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Minchin J, Harris GH, Baumann S, Smith ER. Exclusion of pregnant people from emergency vaccine clinical trials: A systematic review of clinical trial protocols and reporting from 2009 to 2019. Vaccine 2023; 41:5159-5181. [PMID: 37442686 DOI: 10.1016/j.vaccine.2023.06.073] [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: 10/28/2022] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Existing ethics guidance and regulatory requirements emphasize the need for pregnancy-specific safety and efficacy data during the development of vaccines in health emergencies. Our objective was to conduct a systematic review of vaccine clinical trials during active epidemic periods. METHODS We searched for Phase II and Phase III vaccine clinical trials initiated during the H1N1 influenza, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Zika, and Ebola virus disease (EVD) outbreaks from 2009 to 2019. Data were extracted from clinical trial protocols identified in the following registries: ClinicalTrials.gov, Pan African Clinical Trial Registry (PACTR), and all primary registries indicated by the World Health Organization's International Clinical Trials Registry Platform (ICTRP). Published studies from registered clinical trials were located through PubMed. Data was extracted on eligibility criteria and pregnancy outcomes. Data from this study is available in the Center for Open Science Data Repository: https://osf.io/nfk2p/?view_only=47deb3b206724af9b46c9c0c0083a267. RESULTS We identified 96 vaccine clinical trial protocols and included 84 in analysis. 5 records were excluded in screening for irrelevant abstracts, 7 were excluded in full-text assessment (1 for a therapeutic drug trial, 3 for enrolling elderly adults only, 3 for enrolling children/adolescents only). There were no eligible trials for MERS-CoV or Zika virus vaccines. Overall, 8 protocols explicitly included pregnant people; of these, 3 were completed trials with published results. Incidental pregnancies and outcomes of pregnant participants were reported in 2 studies, 10 studies reported serious adverse events related to pregnancy without mentioning total incidental pregnancies. A total of 411 recorded pregnancy outcomes were reported, with 293 from the 3 pregnancy-eligible studies with results. 71 serious adverse events pertaining to pregnancy were reported from all clinical trials with results. CONCLUSION Pregnant people are underrepresented in vaccine clinical trials conducted during outbreaks, resulting in underreporting of pregnancy-related outcomes and a lack of protection for pregnant people and neonates from infectious diseases.
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Affiliation(s)
- Jamie Minchin
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Gavin H Harris
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Sasha Baumann
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA.
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Scatigna M, Appetiti A, Pasanisi M, D'Eugenio S, Fabiani L, Giuliani AR. Experience and attitudes on vaccinations recommended during pregnancy: survey on an Italian sample of women and consultant gynecologists. Hum Vaccin Immunother 2021; 18:1-8. [PMID: 33956557 PMCID: PMC8920149 DOI: 10.1080/21645515.2021.1894061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Active immunization in pregnancy is recommended for the influenza and the tetanus, diphtheria, and acellular pertussis (Tdap) vaccines. Evidence indicates vaccine effectiveness in preventing influenza-related hospitalizations and pertussis in early infancy. We investigate vaccine uptake in pregnant and non-pregnant women through a sample of young women and consultant gynecologists, along with the potential predisposing and/or enabling factors affecting attitudes to vaccination (knowledge, beliefs, barriers). A cross-sectional study was conducted between June and September 2019, with a sample of 251 women and 14 consultant gynecologists at the Local Health Authority (ASL01) of the Abruzzo Region (Italy), using an anonymous, self-report questionnaire survey. Among the participants, 5.6% of women had received influenza vaccination, 16.4% had received Tdap during pregnancy and only 1.2% had received both vaccines. The assessment of the psychometric attitudinal variables has suggested a more positive willingness to receive Tdap than influenza vaccine among women, as the former is considered more important for the maternal and neonatal health. Health care workers have reported vaccine safety concerns, lack of information, and misconceptions about the need for vaccination as barriers to immunization in pregnant women. The results of this study will contribute to defining the goals and strategies to increase vaccine uptake under the current recommendations, through promoting effective training programs for all health care workers involved (gynecologists, obstetricians, public health physicians).
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Affiliation(s)
- Maria Scatigna
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Appetiti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Silvia D'Eugenio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Leila Fabiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Rita Giuliani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Regan AK, Munoz FM. Efficacy and safety of influenza vaccination during pregnancy: realizing the potential of maternal influenza immunization. Expert Rev Vaccines 2021; 20:649-660. [PMID: 33832397 DOI: 10.1080/14760584.2021.1915138] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Pregnant women are at higher risk of severe complications following influenza infection compared to the general population. Influenza vaccination during pregnancy can offer direct protection to pregnant women and passive immunity to infants up to 6 months of age via maternal antibodies. Pregnant women are a high priority group for influenza immunization.Areas covered: This review provides an overview of the basis for recommending influenza vaccine to pregnant women, current immunization policies, the evidence supporting the safety and effectiveness of maternal vaccination, and future research needed. We conducted a search of PubMed for articles describing the safety or efficacy of influenza vaccines administered during pregnancy. Published articles from inception to 17 November 2020 were reviewed.Expert opinion: Experimental and observational evidence support the efficacy, effectiveness and safety of influenza immunization during pregnancy. These data support the continued provision of inactivated influenza vaccine to pregnant women, as recommended by global immunization policies. To achieve success with maternal influenza immunization programs, further work is needed to inform policy development in low- and middle-income settings and implementation and promotion in high-income settings.
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Affiliation(s)
- Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States.,Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, United States.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
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Kittikraisak W, Phadungkiatwatana P, Ditsungnoen D, Kaoiean S, Macareo L, Rungrojcharoenkit K, Srisantiroj N, Chotpitayasunondh T, Dawood FS, Mott JA, Lindblade KA. Comparison of influenza antibody titers among women who were vaccinated in the 2 nd and the 3 rd trimesters of pregnancy. Vaccine 2020; 39:18-25. [PMID: 33243634 DOI: 10.1016/j.vaccine.2020.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND We compared cord blood antibody titers in unvaccinated pregnant women to those vaccinated with seasonal influenza vaccine during the 2nd and the 3rd trimesters. METHODS Pregnant women had cord blood collected at delivery for hemagglutination inhibition assay against vaccine reference viruses: A/California/07/2009 (H1N1)pdm09, A/Switzerland/9715293/2013 (H3N2), and B/Phuket/3073/2013 (Yamagata lineage). Geometric mean titer (GMT) ratios were calculated comparing vaccinated versus unvaccinated pregnant women, and women vaccinated in the 2nd and the 3rd trimesters. Proportions of women achieving defined titers were compared using the χ2 test. RESULTS Of 307 women, 190 (62%) were unvaccinated. Fifty and 67 were vaccinated during the 2nd and the 3rd trimesters, respectively. Median enrollment age was 29 years (interquartile range 24-34). Sixteen (5%) women had pre-existing conditions, but none were immunocompromised. GMT ratios comparing vaccinated and unvaccinated women were 5.90 (95% confidence interval [CI] 5.06-6.96) for influenza A/California, 5.39 (95% CI 4.18-6.08) for influenza A/Switzerland, and 5.05 (95% CI 4.43-5.85) for influenza B/Phuket. Similarly, the GMT ratios comparing the 3rd and the 2nd trimester vaccinated women were 2.90 (95% CI 2.54-3.39), 2.82 (95% CI 2.56-3.13), and 2.83 (95% CI 2.56-3.14), respectively. The proportions of women with defined titers for the three vaccine reference viruses did not differ between 2nd and 3rd trimester vaccinated women (titers ≥40: 68-92% versus 70-93%; ≥110: 32% versus 33-63%; and ≥330: 4-10% versus 3-21%). CONCLUSIONS Pregnant women vaccinated against influenza had more placental transfer of influenza antibodies to their infants than unvaccinated women. Placental transfer of antibodies was higher among those vaccinated in the 3rd trimester than in the 2nd trimester. There was no difference in the proportions of women achieving antibody titers corresponding to protection against influenza in children. Findings support the current World Health Organization's recommendation that pregnant women may be vaccinated in either 2nd or 3rd trimester of pregnancy.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
| | | | - Darunee Ditsungnoen
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Surasak Kaoiean
- Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Louis Macareo
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Fatimah S Dawood
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joshua A Mott
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kim A Lindblade
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Amin AB, Nunes MC, Tapia MD, Madhi SA, Cutland CL, Wairagkar N, Omer SB. Immunogenicity of influenza vaccines administered to pregnant women in randomized clinical trials in Mali and South Africa. Vaccine 2020; 38:6478-6483. [PMID: 32868130 PMCID: PMC7505225 DOI: 10.1016/j.vaccine.2020.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Abstract
Background A key consideration for expanding recommendations for influenza vaccination is a robust assessment of immunogenicity and efficiency of transplacental antibody transfer after maternal vaccination. Methods We pooled data from two trials of maternal influenza vaccination to analyze vaccine immunogenicity with more power than either trial had alone. We compared hemagglutination-inhibition (HAI) titers and titer factor change for women and their infants between trial arms using t-tests; maternal and infant putative seroprotective titers (HAI ≥ 1:40) within each trial arm and maternal seroconversion between trial arms using exact tests; and transplacental antibody transfer between trial arms using t-tests. We used marginal linear models and generalized estimating equations to examine the impact of time between maternal vaccination and delivery on transplacental antibody transfer, infant titers, and infant seroprotection. Results For all vaccine components (A/H1N1, A/H3N2, and Type B), >80% of vaccinated women had seroprotective titers, >60% of them seroconverted, and >50% of their infants were born with seroprotective titers. These immunogenicity outcomes occurred more often in vaccine recipients and their infants than in controls. No difference in efficiency of transplacental antibody transfer was observed between vaccine recipients and controls. Conclusions Our results provide robust support for further expansion of maternal influenza vaccination recommendations. Clinical Trials Registration: NCT01430689 and NCT01306669.
