Influenza virus infection in the second and third trimesters of pregnancy: a clinical and seroepidemiological study (original) (raw)
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Influenza infection during pregnancy
Perinatal Journal, 2017
Influenza is the acute viral infection of respiratory system which is seen commonly and usually self-limiting. In some specific cases such as pregnancy, the complications of the disease tend to be seen more common compared to the general population. During influenza season, the admission to the hospital, hospitalization requirement and intensive care need due to acute respiratory distress in pregnant women because of influenza infection is significantly higher than the women who are not pregnant. Seasonally, the first cases with influenza infection are reported in October, with an increase in the reports during January and February, and the cases are reported until May. During the period between October and May, known as the influenza season, inactive influenza vaccination is recommended for pregnant women. Inactive influenza vaccination can be done at any period of pregnancy. Although live attenuated influenza vaccines can be used during postpartum period, it should not be used dur...
Diseases
Special populations, particularly pregnant women, are uniquely susceptible to infectious diseases due to alterations in their immunological, respiratory, and cardiovascular systems during gestation. Influenza infections during the perinatal period have been associated with more severe maternal and perinatal outcomes, underscoring the critical importance of vaccination data for pregnant women. According to the World Health Organization (WHO), all pregnant women and those of childbearing age should receive the inactivated influenza vaccine, irrespective of their pregnancy stage. This study aimed to elucidate factors influencing neonatal antibody presence following maternal influenza vaccination. Conducted through convenience sampling in Athens, Greece, this study involved 78 pregnant women who received flu vaccinations. The participants completed questionnaires covering demographics, obstetric history, attitudes toward influenza vaccination, and knowledge about the influenza virus and...
Vaccine, 2014
Pregnant women and their infants are vulnerable to severe disease and secondary complications from influenza infection. For this reason, annual influenza vaccination is recommended for all pregnant women in the United States. Women frequently cite concerns about vaccine safety as a barrier to vaccination. This review describes the safety of inactivated influenza vaccination during pregnancy with a focus on maternal obstetric events, including hypertensive disorders, gestational diabetes, and chorioamnionitis. Included in the review are new findings from two studies which examined the safety of seasonal inactivated influenza vaccination during pregnancy. The first study enrolled 641 pregnant women during the 2010-2011 season and prospectively followed them until delivery or pregnancy termination. The second study enrolled 1616 pregnant women during the 2010-2011 influenza season, and followed the women and their infants for six months after delivery. No associations between inactivated influenza vaccination and gestational diabetes, gestational hypertension, preeclampsia/eclampsia, or chorioamnionitis were observed in either cohort. When considered as a whole, these studies should further reassure women and clinicians that influenza vaccination during pregnancy is safe for mothers.
Influenza immunization during pregnancy: Benefits for mother and infant
Human Vaccines & Immunotherapeutics, 2016
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. KEYWORDS adjuvant; influenza; immunization maternal and neonatal protection; Vaccine Pregnancy-associated immunological changes affecting vaccine responses Pregnancy is associated with immunological as well as biochemical, mechanical, hemodynamic changes in the mother, characterized by distinct immunological phases. 8-10 Implantation, placentation and the first and early second trimester of pregnancy are characterized by a pro-inflammatory environment. 11-13 Later, during the period of rapid fetal growth and development, hormonal changes and exposure to fetal antigens, maternal immunity moves toward a more anti-inflammatory setting. 14,15 These immunological phase changes are necessary
Influenza vaccination in pregnancy: current evidence and selected national policies
The Lancet Infectious Diseases, 2008
In several countries, pregnant women are recommended seasonal infl uenza vaccination and identifi ed as a priority group for vaccination in the event of a pandemic. We review the evidence for the risks of infl uenza and the risks and benefi ts of seasonal infl uenza vaccination in pregnancy. Data on infl uenza vaccine safety in pregnancy are inadequate, but the few published studies report no serious side-eff ects in women or their infants, including no indication of harm from vaccination in the fi rst trimester. National policies diff er widely, mainly because of the limited data available, particularly on vaccination in the fi rst trimester. The evidence of excess morbidity during seasonal infl uenza supports vaccinating healthy pregnant women in the second or third trimester and those with comorbidities in any trimester. The evidence of excess mortality in two previous infl uenza pandemics supports vaccinating in any trimester during a pandemic. Figure: 3D electron tomography of the infl uenza virus (120 nm) Haemagglutinin spikes are in green; neuraminidase spikes are in yellow. Reproduced with permission from Alasdair Steven.
Influenza immunization in pregnancy
Obstetrics & Gynecology, 2009
Among healthy persons, two groups are notable for increased risk of serious illness and hospitalization with influenza infection: healthy women in pregnancy and their healthy infants (aged 0 to 6 months). Inactivated influenza vaccine has been used in pregnant women since the 1960s in both the United States and Canada; however, currently, only 15% of pregnant women receive the vaccine. A randomized, controlled trial has shown influenza immunization of pregnant women reduced influenza-like illness by more than 30% in both the mothers and the infants and reduced laboratory-proven influenza infections in 0-to 6-month-old infants by 63%. Physicians caring for pregnant women should be aware of the risks of influenza and of the availability of an effective and cost-saving intervention.
Vaccine, 2017
From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses cha...
2013
Introduction: Illness and death from influenza increase during pregnancy. In the United Kingdom pregnant women were targeted in a national programme for vaccination during the H1N1 2009-10 pandemic. Methods: In this study, pregnant women were recruited in labour from November 9, 2009 to March 10, 2010. Pandemic vaccination status was determined. Venous cord blood collected at delivery was evaluated for transplacental transfer of antibodies by measurement of haemagglutination inhibition and microneutralization titres. Results: Samples were collected from 77 vaccinated and 27 unvaccinated women. Seroprotection (HI titre $1:40) was detected in 58 (75.3%, 95% CI 64.2-84.4) cord blood samples from vaccinated women and 5 (18.5%, 95% CI 6.3-38.1) from unvaccinated women (P,0.0001). There was evidence of transplacental seroprotection 8 days after maternal immunization (77.9%, 95 CI 66.2-87.1), maintained in most cases for at least 16 weeks. Discussion: Immunization of pregnant women with AS03 A-adjuvanted vaccine is followed by transplacental transfer of passive immunity at titres consistent with clinical protection in three-quarters of newborn infants. The findings support national and international pandemic H1N1 2009 recommendations for immunization during pregnancy.