: 37873626 PMCID: PMC10593595 DOI: 10.3346/jkms.2023.38.e314] [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: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND We aimed to assess the risk of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and early abortive outcomes after the association between coronavirus disease 2019 (COVID-19) vaccination during the preconceptional period and preclinical pregnancy, which are likely to be inadvertent vaccination. METHODS We used data from the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort from December 2020 to December 2021. The vaccinated pregnant women were matched to unvaccinated pregnant controls at a 1:4 ratio. The risks of SARS-CoV-2 infection and intensive care unit (ICU) admission within 14 days of infection were analyzed to assess its effectiveness. For safety measures, the adjusted relative risks (aRRs) of early abortive outcomes for the first COVID-19 vaccination during the preconceptional and preclinical periods were calculated considering covariates. We compared the risk of early abortion between mRNA and viral vector vaccines. RESULTS The overall COVID-19 vaccination rates during the preconceptional period and preclinical pregnancy were 3.1% (6,662/215,211) and 2.6% (5,702/215,211), respectively. The cumulative incidence of ICU admission within 14 days of SARS-CoV-2 infection was 6/100,000 in the unvaccinated group, whereas there were no ICU admissions in the vaccinated groups. The risks of early abortive outcomes were not significantly different between the preconceptional vaccination group and the unvaccinated group (aRR, 1.04; 95% confidence interval [CI],0.99-1.10) or between preclinical pregnancy vaccination and their matched controls (1.02; 95% CI, 0.96-1.08). mRNA and viral vector vaccines have shown similar risks for early abortive outcomes and miscarriages. CONCLUSION Our findings have provided compelling evidence regarding the effectiveness and safety of COVID-19 vaccination prior to and during early pregnancy. Further research is required to extend the safety and efficacy profiles of COVID-19 vaccines to pregnant women and their babies.
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Affiliation(s)
- Eunseon Gwak
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Taemi Kim
- Department of Public Health, Korea University, Seoul, Korea
| | - Ju-Young Shin
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Korea
| | - Seungbong Han
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Department of Obstetrics & Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
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Manca TA, Top KA, Graham JE. COVID-19 vaccination in pregnancy: How discrepant public health discourses shape responsibility for fetal health. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100265. [PMID: 37069999 PMCID: PMC10084631 DOI: 10.1016/j.ssmqr.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/16/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023]
Abstract
Early in COVID-19 vaccine rollout, expert recommendations about vaccination while pregnant and breastfeeding changed rapidly. This paper addresses the (re)production of gendered power relations in these expert discourses and recommendations in Canada. We collected texts about COVID-19 vaccine use in pregnancy (N = 52) that Canadian health organizations (e.g., professional societies, advisory groups, health authorities) and vaccine manufacturers made publicly available online. A discourse analysis was undertaken to investigate intertextuality (relations between texts), social construction (incorporation of assumptions about gender), and contradictions between and within texts. National expert recommendations varied in stating COVID-19 vaccines are recommended, should be offered, or may be offered, while manufacturer texts consistently stated there was no evidence. Provincial and territorial texts reproduced discrepancies between the Society of Obstetricians and Gynaecologists of Canada and National Advisory Committee on Immunization recommendations, including that COVID-19 vaccines should be versus may be offered in pregnancy. Our findings suggest gaps in data and discrepant COVID-19 vaccine recommendations, eligibility, and messaging limit guidance regarding vaccination in pregnancy. We argue that these discrepancies magnified the already common practice of deferring responsibility for the uncertainties of vaccination in pregnancy onto parents and healthcare providers. The deferral of responsibility could be reduced by harmonizing recommendations, regularly updating texts that describe evidence and recommendations, and prioritizing research into disease burden, vaccine safety, and efficacy before vaccine rollout.