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Affiliation(s)
- Avnika B Amin
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA.
| | - Marta C Nunes
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology-National Research Foundation, Vaccine-Preventable Diseases, Johannesburg, South Africa
| | - Milagritos D Tapia
- Centre pour le Développement des Vaccins, Bamako, Mali; University of Maryland School of Medicine, Center for Vaccine Development, Baltimore, USA
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology-National Research Foundation, Vaccine-Preventable Diseases, Johannesburg, South Africa
| | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology-National Research Foundation, Vaccine-Preventable Diseases, Johannesburg, South Africa
| | | | - Saad B Omer
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA; Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA; Emory Vaccine Center, Atlanta, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
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Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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Cuningham W, Geard N, Fielding JE, Braat S, Madhi SA, Nunes MC, Christian LM, Lin S, Lee C, Yamaguchi K, Bisgaard H, Chawes B, Chao A, Blanchard‐Rohner G, Schlaudecker EP, Fisher BM, McVernon J, Moss R. Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis. Influenza Other Respir Viruses 2019; 13:438-452. [PMID: 31165580 PMCID: PMC6692549 DOI: 10.1111/irv.12649] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pregnant women have an elevated risk of illness and hospitalisation from influenza. Pregnant women are recommended to be prioritised for influenza vaccination during any stage of pregnancy. The risk of seasonal influenza varies substantially throughout the year in temperate climates; however, there is limited knowledge of how vaccination timing during pregnancy impacts the benefits received by the mother and foetus. OBJECTIVES To compare antenatal vaccination timing with regard to influenza vaccine immunogenicity during pregnancy and transplacental transfer to their newborns. METHODS Studies were eligible for inclusion if immunogenicity to influenza vaccine was evaluated in women stratified by trimester of pregnancy. Haemagglutination inhibition (HI) titres, stratified by trimester of vaccination, had to be measured at either pre-vaccination and within one month post-vaccination, post-vaccination and at delivery in the mother, or in cord/newborn blood. Authors searched PubMed, Scopus, Web of Science and EMBASE databases from inception until June 2016 and authors of identified studies were contacted for additional data. Extracted data were tabulated and summarised via random-effect meta-analyses and qualitative methods. RESULTS Sixteen studies met the inclusion criteria. Meta-analyses found that compared with women vaccinated in an earlier trimester, those vaccinated in a later trimester had a greater fold increase in HI titres (1.33- to 1.96-fold) and higher HI titres in cord/newborn blood (1.21- to 1.64-fold). CONCLUSIONS This review provides comparative analysis of the effect of vaccination timing on maternal immunogenicity and protection of the infant that is informative and relevant to current vaccine scheduling for pregnant women.
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Affiliation(s)
- Will Cuningham
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
- Victorian Infectious Diseases Reference Laboratory, Epidemiology Unit, Peter Doherty Institute for Infection and ImmunityThe Royal Melbourne Hospital and The University of MelbourneMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Nicholas Geard
- Victorian Infectious Diseases Reference Laboratory, Epidemiology Unit, Peter Doherty Institute for Infection and ImmunityThe Royal Melbourne Hospital and The University of MelbourneMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
- Computing and Information Systems, Melbourne School of EngineeringThe University of MelbourneMelbourneVictoriaAustralia
| | - James E. Fielding
- Victorian Infectious Diseases Reference Laboratory, Epidemiology Unit, Peter Doherty Institute for Infection and ImmunityThe Royal Melbourne Hospital and The University of MelbourneMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Sabine Braat
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
- Melbourne Clinical and Translational Sciences (MCATS) Platform, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Shabir A. Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health ScienceUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health ScienceUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Marta C. Nunes
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health ScienceUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health ScienceUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lisa M. Christian
- The Department of Psychiatry & Behavioral Health and The Institute for Behavioral Medicine ResearchThe Ohio State University Wexner Medical CenterColumbusOhio
| | - Shin‐Yu Lin
- Department of OBS & GYNNational Taiwan University HospitalTaipeiTaiwan
| | - Chien‐Nan Lee
- Department of OBS & GYNNational Taiwan University HospitalTaipeiTaiwan
| | - Koushi Yamaguchi
- Division of Immunology and Microbiology, Center of Maternal‐Fetal, Neonatal and Reproductive MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark
| | - An‐Shine Chao
- Department of Obstetrics & GynecologyChang Gung Memorial Hospital & Chang Gung UniversityTaipeiTaiwan
| | - Geraldine Blanchard‐Rohner
- Department of PediatricsChildren’s Hospital of Geneva, University Hospitals of Geneva and Faculty of MedicineGenevaSwitzerland
| | - Elizabeth P. Schlaudecker
- Division of Infectious Diseases, Global Health CenterCincinnati Children’s Hospital Medical CenterCincinnatiOhio
| | - Barbra M. Fisher
- Department of Obstetrics and Gynecology, Section of Maternal‐Fetal MedicineUniversity of Colorado School of MedicineAuroraColorado
| | - Jodie McVernon
- Victorian Infectious Diseases Reference Laboratory, Epidemiology Unit, Peter Doherty Institute for Infection and ImmunityThe Royal Melbourne Hospital and The University of MelbourneMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
- Murdoch Children’s Research InstituteThe Royal Children’s HospitalMelbourneVictoriaAustralia
| | - Robert Moss
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
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Walsh LK, Donelle J, Dodds L, Hawken S, Wilson K, Benchimol EI, Chakraborty P, Guttmann A, Kwong JC, MacDonald NE, Ortiz JR, Sprague AE, Top KA, Walker MC, Wen SW, Fell DB. Health outcomes of young children born to mothers who received 2009 pandemic H1N1 influenza vaccination during pregnancy: retrospective cohort study. BMJ 2019; 366:l4151. [PMID: 31292120 PMCID: PMC6614795 DOI: 10.1136/bmj.l4151] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether any association exists between exposure to 2009 pandemic H1N1 (pH1N1) influenza vaccination during pregnancy and negative health outcomes in early childhood. DESIGN Retrospective cohort study. SETTING Population based birth registry linked with health administrative databases in the province of Ontario, Canada. PARTICIPANTS All live births from November 2009 through October 2010 (n=104 249) were included, and children were followed until 5 years of age to ascertain study outcomes. MAIN OUTCOME MEASURES Rates of immune related (infectious diseases, asthma), non-immune related (neoplasms, sensory disorders), and non-specific morbidity outcomes (urgent or inpatient health services use, pediatric complex chronic conditions) were evaluated from birth to 5 years of age; under-5 childhood mortality was also assessed. Propensity score weighting was used to adjust hazard ratios, incidence rate ratios, and risk ratios for potential confounding. RESULTS Of 104 249 live births, 31 295 (30%) were exposed to pH1N1 influenza vaccination in utero. No significant associations were found with upper or lower respiratory infections, otitis media, any infectious diseases, neoplasms, sensory disorders, urgent and inpatient health services use, pediatric complex chronic conditions, or mortality. A weak association was observed between prenatal pH1N1 vaccination and increased risk of asthma (adjusted hazard ratio 1.05, 95% confidence interval 1.02 to 1.09) and decreased rates of gastrointestinal infections (adjusted incidence rate ratio 0.94, 0.91 to 0.98). These results were unchanged in sensitivity analyses accounting for any potential differential healthcare seeking behavior or access between exposure groups. CONCLUSIONS No associations were observed between exposure to pH1N1 influenza vaccine during pregnancy and most five year pediatric health outcomes. Residual confounding may explain the small associations observed with increased asthma and reduced gastrointestinal infections. These outcomes should be assessed in future studies.
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Affiliation(s)
- Laura K Walsh
- Better Outcomes Registry & Network, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | | | | | - Steven Hawken
- University of Ottawa, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kumanan Wilson
- University of Ottawa, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Eric I Benchimol
- University of Ottawa, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Pranesh Chakraborty
- University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Astrid Guttmann
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Justin R Ortiz
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann E Sprague
- Better Outcomes Registry & Network, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | | | - Mark C Walker
- Better Outcomes Registry & Network, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shi Wu Wen
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deshayne B Fell
- University of Ottawa, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
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9
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Zhong Z, Haltalli M, Holder B, Rice T, Donaldson B, O'Driscoll M, Le-Doare K, Kampmann B, Tregoning JS. The impact of timing of maternal influenza immunization on infant antibody levels at birth. Clin Exp Immunol 2018; 195:139-152. [PMID: 30422307 DOI: 10.1111/cei.13234] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/27/2023] Open
Abstract
Pregnant women and infants are at an increased risk of severe disease after influenza infection. Maternal immunization is a potent tool to protect both these at-risk groups. While the primary aim of maternal influenza vaccination is to protect the mother, a secondary benefit is the transfer of protective antibodies to the infant. A recent study using the tetanus, diphtheria and acellular pertussis (Tdap) vaccine indicated that children born to mothers immunized in the second trimester of pregnancy had the highest antibody titres compared to children immunized in the third trimester. The aim of the current study was to investigate how the timing of maternal influenza immunization impacts infant antibody levels at birth. Antibody titres were assessed in maternal and cord blood samples by both immunoglobulin (Ig)G-binding enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition assay (HAI). Antibody titres to the H1N1 component were significantly higher in infants born to mothers vaccinated in either the second or third trimesters than infants born to unvaccinated mothers. HAI levels in the infant were significantly lower when maternal immunization was performed less than 4 weeks before birth. These studies confirm that immunization during pregnancy increases the antibody titre in infants. Importantly, antibody levels in cord blood were significantly higher when the mother was vaccinated in either trimesters 2 or 3, although titres were significantly lower if the mother was immunized less than 4 weeks before birth. Based on these data, seasonal influenza vaccination should continue to be given in pregnancy as soon as it becomes available.
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Affiliation(s)
- Z Zhong
- Mucosal Infection and Immunity Group, Section of Virology, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - M Haltalli
- Mucosal Infection and Immunity Group, Section of Virology, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - B Holder
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - T Rice
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - B Donaldson
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - M O'Driscoll
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - K Le-Doare
- Infection and Immunity Theme, St George's University of London, Tooting, UK
| | - B Kampmann
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK.,Vaccines and Immunity Theme, MRC Unit The Gambia, at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia.,The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - J S Tregoning
- Mucosal Infection and Immunity Group, Section of Virology, Department of Medicine, St Mary's Campus, Imperial College London, UK
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10
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Katz J, Englund JA, Steinhoff MC, Khatry SK, Shrestha L, Kuypers J, Mullany LC, Chu HY, LeClerq SC, Kozuki N, Tielsch JM. Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal. Clin Infect Dis 2018; 67:334-340. [PMID: 29452372 PMCID: PMC6051462 DOI: 10.1093/cid/ciy090] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background Maternal influenza vaccination protects mothers and their infants in low resource settings, but little is known about whether the protection varies by gestational age at vaccination. Methods Women of childbearing age in rural southern Nepal were surveilled for pregnancy, consented and randomized to receive maternal influenza vaccination or placebo, with randomization stratified on gestational age (17-25 or 26-34 weeks). Enrollment occurred in 2 annual cohorts, and vaccinations occurred from April 2011 through September 2013. Results In sum, 3693 women consented and enrolled, resulting in 3646 live births. Although cord blood antibody titers and the rise in maternal titers were generally greater when women were vaccinated later in pregnancy, this was not statistically significant. The incidence risk ratio (IRR) for maternal influenza in pregnancy through 6 months postpartum was 0.62 (95% confidence interval [CI]: 0.35, 1.10) for those vaccinated 17-25 weeks gestation and 0.89 (95% CI: 0.39, 2.00) for those 26-34 weeks. Infant influenza IRRs were 0.73 (95% CI: 0.51, 1.05) for those whose mothers were vaccinated earlier in gestation, and 0.63 (95% CI: 0.37, 1.08) for those later. Relative risks (RR) for low birthweight were 0.83 (95% CI: 0.71, 0.98) and 0.90 (95% CI: 0.72, 1.12) for 17-25 and 26-34 weeks gestation at vaccination, respectively. IRRs did not differ for small-for-gestational age or preterm. No RRs were statistically different by timing of vaccine receipt. Conclusions Vaccine efficacy did not vary by gestational age at vaccination, making maternal influenza immunization programs easier to implement where women present for care late in pregnancy. Clinical Trials Registration NCT01034254.
