Maternal immunisation to improve the health of HIV-exposed infants

Abstract

HIV-exposed but uninfected (HEU) infants are at an increased risk of many infectious diseases that can contribute to the high mortality seen among HEU children. Maternal immunisation could be a promising strategy to reduce infections in HEU infants. However, very little research has explored the effect of HIV on the immunogenicity and effectiveness of vaccines given during pregnancy. We review the available evidence on maternal immunisation among women living with HIV (WLWH) for all vaccines recommended, considered, or being investigated for routine or riskbased use during pregnancy. Of the 11 vaccines included, only three have been investigated in WLWH. Available evidence suggests that maternal HIV infection limits the immunogenicity of several vaccines, leaving HEU infants more susceptible to infection during their first few months of life. Whether maternal immunisation reduces the infectious morbidity and mortality associated with infectious diseases in HEU children remains unknown. We conclude the Review by identifying future research priorities.

Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward

“…A literature search identified ten research prioritisation activities for only a few of the adverse conditions we considered. These conditions included obstetric fistula, 100 , 101 faecal incontinence, 102 , 103 urinary incontinence, 104 maternal mental health, 105 peripartum cardiomyopathy, 106 HIV in women in the postpartum period, 107 and postpartum infections; 108 , 109 and a WHO-led prioritisation that captured a few other long-term conditions. 5 This inconsistent approach reflects the absence of a comprehensive research agenda that addresses the full range of medium-term and long-term consequences after childbirth.…”

HIV-related immune activation attenuates polyfunctional IgG and memory B-cell responses to Tdap immunization during pregnancy

“…Pertussis immunization during pregnancy with tetanus diphtheria acellular pertussis (Tdap) vaccine is an effective strategy recommended in a growing number of countries to tackle the temporal immunity gap in young infants. 7 , 8 , 9 , 10 Vaccine-induced pertussis-specific IgG are transferred to the fetus through the placenta, providing protection during the first months of life. 11 Maternal Tdap vaccination may be particularly beneficial for HEU newborns.…”

“… 16 People living with HIV have impaired responses to vaccination, in terms of seroconversion rates and persistence of vaccine-induced antibodies for several vaccines including influenza. 7 , 17 , 18 …”

“…Evidence suggests that maternal HIV infection is associated with lower levels of protective vaccine-specific antibodies and reduced efficiency of transplacental antibody transfer for immunization against influenza, tetanus, Streptococcus pneumoniae and group B streptococcus. 7 , 19 , 20 In addition, lower PWH:HEU transfer ratios and/or lower levels of non-vaccine antibodies in HEU have been reported for measles, varicella, tetanus, influenza, pertussis, Streptococcus pneumoniae , hepatitis B and respiratory syncytial virus (RSV). 7 , 20 , 21 Moreover, the association of HIV infection with changes in IgG subclasses and biophysical characteristics, including Fc glycan pattern and functionality, may also have an impact on transfer.…”

The Promise, Problems, and Pitfalls of Including Pregnant Women in Lassa Fever Vaccine Clinical Trials: A Qualitative Analysis of Sub-Sahara Africa Investigators' Perception

“…Awareness of LF as a disease of global health security importance is growing, and the development of a vaccine for its prevention is a public health priority [14,15]. LF runs a more severe and often fatal course in pregnancy, where the case fatality rate (CFR) can be as high as 80%, especially in the third trimester of pregnancy.…”