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Affiliation(s)
- T A Manca
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta, T9S 3A3, Canada
- Department of Sociology and Social Anthropology, Dalhousie University, Room 1128, Marion McCain Arts and Social Sciences Building, Halifax, Nova Scotia, B3H 4R2, Canada
| | - K A Top
- Department of Pediatrics (Infectious Diseases), Dalhousie University, 5850 University Avenue, P. O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada
| | - J E Graham
- Department of Pediatrics (Infectious Diseases), Dalhousie University, 5850 University Avenue, P. O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada
- Technoscience & Regulation Research Unit, Faculty of Medicine, 5849 University Avenue, C-301, Halifax, NS, B3H 4H7, Canada
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9
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Goruntla N, Karisetty B, Nandini N, Bhupasamudram B, Gangireddy HR, Veerabhadrappa KV, Ezeonwumelu JOC, Bandaru V. Adverse events following COVID-19 vaccination among pregnant women attending primary health centers: An active-surveillance study. VACUNAS 2023:S1576-9887(23)00037-7. [PMID: 37362835 PMCID: PMC10192595 DOI: 10.1016/j.vacun.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/28/2023]
Abstract
Introduction Vaccine safety is a major barrier to the uptake of the COVID-19 vaccine by pregnant women. To bring confidence among pregnant women towards vaccine intake, there is a need to synthesize evidence on safety profile of vaccination. Objective To assess adverse events (AEs) following COVID-19 vaccination among pregnant women. Materials and methods A vaccine safety surveillance was conducted at 2 rural primary health centers (PHC) located in Anantapur District, India. A total of 420 pregnant women were monitored for AEs following COVID-19 vaccination for a period of 30 min and followed for 1 month for late reactions through telephonic interviews. All AEs were subjected to causality and severity assessment. Descriptive statistics were used to represent adverse events. Results The COVID-19 vaccine acceptance rate among pregnant women was 64.4%. A total of 420 pregnant women received 670 vaccine doses (Covishield = 372, Covaxin = 298) against COVID-19. Majority of vaccine intake was observed during the second trimester. The incidence rate of AEs following the COVID-19 vaccine among pregnant women was 93.8%, and the majority include injection site pain (28.4%, 29.6%), fever (25.5%, 19.0%), myalgia (8.21%, 12.3%), and malaise (13.6%, 8.4%). Most AEs notified are probable and mild in nature. Conclusion The COVID-19 vaccine acceptance rate among pregnant women was 64.4%. A 30 days incidence rate of AEs following COVID-19 vaccination among pregnant women was 93.8%, with the most common mild events like injection site pain, and fever. A further follow-up cohort study by taking an adequate sample size was recommended to capture fetal-maternal outcomes.
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Affiliation(s)
- Narayana Goruntla
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Kampala International University, Western Campus, Uganda
| | - Basappa Karisetty
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) - Autonomous, Anantapur, Andhra Pradesh, India
| | - Nandini Nandini
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) - Autonomous, Anantapur, Andhra Pradesh, India
| | - Bharadwaj Bhupasamudram
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) - Autonomous, Anantapur, Andhra Pradesh, India
| | - Himaja Reddy Gangireddy
- Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical Education and Research (RIPER) - Autonomous, Anantapur, Andhra Pradesh, India
| | | | | | - Vishnuvandana Bandaru
- Department of Pharmaceutical Analysis, Balaji College of Pharmacy, Anantapur, Andhra Pradesh, India
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10
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Juliá-Burchés C, Martínez-Varea A. An Update on COVID-19 Vaccination and Pregnancy. J Pers Med 2023; 13:jpm13050797. [PMID: 37240967 DOI: 10.3390/jpm13050797] [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: 03/27/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Pregnant women are more prone to experience severe COVID-19 disease, including intensive care unit (ICU) admission, use of invasive ventilation, extracorporeal membrane oxygenation (ECMO), and mortality compared to non-pregnant individuals. Additionally, research suggests that SARS-CoV-2 infection during pregnancy is linked to adverse pregnancy outcomes, such as preterm birth, preeclampsia, and stillbirth, as well as adverse neonatal outcomes, including hospitalization and admission to the neonatal intensive care unit. This review assessed the available literature from November 2021 to 19 March 2023, concerning the safety and effectiveness of COVID-19 vaccination during pregnancy. COVID-19 vaccination administered during pregnancy is not linked to significant adverse events related to the vaccine or negative obstetric, fetal, or neonatal outcomes. Moreover, the vaccine has the same effectiveness in preventing severe COVID-19 disease in pregnant individuals as in the general population. Additionally, COVID-19 vaccination is the safest and most effective method for pregnant women to protect themselves and their newborns from severe COVID-19 disease, hospitalization, and ICU admission. Thus, vaccination should be recommended for pregnant patients. While the immunogenicity of vaccination in pregnancy appears to be similar to that in the general population, more research is needed to determine the optimal timing of vaccination during pregnancy for the benefit of the neonate.