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Affiliation(s)
- Joanne Katz
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland
| | - Janet A Englund
- Seattle Children’s Hospital and Research Foundation, University of Washington, Seattle
| | - Mark C Steinhoff
- Global Health Center, Cincinnati Children’s Hospital Medical Center, Ohio
| | | | - Laxman Shrestha
- Tribhuvan University, Department of Pediatrics and Child Health, Institute of Medicine, Kathmandu, Nepal
| | - Jane Kuypers
- School of Medicine, University of Washington, Molecular Virology Laboratory, Seattle
| | - Luke C Mullany
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland
| | - Helen Y Chu
- University of Washington, Harborview Medical Center, Seattle
| | - Steven C LeClerq
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland
- Nepal Nutrition Intervention Project – Sarlahi, Nepal
| | - Naoko Kozuki
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland
| | - James M Tielsch
- Milken Institute School of Public Health, George Washington University, Department of Global Health, Washington, D.C
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11
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Affiliation(s)
- Paul Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Paris, France
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivia Anselem
- AP-HP, Maternité Port-Royal, Département de Gynécologie-Obstétrique, Hôpital Cochin Broca Hôtel-Dieu, Paris, France
- DHU Risk in pregnancy, Université Paris Descartes, Paris, France
| | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
- Inserm, CIC 1417, Université Paris Descartes, Paris, France
- AP-HP, Département de maladies infectieuses, CIC Cochin Pasteur, Paris, France
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12
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Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev 2018; 2:CD001269. [PMID: 29388196 PMCID: PMC6491184 DOI: 10.1002/14651858.cd001269.pub6] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The consequences of influenza in adults are mainly time off work. Vaccination of pregnant women is recommended internationally. This is an update of a review published in 2014. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated due to their lack of influence on the review conclusions. OBJECTIVES To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in healthy adults, including pregnant women. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12), MEDLINE (January 1966 to 31 December 2016), Embase (1990 to 31 December 2016), the WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017), and ClinicalTrials.gov (1 July 2017), as well as checking the bibliographies of retrieved articles. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy individuals aged 16 to 65 years. Previous versions of this review included observational comparative studies assessing serious and rare harms cohort and case-control studies. Due to the uncertain quality of observational (i.e. non-randomised) studies and their lack of influence on the review conclusions, we decided to update only randomised evidence. The searches for observational comparative studies are no longer updated. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We rated certainty of evidence for key outcomes (influenza, influenza-like illness (ILI), hospitalisation, and adverse effects) using GRADE. MAIN RESULTS We included 52 clinical trials of over 80,000 people assessing the safety and effectiveness of influenza vaccines. We have presented findings from 25 studies comparing inactivated parenteral influenza vaccine against placebo or do-nothing control groups as the most relevant to decision-making. The studies were conducted over single influenza seasons in North America, South America, and Europe between 1969 and 2009. We did not consider studies at high risk of bias to influence the results of our outcomes except for hospitalisation.Inactivated influenza vaccines probably reduce influenza in healthy adults from 2.3% without vaccination to 0.9% (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.36 to 0.47; 71,221 participants; moderate-certainty evidence), and they probably reduce ILI from 21.5% to 18.1% (RR 0.84, 95% CI 0.75 to 0.95; 25,795 participants; moderate-certainty evidence; 71 healthy adults need to be vaccinated to prevent one of them experiencing influenza, and 29 healthy adults need to be vaccinated to prevent one of them experiencing an ILI). The difference between the two number needed to vaccinate (NNV) values depends on the different incidence of ILI and confirmed influenza among the study populations. Vaccination may lead to a small reduction in the risk of hospitalisation in healthy adults, from 14.7% to 14.1%, but the CI is wide and does not rule out a large benefit (RR 0.96, 95% CI 0.85 to 1.08; 11,924 participants; low-certainty evidence). Vaccines may lead to little or no small reduction in days off work (-0.04 days, 95% CI -0.14 days to 0.06; low-certainty evidence). Inactivated vaccines cause an increase in fever from 1.5% to 2.3%.We identified one RCT and one controlled clinical trial assessing the effects of vaccination in pregnant women. The efficacy of inactivated vaccine containing pH1N1 against influenza was 50% (95% CI 14% to 71%) in mothers (NNV 55), and 49% (95% CI 12% to 70%) in infants up to 24 weeks (NNV 56). No data were available on efficacy against seasonal influenza during pregnancy. Evidence from observational studies showed effectiveness of influenza vaccines against ILI in pregnant women to be 24% (95% CI 11% to 36%, NNV 94), and against influenza in newborns from vaccinated women to be 41% (95% CI 6% to 63%, NNV 27).Live aerosol vaccines have an overall effectiveness corresponding to an NNV of 46. The performance of one- or two-dose whole-virion 1968 to 1969 pandemic vaccines was higher (NNV 16) against ILI and (NNV 35) against influenza. There was limited impact on hospitalisations in the 1968 to 1969 pandemic (NNV 94). The administration of both seasonal and 2009 pandemic vaccines during pregnancy had no significant effect on abortion or neonatal death, but this was based on observational data sets. AUTHORS' CONCLUSIONS Healthy adults who receive inactivated parenteral influenza vaccine rather than no vaccine probably experience less influenza, from just over 2% to just under 1% (moderate-certainty evidence). They also probably experience less ILI following vaccination, but the degree of benefit when expressed in absolute terms varied across different settings. Variation in protection against ILI may be due in part to inconsistent symptom classification. Certainty of evidence for the small reductions in hospitalisations and time off work is low. Protection against influenza and ILI in mothers and newborns was smaller than the effects seen in other populations considered in this review.Vaccines increase the risk of a number of adverse events, including a small increase in fever, but rates of nausea and vomiting are uncertain. The protective effect of vaccination in pregnant women and newborns is also very modest. We did not find any evidence of an association between influenza vaccination and serious adverse events in the comparative studies considered in this review. Fifteen included RCTs were industry funded (29%).
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Affiliation(s)
- Vittorio Demicheli
- Azienda Sanitaria Locale ASL ALServizio Regionale di Riferimento per l'Epidemiologia, SSEpi‐SeREMIVia Venezia 6AlessandriaPiemonteItaly15121
| | - Tom Jefferson
- University of OxfordCentre for Evidence Based MedicineOxfordUKOX2 6GG
| | - Eliana Ferroni
- Regional Center for Epidemiology, Veneto RegionEpidemiological System of the Veneto RegionPassaggio Gaudenzio 1PadovaItaly35131
| | - Alessandro Rivetti
- ASL CN2 Alba BraDipartimento di Prevenzione ‐ S.Pre.S.A.LVia Vida 10AlbaPiemonteItaly12051
| | - Carlo Di Pietrantonj
- Local Health Unit Alessandria‐ ASL ALRegional Epidemiology Unit SeREMIVia Venezia 6AlessandriaAlessandriaItaly15121
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13
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Nunes MC, Madhi SA. Prevention of influenza-related illness in young infants by maternal vaccination during pregnancy. F1000Res 2018; 7:122. [PMID: 29445450 PMCID: PMC5791002 DOI: 10.12688/f1000research.12473.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/15/2022] Open
Abstract
The influenza virus circulates yearly and causes global epidemics. Influenza infection affects all age groups and causes mild to severe illness, and young infants are at particular risk for serious disease. The most effective measure to prevent influenza disease is vaccination; however, no vaccine is licensed for use in infants younger than 6 months old. Thus, there is a crucial need for other preventive strategies in this high-risk age group. Influenza vaccination during pregnancy protects both the mothers and the young infants against influenza infection. Vaccination during pregnancy boosts the maternal antibodies and increases the transfer of immunoglobulin G from the mother to the fetus through the placenta, which confers protection against infection in infants too young to be vaccinated. Data from clinical trials and observational studies did not demonstrate adverse effects to the mother, the fetus, or the infant after maternal influenza vaccination. We present the current data on the effectiveness and safety of influenza vaccination during pregnancy in preventing disease in the young infant.
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Affiliation(s)
- Marta C Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
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14
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Immunologic response to vaccine challenge in pregnant PTPN22 R620W carriers and non-carriers. PLoS One 2017; 12:e0181338. [PMID: 28723925 PMCID: PMC5517002 DOI: 10.1371/journal.pone.0181338] [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: 02/26/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives Influenza infection is a significant cause of respiratory morbidity among pregnant women. Seasonal influenza vaccination engages innate immune receptors to promote protective immunity. A coding polymorphism (R620W) in PTPN22 imparts elevated risk for human infection and autoimmune disease, predisposes to diminished innate immune responses, and associates with reduced immunization responses. We sought to quantify the effects of PTPN22-R620W on humoral and cell-mediated immune responses to the inactivated influenza vaccine among healthy pregnant women. Study Design Immune responses were measured in healthy pregnant R620W carrier (n = 17) and non-carrier (n = 33) women receiving the 2013 quadrivalent inactivated influenza vaccine (Fluzone). Hemagglutination inhibition assays were performed to quantify neutralizing antibodies; functional influenza-reactive CD4 T cells were quantified by flow cytometry, and influenza-specific CD8 T cells were enumerated with MHC Class I tetramers. Antibody seroconversion data were evaluated by Chi-square analysis, and the Mann-Whitney or Wilcoxon signed-rank tests were applied to T cell response data. Results PTPN22 R620W carrier (n = 17) and non-carrier (n = 33) groups did not differ in age, parity, BMI, gestational age at time of vaccine, or history of prior influenza vaccination. After Fluzone exposure, 51.5% of non-carriers met criteria for antibody seroconversion to H1N1 influenza, compared with 23.5% of R620W carriers (p = 0.06). Influenza-reactive CD4 T cells showed modest increase at days 9–15 after vaccination in both R620W carriers and non-carriers (p = 0.02 and p = 0.04, respectively). However, there was no difference in overall response between the two groups (p = 0.6). The vaccine did not result in significant induction of influenza-specific CD8 T cells in either group. Conclusions There was no significant difference among healthy pregnant R620W carriers and non-carriers in H1N1 antibody seroconversion rates after influenza vaccination. Studies of larger cohorts will be needed to define the effect of PTPN22 risk allele carriage on antibody and T cell responses to influenza vaccination during pregnancy.