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Affiliation(s)
- Cristina Juliá-Burchés
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
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11
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Davies B, Olivier J, Amponsah-Dacosta E. Health Systems Determinants of Delivery and Uptake of Maternal Vaccines in Low- and Middle-Income Countries: A Qualitative Systematic Review. Vaccines (Basel) 2023; 11:vaccines11040869. [PMID: 37112781 PMCID: PMC10144938 DOI: 10.3390/vaccines11040869] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Maternal vaccination is considered a key component of the antenatal care package for improving maternal and child health. Low- and middle-income countries (LMICs) fall short of global targets to prevent maternal and neonatal deaths, with a disproportionate burden of vaccine-preventable diseases. Strategies towards ending preventable maternal mortality necessitate a health systems approach to adequately respond to this burden. This review explores the health systems determinants of delivery and uptake of essential maternal vaccines in LMICs. We conducted a qualitative systematic review of articles on maternal vaccination in LMICs, published between 2009 and 2023 in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thematic analysis was conducted to identify key themes in the literature, interpreted within a conceptual framing that explores the systems determinants influencing maternal vaccines. Our search yielded 1309 records, of which 54 were included, covering 34 LMICs. Most of the included studies were from South America (28/54) and included pregnant women as the primary study population (34/54). The studies explored influenza (25/54) and tetanus toxoid (20/54) vaccines predominantly. The findings suggest that systems hardware (lack of clear policy guidelines, ineffective cold-chain management, limited reporting and monitoring systems) are barriers to vaccine delivery. Systems software (healthcare provider recommendations, increased trust, higher levels of maternal education) are enablers to maternal vaccine uptake. Findings show that formulation, dissemination and communication of context-specific policies and guidelines on maternal vaccines should be a priority for decision-makers in LMICs.
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Affiliation(s)
- Bronte Davies
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
- Vaccines for Africa Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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12
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Akinosoglou K, Schinas G, Rigopoulos EA, Polyzou E, Tzouvelekis A, Adonakis G, Gogos C. COVID-19 Pharmacotherapy in Pregnancy: A Literature Review of Current Therapeutic Choices. Viruses 2023; 15:787. [PMID: 36992497 PMCID: PMC10054527 DOI: 10.3390/v15030787] [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: 02/22/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
The clinical management of COVID-19 in pregnant women, who are considered a vulnerable population, remains uncertain even as the pandemic subsides. SARS-CoV-2 affects pregnant individuals in multiple ways and has been associated with severe maternal morbidity and mortality, as well as neonatal complications. The unique anatomy and physiology of gestation make managing COVID-19 in this population a complex and challenging task, emphasizing the importance of spreading knowledge and expertise in this area. Therapeutic interventions require distinct clinical consideration, taking into account differences in pharmacokinetics, vertical transmission, drug toxicities, and postnatal care. Currently, there is limited data on antiviral and immunomodulating COVID-19 pharmacotherapy in pregnancy. Some medication has been shown to be safe and well tolerated among pregnant women with COVID-19; however, the lack of randomized clinical trials and studies in this patient population is evident. Available vaccines are considered safe and effective, with no evidence of harm to the fetus, embryo development, or short-term postnatal development. Pregnant women should be counseled about the risks of SARS-CoV-2 infection and informed of available ways to protect themselves and their families. Effective treatments for COVID-19 should not be withheld from pregnant individuals, and more research is needed to ensure the best outcomes.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Department of Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
- Division of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - Georgios Schinas
- Department of Medicine, University of Patras, 26504 Patras, Greece
| | | | - Eleni Polyzou
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Division of Internal Medicine, University General Hospital of Patras, 26504 Patras, Greece
| | - Argyrios Tzouvelekis
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Department of Pulmonology, University General Hospital of Patras, 26504 Patras, Greece
| | - George Adonakis
- Department of Medicine, University of Patras, 26504 Patras, Greece
- Department of Obstetrics and Gynecology, University General Hospital of Patras, 26504 Patras, Greece
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13
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Ahmed AK, Sijercic VC, Sayad R, Ruthig GR, Abdelwahab SF, El-Mokhtar MA, Sayed IM. Risks and Preventions for Pregnant Women and Their Preterm Infants in a World with COVID-19: A Narrative Review. Vaccines (Basel) 2023; 11:640. [PMID: 36992224 PMCID: PMC10056995 DOI: 10.3390/vaccines11030640] [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: 01/29/2023] [Revised: 03/05/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
(1) Background and Aim: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is linked to increasing cases of coronavirus disease 2019 (COVID-19) around the world. COVID-19 infections have an important impact on pregnancy, preterm birth (PTB) and delivery. Although several complications have been reported in infected pregnant women, the effect of infection on PTB is controversial. The purpose of this study was to summarize the existing literature on the effects and complications of COVID-19 on the health of pregnant women and preterm babies and its impact on the incidence of PTB. We also discuss the effect of current COVID-19 vaccines during pregnancy. (2) Methods: We carried out a systematic search of MEDLINE, Embase, and PubMed for studies on preterm births associated with COVID-19. (3) Results and Conclusions: We discovered contradictory results regarding the prevalence of PTB during the pandemic compared to earlier years. While most studies indicated an increase in PTBs with COVID-19, some indicated a decline in the preterm delivery rate during this time. During pregnancy, COVID-19 infection can increase the incidence of cesarean section, stillbirth, ICU admission, preeclampsia/eclampsia, and mortality rates. In the treatment of pregnant women with severe COVID-19, methylprednisolone was favored over prednisolone, and a brief course of dexamethasone is advised for pregnant women with anticipated PTB to accelerate the development of the fetal lung. Generally, vaccination for COVID-19 in pregnant and lactating women stimulates anti-SARS-CoV2 immune responses, and it does not result in any noteworthy negative reactions or outcomes for the mother or baby.
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Affiliation(s)
| | | | - Reem Sayad
- Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Gregory R. Ruthig
- Department of Biology, North Central College, Naperville, IL 60540, USA
| | - Sayed F. Abdelwahab
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Mohamed A. El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Microbiology and Immunology Department, Faculty of Pharmacy, Sphinx University, Assiut 71515, Egypt
| | - Ibrahim M. Sayed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
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14
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Fell DB, Török E, Sprague AE, Regan AK, Dhinsa T, Alton GD, Dimanlig-Cruz S, MacDonald SE, Buchan SA, Kwong JC, Wilson SE, Håberg SE, Gravel CA, Wilson K, Dunn SI, Shah PS, El-Chaâr D, Barrett J, Walker MC, Okun N, Dougan SD. Temporal trends and determinants of COVID-19 vaccine coverage and series initiation during pregnancy in Ontario, Canada, December 2020 to December 2021: A population-based retrospective cohort study. Vaccine 2023; 41:1716-1725. [PMID: 36759282 PMCID: PMC9894778 DOI: 10.1016/j.vaccine.2023.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Population-based COVID-19 vaccine coverage estimates among pregnant individuals are limited. We assessed temporal patterns in vaccine coverage (≥1 dose before or during pregnancy) and evaluated factors associated with vaccine series initiation (receiving dose 1 during pregnancy) in Ontario, Canada. METHODS We linked the provincial birth registry with COVID-19 vaccination records from December 14, 2020 to December 31, 2021 and assessed coverage rates among all pregnant individuals by month, age, and neighborhood sociodemographic characteristics. Among individuals who gave birth since April 2021-when pregnant people were prioritized for vaccination-we assessed associations between sociodemographic, behavioral, and pregnancy-related factors with vaccine series initiation using multivariable regression to estimate adjusted risk ratios (aRR) and risk differences (aRD) with 95% confidence intervals (CI). RESULTS Among 221,190 pregnant individuals, vaccine coverage increased to 71.2% by December 2021. Gaps in coverage across categories of age and sociodemographic characteristics decreased over time, but did not disappear. Lower vaccine series initiation was associated with lower age (<25 vs. 30-34 years: aRR 0.53, 95%CI 0.51-0.56), smoking (vs. non-smoking: 0.64, 0.61-0.67), no first trimester prenatal care visit (vs. visit: 0.80, 0.77-0.84), and residing in neighborhoods with the lowest income (vs. highest: 0.69, 0.67-0.71). Vaccine series initiation was marginally higher among individuals with pre-existing medical conditions (vs. no conditions: 1.07, 1.04-1.10). CONCLUSIONS COVID-19 vaccine coverage among pregnant individuals remained lower than in the general population, and there was lower vaccine initiation by multiple characteristics.