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15
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Abu Raya B, Edwards KM, Scheifele DW, Halperin SA. Pertussis and influenza immunisation during pregnancy: a landscape review. THE LANCET. INFECTIOUS DISEASES 2017; 17:e209-e222. [DOI: 10.1016/s1473-3099(17)30190-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 01/25/2017] [Accepted: 02/07/2017] [Indexed: 12/21/2022]
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16
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Edwards K, Creech C. Vaccine Development in Special Populations. HUMAN VACCINES 2017. [DOI: 10.1016/b978-0-12-802302-0.00007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Effect of Maternal Influenza Vaccination on Hospitalization for Respiratory Infections in Newborns: A Retrospective Cohort Study. Pediatr Infect Dis J 2016; 35:1097-103. [PMID: 27314823 DOI: 10.1097/inf.0000000000001258] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants are at increased risk of hospitalization for influenza. Although vaccinating women during pregnancy has been shown to reduce the incidence of influenza infection among newborns, population-based data are limited. METHODS A population-based cohort of 31,028 mothers and singleton infants were included in the analysis. Hospitalizations with a principal diagnosis or additional diagnoses consistent with severe respiratory illness occurring during the 2012 and 2013 southern hemisphere influenza seasons were identified using a state-wide hospital discharge database. Newborns were defined as "maternally vaccinated" if the mother received influenza vaccine ≥14 days before delivery. Cox regression models were used to estimate adjusted hazard ratios for hospitalization. RESULTS A total of 3169 infants were maternally vaccinated and 27,859 were unvaccinated; 732 hospitalizations were identified, 528 (69%) of which were for bronchiolitis. There were 21.9 hospitalizations per 100,000 person days among maternally vaccinated infants and 30.2 hospitalizations per 100,000 person days among unvaccinated infants. Maternally vaccinated infants were 25% less likely to be hospitalized for an acute respiratory illness during influenza season compared with unvaccinated infants (adjusted hazard ratio: 0.75, 95% confidence interval: 0.56-0.99, P = 0.04). Vaccinations administered in the third trimester were associated with a 33% reduction in the risk of newborn hospitalization (adjusted hazard ratio: 0.67, 95% confidence interval: 0.47-0.95, P = 0.03). No such reduction was identified for vaccinations administered earlier in pregnancy. CONCLUSIONS Maternal influenza vaccination was associated with a reduction in the incidence of hospital admission for acute respiratory illness among infants <6 months of age. These data suggest that vaccination during third trimester may provide optimal benefit to the newborn.
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Holbrook BC, D'Agostino RB, Parks GD, Alexander-Miller MA. Adjuvanting an inactivated influenza vaccine with flagellin improves the function and quantity of the long-term antibody response in a nonhuman primate neonate model. Vaccine 2016; 34:4712-4717. [PMID: 27516064 DOI: 10.1016/j.vaccine.2016.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 01/07/2023]
Abstract
Young infants are at significantly increased risk of developing severe disease following infection with influenza virus. At present there is no approved vaccine for individuals below the age of six months given previous studies showing a failure of these individuals to efficiently seroconvert. Given the major impact of influenza on infant health, it is critical that we develop vaccines that will be safe and effective in this population. Using a nonhuman primate (NHP) model, we have evaluated the ability of an inactivated influenza virus vaccine adjuvanted with flagellin to result in long term immune responses in neonates. To evaluate this critical attribute, neonate NHP were vaccinated and boosted with inactivated influenza virus in combination with either flagellin or a mutant inactive flagellin control. Our studies show that inclusion of flagellin resulted in a significant increase (5-fold, p=0.04) in influenza virus-specific IgG antibody at 6months post-vaccination. In addition, the antibody present at this late time was of higher affinity (2.4-fold, p=0.02). Finally a greater percentage of infants had detectable neutralizing antibody. These results support the use of flagellin in neonates as an adjuvant that promotes long-lived, high affinity antibody responses.
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Affiliation(s)
- Beth C Holbrook
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Griffith D Parks
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Martha A Alexander-Miller
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
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19
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Sakala IG, Honda-Okubo Y, Fung J, Petrovsky N. Influenza immunization during pregnancy: Benefits for mother and infant. Hum Vaccin Immunother 2016; 12:3065-3071. [PMID: 27494630 DOI: 10.1080/21645515.2016.1215392] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The serious consequences of influenza infection during pregnancy have been recognized for almost a century. In this article, we reviewed the evidence on the immunogenicity, safety and impact of maternal influenza immunization for both mother and child. After vaccination, pregnant women have similar protective titers of anti-influenza antibodies as non-pregnant women, demonstrating that pregnancy does not alter the trivalent inactivated influenza vaccine immune response. Studies from the United States, Europe and resource-constrained regions demonstrate that maternal vaccination is associated with increased anti-influenza antibody concentrations and protection in the newborn child as well as the immunized mother. Given the acceptable safety profile of influenza vaccines and the World Health Organization's recommendation for its use in pregnant women, maternal vaccination with inactivated influenza vaccine is a cost-effective approach to decrease influenza disease in newborns. However, as seen for influenza immunization in the elderly, the protective efficacy of current inactivated vaccines in protection of newborns is 50% at best, indicating significant room for vaccine improvement, which could potentially be achieved by addition of a safe and effective adjuvant. Thus, global deployment of inactivated influenza immunization during pregnancy would have substantial and measurable health benefits for mothers and their newborns.
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Affiliation(s)
- Isaac G Sakala
- a Vaxine Pty Ltd , Bedford Park, Adelaide , Australia.,b Department of Diabetes and Endocrinology , Flinders University , Adelaide , Australia
| | - Yoshikazu Honda-Okubo
- a Vaxine Pty Ltd , Bedford Park, Adelaide , Australia.,b Department of Diabetes and Endocrinology , Flinders University , Adelaide , Australia
| | - Johnson Fung
- a Vaxine Pty Ltd , Bedford Park, Adelaide , Australia
| | - Nikolai Petrovsky
- a Vaxine Pty Ltd , Bedford Park, Adelaide , Australia.,b Department of Diabetes and Endocrinology , Flinders University , Adelaide , Australia
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Fell DB, Wilson K, Ducharme R, Hawken S, Sprague AE, Kwong JC, Smith G, Wen SW, Walker MC. Infant Respiratory Outcomes Associated with Prenatal Exposure to Maternal 2009 A/H1N1 Influenza Vaccination. PLoS One 2016; 11:e0160342. [PMID: 27486858 PMCID: PMC4972313 DOI: 10.1371/journal.pone.0160342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/18/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Infants are at high risk for influenza illness, but are ineligible for vaccination before 6 months. Transfer of maternal antibodies to the fetus has been demonstrated for 2009 A/H1N1 pandemic vaccines; however, clinical effectiveness is unknown. Our objective was to evaluate the association between 2009 A/H1N1 pandemic vaccination during pregnancy and rates of infant influenza and pneumonia. METHODS We linked a population-based birth cohort to administrative databases to measure rates of influenza and pneumonia diagnosed during ambulatory physician visits, hospitalizations and emergency department visits during one year of follow-up. We estimated incidence rate ratios and 95% confidence intervals (95% CI) using Poisson regression, comparing infants born to A/H1N1-vaccinated women (vaccine-exposed infants) with unexposed infants, adjusted for confounding using high-dimensional propensity scores. RESULTS Among 117,335 infants in the study, 36,033 (31%) were born to A/H1N1-vaccinated women. Crude rates of influenza during the pandemic (per 100,000 infant-days) for vaccine-exposed and unexposed infants were similar (2.19, 95% CI: 1.27-3.76 and 3.60, 95% CI: 2.51-5.14, respectively), as were crude rates of influenza and pneumonia combined. We did not observe any significant differences in rates of study outcomes between study groups during the second wave of the 2009 A/H1N1 pandemic, nor during any post-pandemic time period. CONCLUSION We observed no difference in rates of study outcomes among infants born to A/H1N1-vaccinated mothers relative to unexposed infants born during the second A/H1N1 pandemic wave; however, due to late availability of the pandemic vaccine, the available follow-up time during the pandemic time period was very limited.
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MESH Headings
- Adult
- Cohort Studies
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/adverse effects
- Influenza Vaccines/therapeutic use
- Influenza, Human/congenital
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Male
- Middle Aged
- Pneumonia/congenital
- Pneumonia/epidemiology
- Pneumonia/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects/epidemiology
- Prenatal Exposure Delayed Effects/etiology
- Prenatal Exposure Delayed Effects/immunology
- Respiratory Distress Syndrome, Newborn/epidemiology
- Respiratory Distress Syndrome, Newborn/etiology
- Retrospective Studies
- Treatment Outcome
- Vaccination/adverse effects
- Vaccination/statistics & numerical data
- Young Adult
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Affiliation(s)
- Deshayne B. Fell
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Ducharme
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann E. Sprague
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Graeme Smith
- Department of Obstetrics & Gynaecology, Queen’s University, Kingston, Ontario, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark C. Walker
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
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21
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Sugimura T, Nagai T, Kobayashi H, Ozaki Y, Yamakawa R, Hirata R. Effectiveness of maternal influenza immunization in young infants in Japan. Pediatr Int 2016; 58:709-13. [PMID: 26670462 DOI: 10.1111/ped.12888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infants with influenza, particularly those younger than 1 year of age, are at high risk of developing a severe case or of dying. Recently, owing to the spread of pandemic influenza A (H1N1) 2009, the Advisory Committee on Immunization Practices recommended maternal immunization to reduce the risk of influenza infection in pregnant women and infants. Such reporting is rare in Japan. The aim of this study was therefore to investigate the effect on the newborn of influenza vaccination of pregnant women in Japan. METHODS The study included 200 infants who were born to healthy mothers at Kobayashi Ladies Clinic during influenza season from November 2010 to April 2011. The incidence of fever and laboratory-confirmed influenza was assessed in the infants for the 6 months after their birth. RESULTS Of the 200 infants, four were excluded from this study due to loss to follow up. The 106 infants in the group whose mothers received the influenza vaccine (vaccinated group) before parturition were compared with the 90 infants in the group whose mothers did not receive the influenza vaccine (non-vaccinated group). Fever was noted in 36 infants (34.0%) in the vaccinated group and in 47 infants (52.2%) in the non-vaccinated group (P < 0.007), and the incidence of influenza was 0 (0%) and 5 (5.6%), respectively (P = 0.019). The incidence of fever and influenza among infants was significantly lower in the vaccinated group compared with the non-vaccinated group. CONCLUSIONS Maternal influenza immunization should be actively recommended in Japan to protect newborns from influenza viruses.
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Affiliation(s)
- Tetsu Sugimura
- Department of Pediatrics and Allergology, Sugimura Children's Medical Clinic, Chikugo, Fukuoka, Japan
| | - Takao Nagai
- Department of Pediatrics, Nagai Children's Clinic, Takamatsu, Kagawa, Japan
| | - Hiroshi Kobayashi
- Department of Obstetrics, Gynecology and Anesthesiology, Kobayashi Ladies Clinic, Chikugo, Fukuoka, Japan
| | - Yukiko Ozaki
- Department of Pediatrics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Rumi Yamakawa
- Department of Pediatrics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Rumiko Hirata
- Department of Pediatrics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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22
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Loubet P, Loulergue P, Galtier F, Launay O. Seasonal influenza vaccination of high-risk adults. Expert Rev Vaccines 2016; 15:1507-1518. [PMID: 27169689 DOI: 10.1080/14760584.2016.1188696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Adults at a high risk of severe influenza, because of their age and/or underlying health disorders, should receive seasonal influenza vaccination in order to reduce the incidence of severe illness and premature death. However, because current influenza vaccines are perceived to have suboptimal efficacy, vaccine coverage is below the recommended level in this population. Areas covered: This review examines, for each high-risk group, available data on influenza infection, vaccine efficacy and safety, and vaccine coverage. We conducted a literature search in the PubMed database to identify randomized controlled trials, observational studies and reviews published from 2000 through 2015 on both seasonal and pandemic influenza. Only studies published in English were considered. While the topic of this review is seasonal influenza, data on pandemics are included when relevant. Expert Commentary: Current seasonal influenza vaccines are only moderately protective, and vaccines eliciting broader and more durable immunity are therefore needed. Research on the use of higher doses, adjuvants, and a universal influenza vaccine is ongoing. Influenza vaccine coverage needs to be increased. Vaccination of contacts of high-risk individuals, including healthcare workers, should be encouraged.