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Affiliation(s)
- Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Eszter Török
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Ann E Sprague
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Tavleen Dhinsa
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Gillian D Alton
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Sheryll Dimanlig-Cruz
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Wilson
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christopher A Gravel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
| | - Sandra I Dunn
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Darine El-Chaâr
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Mark C Walker
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Nannette Okun
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Shelley D Dougan
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, ON, Canada
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15
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Ding C, Liu Y, Pang W, Zhang D, Wang K, Chen Y. Associations of COVID-19 vaccination during pregnancy with adverse neonatal and maternal outcomes: A systematic review and meta-analysis. Front Public Health 2023; 11:1044031. [PMID: 36794075 PMCID: PMC9922836 DOI: 10.3389/fpubh.2023.1044031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023] Open
Abstract
Objectives The low COVID-19 vaccine uptake rate among pregnant women is mainly due to safety concerns about COVID-19 vaccines due to limited safety evidence. Our goal was to evaluate the safety of COVID-19 vaccination during pregnancy with up-to-date evidence. Methods A comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and clinicaltrials.gov was performed on April 5th, 2022, and updated on May 25th, 2022. Studies evaluating the association of COVID-19 vaccination during pregnancy with adverse maternal and neonatal outcomes were included. Two reviewers independently performed the risk of bias assessment and data extraction. Inverse variance random effect meta-analyses were performed to pool outcome data. Results Forty-three observational studies were included. COVID-19 vaccination [96,384 (73.9%) BNT162b2, 30,889 (23.7%) mRNA-1273, and 3,172 (2.4%) other types] during pregnancy [23,721 (18.3%) in the first trimester, 52,778 (40.5%) in the second trimester, and 53,886 (41.2%) in the third trimester].was associated with reduced risks of stillbirth or neonatal death (OR, 0.74; 95% CI, 0.60-0.92). Sensitivity analysis restricted to studies in participants without COVID-19 showed that the pooled effect was not robust. COVID-19 vaccination during pregnancy was not associated with congenital anomalies (OR, 0.83; 95% CI, 0.63-1.08), preterm birth (OR, 0.98; 95% CI, 0.90-1.06), NICU admission or hospitalization (OR, 0.94; 95% CI, 0.84-1.04), an Apgar score at 5 min <7 (OR, 0.93; 95% CI, 0.86-1.01), low birth weight (OR, 1.00; 95% CI, 0.88-1.14), miscarriage (OR, 0.99; 95% CI, 0.88-1.11), cesarean delivery (OR, 1.07; 95% CI, 0.96-1.19), or postpartum hemorrhage (OR, 0.91; 95% CI, 0.81-1.01). Conclusions COVID-19 vaccination during pregnancy was not associated with any of the adverse neonatal or maternal outcomes studied. Interpretation of study findings is limited by the types and timing of vaccination. The vaccinations in our study received during pregnancy were primarily mRNA vaccines administered in the second and third trimester. Future RCTs and meta-analysis are warranted to evaluate the efficacy and long-term effects of the COVID-19 vaccines. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022322525, identifier: PROSPERO, CRD42022322525.
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16
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Carbone L, Trinchillo MG, Di Girolamo R, Raffone A, Saccone G, Iorio GG, Gabrielli O, Maruotti GM. COVID-19 vaccine and pregnancy outcomes: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022; 159:651-661. [PMID: 35810414 PMCID: PMC9349529 DOI: 10.1002/ijgo.14336] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To explore perinatal outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-vaccinated pregnant women compared with unvaccinated counterparts. METHODS Search was conducted using Web of Science, Scopus, ClinicalTrial.gov, MEDLINE, Embase, OVID, and Cochrane Library as electronic databases. We included observational studies evaluating pregnant women undergoing SARS-CoV-2 vaccination and compared pregnancy and perinatal outcomes with those in unvaccinated women. Categorical variables were assessed using odds ratio (OR) with 95% confidence interval (CI), whereas for continuous variables, the results were expressed as mean difference with their 95% CI. All analyses were performed by adopting the random effect model of DerSimonian and Laird. RESULTS There was no difference in the probability of having a small-for-gestational-age fetus (OR 0.97, 95% CI 0.85-1.09; P = 0.570), but we observed a reduced probability of a non-reassuring fetal monitoring, a reduced gestational age at delivery, and a reduced probability of premature delivery in vaccinated pregnant women versus unvaccinated ones. CONCLUSION The probability of small for gestational age is similar between vaccinated and unvaccinated pregnant women, and the former also had a slightly reduced rate of premature delivery.
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Affiliation(s)
- Luigi Carbone
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Maria Giuseppina Trinchillo
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Raffaella Di Girolamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC)IRCCS Azienda Ospedaliero‐Universitaria di Bologna, S. Orsola Hospital, University of BolognaBolognaItaly
| | - Gabriele Saccone
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Giuseppe Gabriele Iorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Olimpia Gabrielli
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Giuseppe Maria Maruotti
- Department of Neurosciences, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
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Zavala E, Fesshaye B, Lee C, Mutwiwa S, Njagi W, Munyao P, Njogu R, Gur-Arie R, Paul AM, Holroyd TA, Singh P, Karron RA, Limaye RJ. Lack of clear national policy guidance on COVID-19 vaccines influences behaviors in pregnant and lactating women in Kenya. Hum Vaccin Immunother 2022; 18:2127561. [PMID: 36315852 PMCID: PMC9746464 DOI: 10.1080/21645515.2022.2127561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
SARS-CoV-2 infection in pregnancy is associated with a greater risk of maternal and newborn morbidity and maternal death. In Kenya, pregnant and lactating women (PLW) were ineligible to receive COVID-19 vaccines until August 2021. How shifts in policy influence vaccine behaviors, such as health worker recommendations and vaccine uptake, is not well documented. We conducted qualitative interviews with PLW, health workers, and policymakers in Kenya to understand how different stakeholders' perceptions of national policy regarding COVID-19 vaccination in pregnancy shaped vaccine behaviors and decision-making. Policymakers and health workers described pervasive uncertainty and lack of communication about the national policy, cited vaccine safety as their primary concern for administering COVID-19 vaccines to PLW, and expressed that PLW were inadequately prioritized in the COVID-19 vaccine program. PLW perceived the restrictive policy as indicative of a safety risk, resulting in vaccine hesitancy and potentially exacerbated inequities in vaccine access. These findings support the need for the development and dissemination of effective vaccine communication guidelines and the prioritization of PLW in COVID-19 vaccination policies and campaigns. To ensure PLW do not face the same inequities in future epidemics, data on infectious disease burdens and vaccine uptake should be collected systematically among pregnant women, and PLW should be included in future vaccine trials.
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Affiliation(s)
- Eleonor Zavala
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,CONTACT Eleonor Zavala Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205USA
| | - Berhaun Fesshaye
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Clarice Lee
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Rachel Gur-Arie
- Berman Institute of Bioethics, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alicia M. Paul
- International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,Department of Health, Behavior, and Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taylor A. Holroyd
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prachi Singh
- International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth A. Karron
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,Center for Immunization Research, Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rupali J. Limaye
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,Department of Health, Behavior, and Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA,Rupali J. Limaye Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 W Wolfe St E5521, Baltimore, MD, USA
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18
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Manca TA, Sadarangani M, Halperin SA, Langley JM, McClymont E, MacDonald SE, Top KA. Vaccine regulation should require and enforce the inclusion of pregnant and breastfeeding women in prelicensure clinical trials. Hum Vaccin Immunother 2022; 18:2104019. [PMID: 35880903 DOI: 10.1080/21645515.2022.2104019] [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: 12/15/2022] Open
Abstract
Exclusion of pregnant and breastfeeding women from the pivotal randomized controlled trials for COVID-19 vaccines that led to emergency regulatory approval created gaps in data needed for vaccine policy, healthcare provider recommendations, and women's decisions about vaccination. We argue that such knowledge gaps increase potential for vaccine hesitancy and misinformation relating to the health of women and infants, and that these gaps in evidence are avoidable. Over several decades, ethical and scientific guidance, scholarship, and advocacy in favor of pregnant and breastfeeding women's participation in clinical development of vaccines has accumulated. Guidance on how to include pregnant and breastfeeding women in vaccine trials ethically and safely predates the COVID-19 pandemic but has yet to be routinely incorporated in vaccine development. We highlight the important role regulatory authorities could play in requiring that pregnant and breastfeeding women be eligible as volunteer participants in prelicensure vaccine trials for products that are expected to be used in this population. Inclusion of pregnant and breastfeeding populations in clinical trials leading to market approval or emergency use authorization should be undertaken early or concurrently at the time of trials in the general population.