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Affiliation(s)
- Paul Loubet
- a Inserm, CIC 1417 , Paris , France.,b Department of Infectious Diseases , Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Broca Hôtel-Dieu hospital, CIC Cochin Pasteur , Paris , France
| | - Pierre Loulergue
- a Inserm, CIC 1417 , Paris , France.,b Department of Infectious Diseases , Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Broca Hôtel-Dieu hospital, CIC Cochin Pasteur , Paris , France.,c Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC) , Paris , France
| | - Florence Galtier
- c Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC) , Paris , France.,d CHRU de Montpellier, CIC 1411, Hôpital Saint-Eloi , Montpellier , France
| | - Odile Launay
- a Inserm, CIC 1417 , Paris , France.,b Department of Infectious Diseases , Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Broca Hôtel-Dieu hospital, CIC Cochin Pasteur , Paris , France.,c Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC) , Paris , France.,e Université Paris Descartes, Sorbonne Paris Cité , Paris , France
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23
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Phadke VK, Omer SB. Maternal vaccination for the prevention of influenza: current status and hopes for the future. Expert Rev Vaccines 2016; 15:1255-80. [PMID: 27070268 DOI: 10.1080/14760584.2016.1175304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Influenza is an important cause of morbidity and mortality among pregnant women and young infants, and influenza infection during pregnancy has also been associated with adverse obstetric and birth outcomes. There is substantial evidence - from randomized trials and observational studies - that maternal influenza immunization can protect pregnant women and their infants from influenza disease. In addition, there is compelling observational evidence that prevention of influenza in pregnant women can also protect against certain adverse pregnancy outcomes, including stillbirth and preterm birth. In this article we will review and evaluate the literature on both the burden of influenza disease in pregnant women and infants, as well as the multiple potential benefits of maternal influenza immunization for mother, fetus, and infant. We will also review key clinical aspects of maternal influenza immunization, as well as identify remaining knowledge gaps, and discuss avenues for future investigation.
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Affiliation(s)
- Varun K Phadke
- a Division of Infectious Diseases, School of Medicine , Emory University , Atlanta , GA , USA
| | - Saad B Omer
- b Department of Pediatrics, School of Medicine , Emory University , Atlanta , GA , USA.,c Departments of Global Health and Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,d Emory Vaccine Center , Emory University , Atlanta , GA , USA
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24
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Kay AW, Bayless NL, Fukuyama J, Aziz N, Dekker CL, Mackey S, Swan GE, Davis MM, Blish CA. Pregnancy Does Not Attenuate the Antibody or Plasmablast Response to Inactivated Influenza Vaccine. J Infect Dis 2015; 212:861-70. [PMID: 25740957 PMCID: PMC4548461 DOI: 10.1093/infdis/jiv138] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/26/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Inactivated influenza vaccine (IIV) is recommended during pregnancy to prevent influenza infection and its complications in pregnant women and their infants. However, the extent to which pregnancy modifies the antibody response to vaccination remains unclear, and prior studies have focused primarily on hemagglutinin inhibition (HI) titers. A more comprehensive understanding of how pregnancy modifies the humoral immune response to influenza vaccination will aid in maximizing vaccine efficacy. METHODS Healthy pregnant women and control women were studied prior to, 7 days after, and 28 days after vaccination with IIV. HI titers, microneutralization (MN) titers, and the frequency of circulating plasmablasts were evaluated in pregnant versus control women. RESULTS Pregnant women and control women mount similarly robust serologic immune responses to IIV, with no significant differences for any influenza strain in postvaccination geometric mean HI or MN titers. HI and MN titers correlate, though MN titers demonstrate more robust changes pre- versus postvaccination. The induction of circulating plasmablasts is increased in pregnant women versus controls (median fold-change 2.60 vs 1.49 [interquartile range, 0.94-7.53 vs 0.63-2.67]; P = .03). CONCLUSIONS Pregnant women do not have impaired humoral immune responses to IIV and may have increased circulating plasmablast production compared to control women.
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Affiliation(s)
| | | | | | | | | | | | - Gary E. Swan
- Stanford Prevention Research Center, Department of Medicine
| | - Mark M. Davis
- Stanford Immunology, Stanford University School of Medicine
- Department of Microbiology & Immunology
| | - Catherine A. Blish
- Stanford Immunology, Stanford University School of Medicine
- Department of Medicine, Stanford University School of Medicine, California
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25
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Helmig RB, Maimburg RD, Erikstrup C, Nielsen HS, Petersen OB, Nielsen LP, Hvidman L, Veirum JE, Henriksen TB, Storgaard M. Antibody response to influenza A(H1N1)pdm09 in vaccinated, serologically infected and unaffected pregnant women and their newborns. Acta Obstet Gynecol Scand 2015; 94:833-9. [PMID: 25958884 PMCID: PMC4745092 DOI: 10.1111/aogs.12668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 04/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the serological response in pregnant Danish women immunized during the 2009 pandemic by serologic infection or by vaccination with influenza A(H1N1) Pandemrix(®) and describe levels of passively acquired maternal antibody in their offspring. DESIGN Observational cohort study. SETTING Department of Obstetrics, Aarhus University Hospital, Skejby, Denmark, October to December 2009. POPULATION Pregnant women and their offspring METHODS Serological analysis of antibodies to influenza A(H1N1)pdm09 by hemagglutination inhibition assay in 197 women and their offspring. Blood samples were collected consecutively at delivery from the mother and the umbilical cord. In a subgroup of 124 of the 197 women, an additional blood sample from gestational weeks 9-12 was available for analysis. MAIN OUTCOME MEASURES Seroconversion, geometric mean titer, geometric mean-fold rise and protective antibodies. RESULTS 33 of the 124 subgroup women (27%) seroconverted during pregnancy, 79% after vaccination and 17% after serologic infection (p < 0.001). The geometric mean titer after delivery in non-vaccinated, non-serologically infected women was 17.1 (95%CI 15.7-18.6). The geometric mean titer increased significantly after serologic infection with H1N1 [76.5 (95%CI 51.3-113.9), p < 0.001] and after vaccination [589.6 (95%CI 339.3-1024.7), p < 0.001]. The geometric mean-fold rise (mother at delivery/mother early pregnancy) was significantly higher after vaccination [2.23 (1.93-2.54)] than after serologic infection [1.73 (1.59-1.87), p = 0.013]. In newborns of vaccinated mothers, 89.5% had protective antibody levels compared with 15.8% in newborns of serologically infected mothers (p < 0.001). CONCLUSIONS Influenza vaccination during pregnancy confers passive immunity to the newborn.
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Affiliation(s)
- Rikke B Helmig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - Rikke D Maimburg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | | | - Henriette S Nielsen
- Department of Microbiological Diagnostics and Virology, Statens Seruminstitut, Copenhagen, Denmark
| | - Olav B Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - Lars P Nielsen
- Department of Microbiological Diagnostics and Virology, Statens Seruminstitut, Copenhagen, Denmark
- Health Sciences, Aalborg University, Aalborg, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - Jens E Veirum
- Pediatric Department, Aarhus University Hospital, Skejby, Denmark
| | - Tine B Henriksen
- Pediatric Department, Aarhus University Hospital, Skejby, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
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26
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Nunes MC, Cutland CL, Dighero B, Bate J, Jones S, Hugo A, van Niekerk N, Kuwanda L, Izu A, Weinberg A, Madhi SA. Kinetics of Hemagglutination-Inhibiting Antibodies Following Maternal Influenza Vaccination Among Mothers With and Those Without HIV Infection and Their Infants. J Infect Dis 2015; 212:1976-87. [PMID: 26080370 DOI: 10.1093/infdis/jiv339] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/09/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We evaluated the immunogenicity of trivalent inactivated influenza vaccine (IIV3) in pregnant women with and those without human immunodeficiency virus (HIV) infection and the persistence of hemagglutination-inhibiting antibodies in mothers and infants. METHODS Antibodies were measured before vaccination, 1 month after vaccination, at delivery, and at postpartum week 24 in mothers and within 1 week of birth and at 8, 16, and 24 weeks of age in infants. RESULTS We enrolled 98 HIV-uninfected and 100 HIV-infected pregnant women, including 93% with a CD4(+) T-cell count of ≥ 200 cells/µL. Compared with HIV-uninfected women, HIV-infected women had lower seroconversion rates (ranging from 63%-92% vs 36%-40%), lower antibody titers through postpartum week 24, and overlapping antibody half-lives (ranging from 106-121 vs 87-153 days). Infant titers were lower than the maternal titers within 1 week of delivery, regardless of vaccine strain and HIV exposure status. Compared with HIV-unexposed infants, HIV-exposed infants had a similar transplacental influenza virus antibody transfer ratio, lower titers, and a lower frequency of titers ≥ 1:40 (ranging from 82%-95% vs 43%-79%) at birth and higher antibody half-lives (ranging from 43-45 vs 56-65 days). CONCLUSIONS Compared with HIV-uninfected pregnant women, HIV-infected pregnant women had lower antibody responses and persistence. Compared with HIV-unexposed infants, HIV-exposed infants had lower antibody levels at birth but similar antibody levels after 8 weeks of life. Early IIV3 administration during pregnancy did not decrease antibody titers among infants at birth.
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Affiliation(s)
- Marta C Nunes
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Clare L Cutland
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Bonnie Dighero
- Department of Pediatrics, University of Colorado, Aurora Department of Medicine, University of Colorado, Aurora Department of Pathology, University of Colorado, Aurora
| | - Janie Bate
- Department of Pediatrics, University of Colorado, Aurora Department of Medicine, University of Colorado, Aurora Department of Pathology, University of Colorado, Aurora
| | - Stephanie Jones
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Andrea Hugo
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Nadia van Niekerk
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Locadiah Kuwanda
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Alane Izu
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado, Aurora Department of Medicine, University of Colorado, Aurora Department of Pathology, University of Colorado, Aurora
| | - Shabir A Madhi
- Vaccine Preventable Diseases Unit, Department of Science and Technology, National Research Foundation Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, University of the Witwatersrand National Institute for Communicable Diseases, National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa
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27
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Meijer WJ, van Noortwijk AGA, Bruinse HW, Wensing AMJ. Influenza virus infection in pregnancy: a review. Acta Obstet Gynecol Scand 2015; 94:797-819. [PMID: 26012384 DOI: 10.1111/aogs.12680] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/24/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Influenza virus infection is very common and a significant cause of morbidity and mortality in specific populations like pregnant women. Following the 2009 pandemic, several reports on the effects of influenza virus infection on maternal health and pregnancy outcome have been published. Also the safety and efficacy of antiviral treatment and vaccination of pregnant women have been studied. In this review, we have analyzed and summarized these data. OBJECTIVE To provide information on the influence of influenza virus infection during pregnancy on maternal health and pregnancy outcome and on the effect of treatment and vaccination. DATA SOURCES We have searched Medline, Embase and the Cochrane Library. We used influenza, influenz*, pregnancy and pregnan* as search terms. STUDY SELECTION In total, 294 reports were reviewed and judged according to the STROBE guidelines or CONSORT statement. In all, 100 studies, published between 1961 and 2015, were included. RESULTS Compared to the general population, pregnant women are more often hospitalized and admitted to an intensive care unit due to influenza virus infection. For hospitalized patients, increased rates of preterm birth and fetal/neonatal death are reported. Early treatment with oseltamivir is associated with a reduced risk of severe disease. Vaccination of pregnant women is safe and reduces maternal and neonatal morbidity. CONCLUSIONS There is level 2b evidence that maternal health and pregnancy outcome can be severely affected by influenza virus infection. Antiviral treatment may diminish these effects and vaccination protects pregnant women and neonates from infection (level of evidence 2b and 1b, respectively).