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Affiliation(s)
- Terra A Manca
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada
| | - Elisabeth McClymont
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada.,School of Public health, University of Alberta, Edmonton, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health and Dalhousie University, Halifax, Canada.,Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
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19
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Waitt C, Astill D, Zavala E, Karron RA, Faden RR, Stratton P, Temkin SM, Clayton JA. Clinical trials and pregnancy. COMMUNICATIONS MEDICINE 2022; 2:132. [PMID: 36299562 PMCID: PMC9593973 DOI: 10.1038/s43856-022-00198-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Catriona Waitt
- grid.10025.360000 0004 1936 8470University of Liverpool, Liverpool, UK
| | - Denise Astill
- Foetal Anti-Convulsant Syndrome New Zealand, PO Box 82-175, Highland Park, Auckland, 2143 New Zealand ,Consumer Advocacy Alliance, PO Box 32 445, Devonport, Auckland, 0744 New Zealand
| | - Eleonor Zavala
- grid.21107.350000 0001 2171 9311Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Ruth A. Karron
- grid.21107.350000 0001 2171 9311Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Ruth R. Faden
- grid.21107.350000 0001 2171 9311Berman Institute for Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD 21205 USA
| | - Pamela Stratton
- grid.94365.3d0000 0001 2297 5165Office of Research on Women’s Health, National Institutes of Health, Building 10, Room 7-4647, 10 Center Dr., Bethesda, Maryland 20892 USA
| | - Sarah M. Temkin
- grid.94365.3d0000 0001 2297 5165Office of Research on Women’s Health, National Institutes of Health, Building 10, Room 7-4647, 10 Center Dr., Bethesda, Maryland 20892 USA
| | - Janine A. Clayton
- grid.94365.3d0000 0001 2297 5165Office of Research on Women’s Health, National Institutes of Health, Building 10, Room 7-4647, 10 Center Dr., Bethesda, Maryland 20892 USA
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20
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Nachega JB, Sam-Agudu NA, Siedner MJ, Rosenthal PJ, Mellors JW, Zumla A, Hermans MP, Ntakwinja MB, Mukwege DM, Langenegger E, Mofenson LM. Prioritizing Pregnant Women for Coronavirus Disease 2019 Vaccination in African Countries. Clin Infect Dis 2022; 75:1462-1466. [PMID: 36130226 PMCID: PMC9214132 DOI: 10.1093/cid/ciac362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) in pregnancy is associated with excess maternal and infant morbidity and mortality in both African and higher-resource settings. Furthermore, mounting evidence demonstrates the safety and efficacy of COVID-19 vaccination for pregnant women and infants. However, national guidelines in many African countries are equivocal or lack recommendations on COVID-19 vaccine in pregnancy. We summarize key data on COVID-19 epidemiology and vaccination among pregnant African women to highlight major barriers to vaccination and recommend 4 interventions. First, policymakers should prioritize pregnant women for COVID-19 vaccination, with a target of 100% coverage. Second, empirically supported public health campaigns should be sustainably implemented to inform and support pregnant women and their healthcare providers in overcoming vaccine hesitancy. Third, COVID-19 vaccination for pregnant women should be expanded to include antenatal care, obstetrics/gynecology, and targeted mass vaccination campaigns. Fourth, national monitoring and evaluation of COVID-19 vaccine uptake, safety, surveillance, and prospective outcomes assessment should be conducted.