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Affiliation(s)
- Wouter J Meijer
- Perinatal Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Hein W Bruinse
- Perinatal Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemarie M J Wensing
- Department of Virology, Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
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28
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Kay AW, Blish CA. Immunogenicity and Clinical Efficacy of Influenza Vaccination in Pregnancy. Front Immunol 2015; 6:289. [PMID: 26089824 PMCID: PMC4455389 DOI: 10.3389/fimmu.2015.00289] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/19/2015] [Indexed: 11/13/2022] Open
Abstract
Pregnant women are at high risk from influenza due to disproportionate morbidity, mortality, and adverse pregnancy outcomes following infection. As such, they are classified as a high-priority group for vaccination. However, changes in the maternal immune system required to accommodate the allogeneic fetus may alter the immunogenicity of influenza vaccines. A large number of studies have evaluated the safety of the influenza vaccine. Here, we will review available studies on the immunogenicity and efficacy of the influenza vaccine during pregnancy, focusing on both humoral and cellular immunity.
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Affiliation(s)
- Alexander W Kay
- Blish Laboratory, Department of Pediatrics, Stanford University School of Medicine , Stanford, CA , USA
| | - Catherine A Blish
- Blish Laboratory, Department of Medicine and Stanford Immunology, Stanford University School of Medicine , Stanford, CA , USA
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29
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Gabas T, Leruez-Ville M, Le Mercier D, Lortholary O, Lecuit M, Charlier C. [Influenza and pregnancy]. Presse Med 2015; 44:639-46. [PMID: 26033556 DOI: 10.1016/j.lpm.2015.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022] Open
Abstract
Influenza is a respiratory disease caused by influenza viruses. The virus is responsible for pandemics by emergence of new viral strains, then for seasonal flu by antigenic drift. Seasonal flu is more frequent and severe in pregnant women, with increased risk of pneumonia and increased risk of hospitalization (but no increased death reported). Pandemic flu is more severe in pregnant women, with increased risk of pneumonia and increased mortality. Influenza vaccination is recommended for all women who are or will be pregnant (in any trimester) during influenza season. After closed contact with a flu case or in case of symptoms compatible with flu, early oseltamivir-based treatment (prophylactic in the first situation, curative in the latter one) is recommended, at any term of pregnancy. The occurrence of flu symptoms in a pregnant woman requires medical evaluation to confirm the diagnosis or identify any alternative infection requiring appropriate therapy like listeriosis, chorioamniotitis, pyelonephritis or viral primo-infection.
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Affiliation(s)
- Thomas Gabas
- Assistance publique-Hôpitaux de Paris, université Paris Descartes Sorbonne Paris Cité, hôpital universitaire Necker-Enfants-Malades, centre d'infectiologie Necker-Pasteur, institut Imagine, service de maladies infectieuses et tropicales, 75015 Paris, France
| | - Marianne Leruez-Ville
- Assistance publique-Hôpitaux de Paris, université Paris Descartes Sorbonne Paris Cité, hôpital universitaire Necker-Enfants-Malades, service de microbiologie, 75015 Paris, France
| | - Delphine Le Mercier
- Assistance publique-Hôpitaux de Paris, université Paris Descartes Sorbonne Paris Cité, hôpital universitaire Necker-Enfants-Malades, service d'obstétrique, 75015 Paris, France
| | - Olivier Lortholary
- Assistance publique-Hôpitaux de Paris, université Paris Descartes Sorbonne Paris Cité, hôpital universitaire Necker-Enfants-Malades, centre d'infectiologie Necker-Pasteur, institut Imagine, service de maladies infectieuses et tropicales, 75015 Paris, France
| | - Marc Lecuit
- Assistance publique-Hôpitaux de Paris, université Paris Descartes Sorbonne Paris Cité, hôpital universitaire Necker-Enfants-Malades, centre d'infectiologie Necker-Pasteur, institut Imagine, service de maladies infectieuses et tropicales, 75015 Paris, France; Institut Pasteur, unité de biologie des infections, Inserm U1117, 75015 Paris, France
| | - Caroline Charlier
- Assistance publique-Hôpitaux de Paris, université Paris Descartes Sorbonne Paris Cité, hôpital universitaire Necker-Enfants-Malades, centre d'infectiologie Necker-Pasteur, institut Imagine, service de maladies infectieuses et tropicales, 75015 Paris, France; Institut Pasteur, unité de biologie des infections, Inserm U1117, 75015 Paris, France.
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30
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Manske JM. Efficacy and effectiveness of maternal influenza vaccination during pregnancy: a review of the evidence. Matern Child Health J 2015; 18:1599-609. [PMID: 24272875 DOI: 10.1007/s10995-013-1399-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Influenza vaccine is universally recommended for pregnant women during any trimester of pregnancy. In light of this recommendation, a comprehensive literature review was conducted to examine the available evidence regarding influenza vaccine efficacy and effectiveness during pregnancy. A comprehensive Medline search identified potentially relevant articles published between January 1, 1964 and February 1, 2013. Articles were selected that specifically evaluated the efficacy and effectiveness of maternal influenza vaccine in protecting women and infants from influenza infection. These were reviewed with a particular focus on the methods used to confirm influenza infection. Ten of 476 articles met the inclusion criteria. None of the six studies evaluating maternal outcomes were randomized controlled studies using a laboratory-confirmed influenza diagnosis to measure vaccine efficacy. Two studies included reverse-transcriptase polymerase chain reaction confirmation; four relied solely on clinical outcomes. The reported vaccine effectiveness (VE) ranged from -15 to 70 %. Seven studies examined the potential for maternal vaccination to protect infants. Four of these applied some form of laboratory confirmation, with VE ranging from 41 to 91 %. Vaccination against infectious disease is an unparalleled public health success. However, studies to date demonstrate that influenza vaccine provides only moderate protection from influenza infection in pregnant women. This review found broad heterogeneity among studies, with no uniform outcome measured and little data based on laboratory-confirmed influenza, leading to wide-ranging estimates of effectiveness. Rigorously designed studies assessing clearly defined outcomes are needed to support the development of reasoned public health policy about influenza prevention in this population.
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Affiliation(s)
- Jill M Manske
- Department of Biology, University of St. Thomas, St. Paul, MN, 55105, USA,
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Ghesquière L, Deruelle P, Charbonneau P, Puech F. [Epidemiology of maternal mortality by infectious cause in France, 2007-2009, using data from confidential maternal mortality report]. J Gynecol Obstet Hum Reprod 2015; 44:1-9. [PMID: 25060866 DOI: 10.1016/j.jgyn.2014.05.013] [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: 05/08/2014] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 06/03/2023]
Abstract
Although deaths caused by infection during pregnancy and the postpartum period are rare in France, mortality rates have increased in several countries of the European community. In France, the rate of maternal mortality by infectious cause has decreased over the last 12 years. Infectious causes are currently in fifth place of maternal deaths. Over the period 2007-2009, 18 deaths occurred, eight by direct infectious causes and 10 by indirect infectious causes. Among the 18 deaths, 17 were examined by the National Expert Committee on Maternal Mortality (CNEMM) with the objectives to determine the direct or indirect link with pregnancy, the adequacy of care and the preventability of death. Among 8 deaths from direct infectious causes, four deaths were deemed "preventable" or "possibly preventable" because of inadequate care. Among nine deaths from indirect infectious causes, preventability could not be established in two deaths, five were non-preventable and two were preventable due to non-optimal care. These cases of puerperal septicemia show that when sepsis is clinically manifest, infection is already well established and widespread deterioration is therefore often irreversible. Maternal mortality is preventable in most cases if several points are observed: early diagnosis, probabilistic antibiotics targeting most frequently involved bacteria including Escherichia coli and Streptococcus A, early transfer to ICU, control septic portal entry, simple preventive measures, influenza vaccination. A "microbiological clinical diagnosis" approach must be initiated at the first clinical signs.
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Affiliation(s)
- L Ghesquière
- Pôle Femme-Mère-Nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - P Deruelle
- Pôle Femme-Mère-Nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; EA4489, environnement périnatal et croissance, faculté de médecine. université Lille 2, 59800 Lille, France.
| | - P Charbonneau
- Comité national d'experts sur la mortalité maternelle (CNEMM), 59800 Lille, France
| | - F Puech
- Faculté de médecine, université droit et santé Lille II, Comité national d'experts sur la mortalité maternelle (CNEMM), 59800 Lille, France
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Abstract
Pregnant women are at risk for the same infectious diseases as nonpregnant individuals and often have increased morbidity and mortality associated with infection. Thus, immunizing women during pregnancy with recommended vaccines provides direct maternal benefit. Furthermore, maternal immunization has the potential for both fetal and infant benefit by preventing adverse pregnancy outcomes and infection during early life through passive immunity. This article reviews current knowledge on the importance and benefits of maternal immunization, which are 3-fold: protecting the mother from antepartum infection; reducing poor pregnancy and fetal outcomes; and providing immunity for infants during the first few months of life.
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Loubet P, Kerneis S, Anselem O, Tsatsaris V, Goffinet F, Launay O. Should expectant mothers be vaccinated against flu? A safety review. Expert Opin Drug Saf 2014; 13:1709-20. [DOI: 10.1517/14740338.2014.977252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Influenza poses unique risks to pregnant women, who are particularly susceptible to morbidity and mortality. Historically, pregnant women have been overrepresented among patients with severe illness and complications from influenza, and have been more likely to require hospitalization and intensive care unit admission. An increased risk of adverse outcomes is also present for fetuses/neonates born to women affected by influenza during pregnancy. These risks to mothers and babies have been observed during both nonpandemic and pandemic influenza seasons. During the H1N1 influenza pandemic of 2009-2010, pregnant women were more likely to be hospitalized or admitted to intensive care units, and were at higher risk of death compared to nonpregnant adults. Vaccination remains the most effective intervention to prevent severe illness, and antiviral medications are an important adjunct to ameliorate disease when it occurs. Unfortunately, despite national guidelines recommending universal vaccination for women who are pregnant during influenza season, actual vaccination rates do not achieve desired targets among pregnant women. Pregnant women are also sometimes reluctant to use antiviral medications during pregnancy. Some of the barriers to use of vaccines and medications during pregnancy are a lack of knowledge of recommendations and of safety data. By improving knowledge and understanding of influenza and vaccination recommendations, vaccine acceptance rates among pregnant women can be improved. Currently, the appropriate use of vaccination and antiviral medications is the best line of defense against influenza and its sequelae among pregnant women, and strategies to increase acceptance are crucial. This article will review the importance of influenza in pregnancy, and discuss vaccination and antiviral medications for pregnant women.