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Affiliation(s)
- Jean B. Nachega
- Department of Epidemiology, Infectious Diseases and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Mark J. Siedner
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Philip J. Rosenthal
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - John W. Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, University College London, London, United Kingdom
- National Institutes of Health and Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Michel P. Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Mukanire B. Ntakwinja
- Department of Obstetrics and Gynecology, Panzi Hospital and Université Evangelique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Denis M. Mukwege
- Department of Obstetrics and Gynecology, Panzi Hospital and Université Evangelique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Eduard Langenegger
- Department of Obstetrics and Gynecology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
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21
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Rodewald L, Wu D, Yin Z, Feng Z. Vaccinate with Confidence and Finish Strong. China CDC Wkly 2022; 4:828-831. [PMID: 36284540 PMCID: PMC9547736 DOI: 10.46234/ccdcw2022.172] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/30/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Lance Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dan Wu
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, Beijing, China
- Chinese Preventive Medicine Association, Beijing, China
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22
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Magnus MC, Håberg SE, Carlsen EØ, Kwong JC, Buchan SA, Fell DB. Pregnancy Status at the Time of Coronavirus Disease 2019 Vaccination and Incidence of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Clin Infect Dis 2022; 76:57-65. [PMID: 36071540 PMCID: PMC9494391 DOI: 10.1093/cid/ciac739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pregnant women are recommended to receive coronavirus disease 2019 (COVID-19) vaccines; however, relative effectiveness of vaccination by pregnancy status is unclear. METHODS We compared the relative effectiveness of messenger RNA (mRNA) COVID-19 vaccines according to whether women received both doses while pregnant (n = 7412), 1 dose while pregnant (n = 3538), both doses while postpartum (n = 1856), or both doses while neither pregnant nor postpartum (n = 6687). We estimated risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection starting 14 days after the second dose using Cox regression, reporting hazard ratios (HRs) and 95% confidence intervals (CIs). Second, we examined relative effectiveness of a third (booster) dose while pregnant compared to outside pregnancy. The major circulating variant during the study period was the Delta variant. RESULTS Fifty-four percent of women received 2 doses of the BNT162b2 vaccine, 16% received 2 doses of the mRNA-1273 vaccine, while 30% received 1 dose of both vaccines. Compared to women who received both doses while neither pregnant nor postpartum, the adjusted HR for a positive SARS-CoV-2 polymerase chain reaction test was similar if the woman received both doses while pregnant (1.04 [95% CI, .94-1.17]), 1 dose while pregnant and 1 dose before or after pregnancy (1.03 [95% CI, .93-1.14]), or both doses while postpartum (0.99 [95% CI, .92-1.07]). The findings were similar for BNT162b2 (Pfizer-BioNTech Comirnaty) and mRNA-1273 (Moderna Spikevax), and during Delta- and Omicron-dominant periods. We observed no differences in the relative effectiveness of the booster dose according to pregnancy status. CONCLUSIONS We observed similar effectiveness of mRNA vaccines against SARS-CoV-2 infection among women regardless of pregnancy status at the time of vaccination.
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Affiliation(s)
- Maria C Magnus
- Correspondence: M. C. Magnus, Centre for Fertility and Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213 Oslo, Norway ()
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen Ø Carlsen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Canada,ICES, Toronto, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Canada,University Health Network, Toronto, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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23
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Sethy G, Chisema M, Sharma L, Joshi K, Singhal S, Omar Nicks P, Macheso S, Damte T, Eleonore Ba A, Mitambo C, Thomas M, Laher B, Phuka J. COVID-19 vaccine express strategy in Malawi: An effort to reach the un-reach. Vaccine 2022; 40:5089-5094. [PMID: 35871867 PMCID: PMC9291406 DOI: 10.1016/j.vaccine.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
Objectives To establish the impact of “Covid-19 Vaccination express” (CVE) on vaccine uptake in Malawi Design Retrospective cross-sectional study to compare the daily vaccine administration rate in CVE and routine covid vaccination (RCV). RCV data was collected from March 2021 to October 2021. The data regarding CVE was collected from 5 November 2021 to 31 December 2021. Data was collected regarding (1) the total number and type of vaccine doses administered and (2) Demographic details like age, gender, occupation, presence of comorbidities, the first dose, or the second dose of the people who received a vaccine. Results From March-December 2021, a total of 1,866,623 COVID-19 vaccine doses were administered, out of which 1,290,145 doses were administered at a mean daily vaccination rate of 1854 (95% CI: 1292-2415) doses as a part of RCV, and 576,478 doses were administered at a mean daily vaccination rate of 3312 (95% CI: 2377-4248) doses as a part of CVE. Comparing the mean daily doses (Astra Zeneca, AZ doses 1 & 2) administered in the CVE and RCV showed that the mean daily doses of AZ vaccine administered were significantly higher in the CVE (p<0.05). Conclusion CVE successfully increased the uptake of the Covid-19 vaccine.
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Affiliation(s)
| | | | | | - Krupal Joshi
- Department of Community and Family Medicine, All India Institute of Medical Science -Rajkot, Gujarat, India.
| | - Sanjay Singhal
- Department of Pulmonary Medicine, All India Institute of Medical Science -Rajkot, Gujarat, India
| | | | | | - Tedla Damte
- UNICEF Country Office, Malawi; LIKA UFPE, Brazil
| | | | | | - Mavuto Thomas
- Health Education Services, Ministry of Health, Malawi
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