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Affiliation(s)
- Mark H Yudin
- The Department of Obstetrics and Gynecology, St Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada
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Fell DB, Dodds L, MacDonald NE, Allen VM, McNeil S. Influenza vaccination and fetal and neonatal outcomes. Expert Rev Vaccines 2014; 12:1417-30. [PMID: 24195480 DOI: 10.1586/14760584.2013.851607] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
As pregnant women are considered a high-risk group for severe influenza illness, current recommendations advise vaccination of all pregnant women with inactivated influenza vaccine. Nevertheless, rates of maternal influenza vaccination have historically been low, possibly reflecting ongoing concerns about vaccine safety. Until recently, the majority of evidence concerning safety of influenza vaccination during pregnancy was limited to post-marketing pharmacovigilance studies; however, in the past 5 years, one randomized clinical trial and a number of observational studies reflecting seasonal trivalent inactivated influenza vaccines and monovalent H1N1 influenza vaccines have been published. This review summarizes the evidence pertaining to fetal and neonatal outcomes following influenza vaccination during pregnancy for comparative analytic studies published between 2008 and August 2013. Since the majority of these studies are observational in nature, issues related to study quality are also addressed.
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Affiliation(s)
- Deshayne B Fell
- Better Outcomes Registry & Network [BORN] Ontario, Children's Hospital of Eastern Ontario Research Institute, Centre for Practice Changing Research, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
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McMillan M, Kralik D, Porritt K, Marshall H. Influenza vaccination during pregnancy: a systematic review of effectiveness and safety. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Vaccination against influenza is recommended during the vaccination period in pregnant women regardless of trimester. In contrast, administration of live vaccines, such as the vaccine against varicella, MMR (measles-mumps-rubella) is contraindicated in pregnant women. Vaccinations against hepatitis B, diphtheria, tetanus, poliomyelitis, hepatitis A can be made as indicated. Vaccination against yellow fever may be considered in pregnant women travelling to endemic countries. In post-partum period, live vaccines may be administered if necessary, especially vaccination against whooping cough for women not to date with their vaccinations. Vaccination against yellow fever is contraindicated in case of breast feeding. Prevention of pertussis in newborns is based in France on vaccination of the mothers in the post-partum period, and the close contacts of the newborn during the pregnancy ("cocooning").
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Seroprevalence of influenza A H1N1 and seroconversion of mothers and infants induced by a single dose of monovalent vaccine. Taiwan J Obstet Gynecol 2014; 52:356-9. [PMID: 24075373 DOI: 10.1016/j.tjog.2013.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the prevalence of preexisting antibodies against the pandemic 2009 Influenza A (H1N1) virus in pregnant women and to evaluate the seroprotection of the mothers and infants by a single injection of monovalent vaccine during the pandemic. MATERIALS AND METHODS Seropositivity rate of H1N1 among the nonvaccinated were compared with the vaccinated women. A single dose of vaccine, either nonadjuvanted AdimFlu-S or MF59-adjuvanted vaccine, was injected to the voluntarily vaccinated group. Maternal and cord blood sera were collected to evaluate the antibody response of the H1N1 virus. Seropositivity was defined as a hemagglutination inhibition titer to H1N1 (A/Taiwan/126/09) ≥ 1:40. RESULTS A total of 210 healthy, singleton, pregnant women were enrolled between January 2010 and May 2010. Seropositivity (≥ 1:40) of maternal hemagglutination inhibition was significantly higher in the vaccinated group (78%) than the nonvaccinated group (9.5%); 41.6% (20/48) of seropositive titers were >1:80. In nine vaccinated cases resulting in negative serum titers (<1:40), the prevalence of negative titer in the women received AdimFlu-S (14.8%, 4/31) was lower (p = 0.025) than those received MF59-adjuvanted vaccine (50%, 5/10). CONCLUSIONS Subclinical infection against H1N1 was low in Taiwanese pregnant women in the pandemic 2009. Seropositivity >75% could be achieved in the paired maternal and cord serum samples by a single injection of monovalent H1N1 vaccine.
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Demicheli V, Jefferson T, Al-Ansary LA, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev 2014:CD001269. [PMID: 24623315 DOI: 10.1002/14651858.cd001269.pub5] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Different types of influenza vaccines are currently produced worldwide. Vaccination of pregnant women is recommended internationally, while healthy adults are targeted in North America. OBJECTIVES To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harm) of vaccines against influenza in healthy adults, including pregnant women. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 2), MEDLINE (January 1966 to May 2013) and EMBASE (1990 to May 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy individuals aged 16 to 65 years. We also included comparative studies assessing serious and rare harms. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS We included 90 reports containing 116 data sets; among these 69 were clinical trials of over 70,000 people, 27 were comparative cohort studies (about eight million people) and 20 were case-control studies (nearly 25,000 people). We retrieved 23 reports of the effectiveness and safety of vaccine administration in pregnant women (about 1.6 million mother-child couples).The overall effectiveness of parenteral inactivated vaccine against influenza-like illness (ILI) is limited, corresponding to a number needed to vaccinate (NNV) of 40 (95% confidence interval (CI) 26 to 128). The overall efficacy of inactivated vaccines in preventing confirmed influenza has a NNV of 71 (95% CI 64 to 80). The difference between these two values depends on the different incidence of ILI and confirmed influenza among the study populations: 15.6% of unvaccinated participants versus 9.9% of vaccinated participants developed ILI symptoms, whilst only 2.4% and 1.1%, respectively, developed laboratory-confirmed influenza.No RCTs assessing vaccination in pregnant women were found. The only evidence available comes from observational studies with modest methodological quality. On this basis, vaccination shows very limited effects: NNV 92 (95% CI 63 to 201) against ILI in pregnant women and NNV 27 (95% CI 18 to 185) against laboratory-confirmed influenza in newborns from vaccinated women.Live aerosol vaccines have an overall effectiveness corresponding to a NNV 46 (95% CI 29 to 115).The performance of one-dose or two-dose whole virion pandemic vaccines was higher, showing a NNV of 16 (95% CI 14 to 20) against ILI and a NNV of 35 (95% CI 33 to 47) against influenza, while a limited impact on hospitalisation was found (NNV 94, 95% CI 70 to 1022).Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms. No evidence of association with serious adverse events was found, but the harms evidence base was limited.The overall risk of bias in the included trials is unclear because it was not possible to assess the real impact of bias. AUTHORS' CONCLUSIONS Influenza vaccines have a very modest effect in reducing influenza symptoms and working days lost in the general population, including pregnant women. No evidence of association between influenza vaccination and serious adverse events was found in the comparative studies considered in the review. This review includes 90 studies, 24 of which (26.7%) were funded totally or partially by industry. Out of the 48 RCTs, 17 were industry-funded (35.4%).
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Affiliation(s)
- Vittorio Demicheli
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Azienda Sanitaria Locale ASL AL, Via Venezia 6, Alessandria, Piemonte, 15121, Italy. .
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Hisano M, Yamaguchi K. Usefulness of influenza vaccination during pregnancy to mothers and young infants. Expert Rev Vaccines 2014; 11:903-5. [DOI: 10.1586/erv.12.67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Influenza vaccination given at least 2 weeks before delivery to pregnant women facilitates transmission of seroprotective influenza-specific antibodies to the newborn. Pediatr Infect Dis J 2013; 32:1374-80. [PMID: 24569309 DOI: 10.1097/01.inf.0000437066.40840.c4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pregnant women and infants are at higher risk of complications secondary to influenza infection. Immunization during pregnancy facilitates protection of the neonates through passive transfer of maternal antibodies. METHODS This was a cross-sectional study performed during the post-H1N1 pandemic winter season of 2010/2011 in Geneva, Switzerland. We measured antibody titers against the seasonal influenza A H1N1, H3N2 and B 2010/2011 strains by hemagglutination inhibition in the umbilical cord blood of newborns born to vaccinated and nonvaccinated mothers. Seroprotection was defined as a hemagglutination inhibition titer ≥ 40. RESULTS A total of 188 women were enrolled, 101 of whom had been vaccinated with a nonadjuvanted influenza vaccine (all during the second or third trimester) and the other 87 had not. Among newborns of vaccinated women, 84-86% showed seroprotective levels depending on the strain. In comparison, seroprotection rates were significantly lower in babies of nonvaccinated women (29-33%, P < 0.001). Adjusting for various confounding factors and applying multivariate regression analysis, vaccination during pregnancy ≥ 2 weeks before delivery increased geometric mean titers in umbilical cord blood 5-17 times and seroprotection rates 5.8-34.4 times, depending on the strain and the interval between vaccination and delivery. Vaccinating pregnant women only 2-4 weeks before delivery was still more effective than no vaccination at all (geometric mean titers increased 6.8-11.1 times and seroprotection rates increased 5.8-34.4 times compared with nonvaccinated women). CONCLUSIONS Influenza vaccination at any time during the second and third trimester of pregnancy, but at least 15 days before delivery, confers seroprotection to many neonates.
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Lin SY, Wu ET, Lin CH, Shyu MK, Lee CN. The safety and immunogenicity of trivalent inactivated influenza vaccination: a study of maternal-cord blood pairs in Taiwan. PLoS One 2013; 8:e62983. [PMID: 23762229 PMCID: PMC3675132 DOI: 10.1371/journal.pone.0062983] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 03/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background There are little data about adverse effects and immunogenicity of flu vaccine in Asian pregnant women. Methods This prospective trial (NCT01514708) enrolled 46 pregnant women who received a single intramuscular dose of trivalent flu vaccine (AdimFlu-S®) containing 15 mcg of hemagglutinin for each strain/0.5 mL from influenza A (H1N1), influenza A (H3N2), and influenza B after the first trimester. Blood samples were collected at day 0 and 28 after vaccination, and at delivery. Cord blood was also collected. Hemagglutination inhibition (HAI) assays were performed to determine seroprotection and seroconversion rates and fold increase in the HAI geometric mean titer (GMT). Results Twenty-eight days after vaccination the seroprotection rate against H1N1, H3N2, and influenza B was 91.3%, 84.8% and 56.5%, respectively. The GMT fold increase was 12.8, 8.4, and 4.6 for H1N1, H3N2, and influenza B, respectively. At delivery, both the seroprotection rate (86.4%, 68.2%, and 47.7%) and GMT fold increase (9.4, 5.7 and 3.8) were slightly lower than day 28. The seroprotection rate and GMT fold increase in maternal and cord blood samples were comparable. No significant adverse effects were detected. Conclusions Trivalent flu vaccine induces a strong immune response in pregnant women and their infants without adverse effects. Trial Registration Clinical Trials. gov NCT01514708
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Affiliation(s)
- Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin Chu branch, Hsin Chu, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - En-Tzu Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hui Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Kwang Shyu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Anselem O, Floret D, Tsatsaris V, Goffinet F, Launay O. [Influenza infection and pregnancy]. Presse Med 2013; 42:1453-60. [PMID: 23683385 DOI: 10.1016/j.lpm.2013.01.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/02/2013] [Accepted: 01/13/2013] [Indexed: 11/15/2022] Open
Abstract
Pregnant woman have an increased risk of respiratory complications and hospitalization related to influenza. The flu, like any systemic infection, may also be responsible for uterine contractions constituting a threat of miscarriage or premature labor according to gestational age at which it occurs. There is no specific recommendation regarding the management of influenza-like illness in pregnant women, but a nasopharyngeal sample can be performed in the presence of respiratory or general symptoms occurring during an epidemic to search influenza and establish if a specific treatment with oseltamivir (Tamiflu(®)). Surveillance in hospital or intensive care unit may be necessary. Vaccination against influenza provides a satisfactory immunity in pregnant women and reduces the risk of respiratory complications. Transplacental passage of maternal antibody protects newborns who are more likely to have severe influenza infection and because the vaccine cannot be administered before the age of 6 months. The available data show good tolerance influenza vaccination performed during pregnancy. Since 2012, vaccination against seasonal influenza is recommended for pregnant women, whatever the stage of pregnancy at the time of the vaccination campaign.
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Affiliation(s)
- Olivia Anselem
- Maternité Port-Royal, université Paris Descartes, DHU risques et grossesse, PRES Sorbonne Paris Cité, service de gynécologie et obstétrique de Port-Royal, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France(1).
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Bischoff AL, Følsgaard NV, Carson CG, Stokholm J, Pedersen L, Holmberg M, Bisgaard A, Birch S, Tsai TF, Bisgaard H. Altered response to A(H1N1)pnd09 vaccination in pregnant women: a single blinded randomized controlled trial. PLoS One 2013; 8:e56700. [PMID: 23637733 PMCID: PMC3630160 DOI: 10.1371/journal.pone.0056700] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/14/2013] [Indexed: 12/20/2022] Open
Abstract
Background Pregnant women were suspected to be at particular risk when H1N1pnd09 influenza became pandemic in 2009. Our primary objective was to compare the immune responses conferred by MF59®-adjuvanted vaccine (Focetria®) in H1N1pnd09-naïve pregnant and non-pregnant women. The secondary aims were to compare influences of dose and adjuvant on the immune response. Methods The study was nested in the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC2010) pregnancy cohort in 2009-2010 and conducted as a single-blinded block-randomised [1∶1∶1] controlled clinical trial in pregnant women after gestational week 20: (1) 7.5 µg H1N1pnd09 antigen with MF59-adjuvant (Pa7.5 µg); (2) 3.75 µg antigen half MF59-adjuvanted (Pa3.75 µg); (3) 15 µg antigen unadjuvanted (P15 µg); and in non-pregnant women receiving (4) 7.5 µg antigen full adjuvanted (NPa7.5 µg). Blood samples were collected at baseline, 3 weeks, 3 and 10 months after vaccination, adverse events were recorded prospectively. Results 58 pregnant women were allocated to Pa7.5 µg and 149 non-pregnant women were recruited to NPa7.5 µg. The sero-conversion rate was significantly increased in non-pregnant (NPa7.5 µg) compared with pregnant (Pa7.5 µg) women (OR = 2.48 [1.03–5.95], p = 0.04) and geometric mean titers trended towards being higher, but this difference was not statistically significant (ratio 1.27 [0.85–1.93], p = 0.23). The significant titer increase rate showed no difference between pregnant (Pa7.5 µg) and non-pregnant (NPa7.5 µg) groups (OR = 0.49 [0.13–1.85], p = 0.29). Conclusion Our study suggests the immune response to the 7.5 µg MF59-adjuvanted Focetria® H1N1pnd09 vaccine in pregnant women may be diminished compared with non-pregnant women. Trial Registration ClinicalTrials.gov NCT01012557.
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Affiliation(s)
- Anne Louise Bischoff
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Nilofar Vahman Følsgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Charlotte Giwercman Carson
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Louise Pedersen
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Maria Holmberg
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Amalie Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Sune Birch
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
| | - Theodore F. Tsai
- Novartis Vaccines, Cambridge, Massachusetts, United States of America
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Health Sciences, University of Copenhagen, Copenhagen University Hospital, Gentofte, Denmark
- * E-mail:
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Abzug MJ, Nachman SA, Muresan P, Handelsman E, Watts DH, Fenton T, Heckman B, Petzold E, Weinberg A, Levin MJ. Safety and immunogenicity of 2009 pH1N1 vaccination in HIV-infected pregnant women. Clin Infect Dis 2013; 56:1488-97. [PMID: 23378284 DOI: 10.1093/cid/cit057] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pregnant women infected with human immunodeficiency virus (HIV) may have particular vulnerability to 2009 pandemic H1N1 influenza (pH1N1) infection. The safety and immunogenicity of pH1N1 vaccination in HIV-infected pregnant women are unknown. METHODS HIV-infected women 18-39 years of age and 14-34 weeks' gestation on antiretroviral therapy received two 30-μg doses of unadjuvanted, inactivated pH1N1 vaccine 21 days apart. Hemagglutination inhibition titers were measured at entry, 21 days after dose 1, and 10 and 21 days after dose 2, and, in mothers and infants, at delivery and 3 and 6 months postdelivery. RESULTS No severe vaccine-related adverse events were observed among 127 subjects. At entry, 21% had seroprotective (≥1:40) titers. Seroprotection and seroresponse (≥4-fold rise) occurred in 73% and 66% after dose 1 and 80% and 72% after dose 2, respectively. Of women lacking seroprotection at entry, 66% attained seroprotection after dose 1 and 75% after dose 2. Seroprotective titers were present in 67% of mothers and 65% of infants at delivery (median 66 days after dose 2), 60% of mothers and 26% of infants at 3 months postdelivery, and 59% of mothers and 12% of infants at 6 months postdelivery. CONCLUSIONS Two 30-μg doses were moderately immunogenic in HIV-infected pregnant women. No concerning vaccine-related safety signals were observed. Seroprotection persisted in most women postpartum. Efficient transplacental antibody transfer occurred, but seroprotection in infants waned rapidly. Vaccination to protect HIV-infected pregnant women and their newborns from new influenza strains is feasible, but more immunogenic platforms should be evaluated. Clinical Trials Registration. NCT00992017.
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Affiliation(s)
- Mark J Abzug
- Department of Pediatrics, Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
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Launay O, Krivine A, Charlier C, Truster V, Tsatsaris V, Lepercq J, Ville Y, Avenell C, Andrieu T, Rozenberg F, Artiguebielle F, Tréluyer JM, Goffinet F. Low rate of pandemic A/H1N1 2009 influenza infection and lack of severe complication of vaccination in pregnant women: a prospective cohort study. PLoS One 2012; 7:e52303. [PMID: 23300637 PMCID: PMC3531481 DOI: 10.1371/journal.pone.0052303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 11/16/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2009, pregnant women were specifically targeted by a national vaccination campaign against pandemic A/H1N1 influenza virus. The objectives of the COFLUPREG study, initially set up to assess the incidence of serious forms of A/H1N1 influenza, were to assess the consequences of maternal vaccination on pregnancy outcomes and maternal seroprotection at delivery. METHODS Pregnant women, between 12 and 35 weeks of gestation, non vaccinated against A/H1N1 2009 influenza were randomly selected to be included in a prospective cohort study conducted in three maternity centers in Paris (France) during pandemic period. Blood samples were planned to assess hemagglutination inhibition (HI) antibody against A/H1N1 2009 influenza at inclusion and at delivery. RESULTS Among the 877 pregnant women included in the study, 678 (77.3%) had serum samples both at inclusion and delivery, and 320 (36.5%) received pandemic A/H1N1 2009 influenza vaccine with a median interval between vaccination and delivery of 92 days (95% CI 48-134). At delivery, the proportion of women with seroprotection (HI antibodies titers against A/H1N1 2009 influenza of 1∶40 or greater) was 69.9% in vaccinated women. Of the 422 non-vaccinated women with serological data, 11 (2.6%; 95%CI: 1.3-4.6) had laboratory documented A/H1N1 2009 influenza (1 with positive PCR and 10 with serological seroconversion). None of the 877 study's women was hospitalized for flu. No difference on pregnancy outcomes was evidenced between vaccinated women, non-vaccinated women without seroconversion and non-vaccinated women with flu. CONCLUSION Despite low vaccine coverage, incidence of pandemic flu was low in this cohort of pregnant women.No effect on pregnancy and delivery outcomes was evidenced after vaccination.
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Schlaudecker EP, McNeal MM, Dodd CN, Ranz JB, Steinhoff MC. Pregnancy modifies the antibody response to trivalent influenza immunization. J Infect Dis 2012; 206:1670-3. [PMID: 22984116 DOI: 10.1093/infdis/jis592] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the immunogenicity of trivalent influenza immunization in 29 pregnant women compared with 22 nonpregnant women. We obtained blood specimens on day 0 prior to 2011-2012 influenza vaccine administration and day 28 after immunization. Hemagglutination inhibition (HAI) geometric mean titers were similar before immunization but were significantly reduced by 40%-50% in pregnant women after immunization for influenza A/California(H1N1) (P = .027) and A/Perth(H3N2) (P = .037). Postimmunization HAI titers were similar between groups for influenza B/Brisbane (P = .390). The geometric mean ratio (fold increase) for influenza A(H1N1) was nonsignificantly reduced in pregnant participants (P = .089). The percentages of participants who seroconverted and achieved seroprotection were similar between groups.
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Affiliation(s)
- Elizabeth P Schlaudecker
- Division of Infectious Diseases, Global Health Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohip 45229, USA.
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Jamieson DJ, Kissin DM, Bridges CB, Rasmussen SA. Benefits of influenza vaccination during pregnancy for pregnant women. Am J Obstet Gynecol 2012; 207:S17-20. [PMID: 22920053 DOI: 10.1016/j.ajog.2012.06.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 05/13/2012] [Accepted: 06/28/2012] [Indexed: 11/18/2022]
Abstract
Influenza vaccination is a cornerstone of influenza prevention efforts among pregnant women. Prior to 2005, data from studies conducted on pregnant women were limited, with much of the supporting evidence coming from influenza vaccine studies conducted among nonpregnant, age-matched populations. Since 2005, however, an increasing number of studies have demonstrated the safety and immunogenicity of influenza vaccine for pregnant women, including evidence of maternal transfer of antibody. In addition, the clinical benefit of influenza vaccination, both for the mother and infant, was demonstrated in a landmark randomized clinical trial conducted in Bangladesh. Additional randomized clinical trials with laboratory-confirmed influenza as the primary outcome are underway in countries without a current influenza vaccination program, but such trials are unlikely to be conducted in the United States or other countries that already recommend the vaccination of pregnant women. However, current evidence supports the safety and immunogenicity of inactivated influenza vaccine and its effectiveness in reducing the risk of influenza-related illness among pregnant women.
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Affiliation(s)
- Denise J Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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