Pneumococcal vaccination during pregnancy for preventing infant infection

Chaithongwongwatthana, Surasith; Yamasmit, Waralak; Limpongsanurak, Sompop; Lumbiganon, Pisake; DeSimone, Joseph; Baxter, Jason K.; Tolosa, Jorge E.

doi:10.1002/14651858.cd004903.pub3

Cited by 22 publications

(24 citation statements)

References 31 publications

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“…While the mortality risk for HIV-exposed, uninfected, infants in a UK setting is likely to be lower, our data suggest that this population remains vulnerable to invasive pneumoccocal disease. Previous studies of maternal immunisation to prevent pneumococcal disease in infants have demonstrated an increased immune response in mothers and infants lasting several months38–42; however, a recent systematic review concluded there was insufficient evidence that maternal pneumococcal immunisation reduced neonatal infection 43. Included trials were limited by small sample size, and all used the (unconjugated) pneumococcal polysaccharide vaccine.…”

Section: Discussionmentioning

confidence: 99%

Specific antibodies against vaccine-preventable infections: a mother–infant cohort study

et al. 2013

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ObjectivesTo determine maternal and neonatal specific antibody levels to selected vaccine-preventable infections (pertussis, Haemophilus influenzae type b (Hib), tetanus and pneumococcus).DesignProspective cohort study.SettingA UK secondary care maternity unit (March 2011–January 2012).ParticipantsMothers and infants within 72 h of delivery were eligible. Unwell individuals, mothers less than 18 years of age, and infants born at less than 36 weeks gestation, or weighing less than 2500 g, were excluded. HIV-infected mothers were included. 112 mother–infant pairs were recruited. Samples from 111 mothers and 109 infants (108 pairs) were available for analysis.Outcome measuresSpecific antibody levels were determined using standard commercial ELISAs. Specific antibody to pertussis antigens (PT and FHA) of >50 IU/ml, defined as ‘positive’ by the test manufacturer, were interpreted as protective. Antitetanus antibody titres >0.1 IU/ml and anti-Hib antibody titres >1 mg/l were regarded as protective.ResultsOnly 17% (19/111) of women exhibited a protective antibody response against pertussis. 50% (56/111) of women had levels of antibody protective against Hib and 79% (88/111) against tetanus. There was a strong positive correlation between maternal-specific and infant-specific antibodies’ responses against pertussis (rs=0.71, p<0.001), Hib (rs=0.80, p<0.001), tetanus (rs=0.90, p<0.001) and pneumococcal capsular polysaccharide (rs=0.85, p<0.001). Only 30% (33/109) and 42% (46/109) of infants showed a protective antibody response to pertussis and Hib, respectively. Placental transfer (infant:mother ratio) of specific IgG to pertussis, Hib, pneumococcus and tetanus was significantly reduced from HIV-infected mothers to their HIV-exposed, uninfected infants (n=12 pairs) compared with HIV-uninfected mothers with HIV-unexposed infants (n=96 pairs) by 58% (<0.001), 61% (<0.001), 28% (p=0.034) and 32% (p=0.035), respectively.ConclusionsLow baseline antibody levels against pertussis in this cohort suggest the recently implemented UK maternal pertussis immunisation programme has potential to be effective.

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Section: Discussionmentioning

confidence: 99%

Specific antibodies against vaccine-preventable infections: a mother–infant cohort study

et al. 2013

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“…All of these data clearly indicate that, although the administration of PPV to pregnant women can induce higher breast milk and infant blood antibody levels against the serotypes included in the vaccine, there is still too little evidence to support its use in the prevention of infant pneumococcal infections [38]. Further studies are needed to evaluate this possibility and to measure the possible interference of maternal antibodies with the subsequent response to pneumococcal conjugate vaccine.…”

Section: Pneumococcal Vaccinesmentioning

confidence: 99%

Can infants be protected by means of maternal vaccination?

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Morlacchi

et al. 2012

Clinical Microbiology and Infection

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The administration of vaccines is not usually recommended in pregnant women because of a fear of severe adverse events for the fetus. However, contraindication to vaccination applies only to vaccines based on live attenuated viruses for the theoretical possibility that they might infect the fetus. In contrast, the use of several inactivated vaccines is useful and recommended. As a result of the transplacental passage of antibodies, maternal immunization can reduce the risk of vaccine-preventable diseases that may occur in the first months of life before the start or completion of the suggested vaccination schedule. One of the best examples is vaccination against influenza that can protect pregnant women from a disease that can lead to hospitalization and death in a significantly higher number of cases than in the general population and can induce protective specific antibody levels as well as being effective in infants in the first months of life. Other examples are vaccinations against tetanus, pertussis, pneumococcal infections and Haemophilus influenzae type b infection. This review analyses the advantages and limitations of maternal immunization as revealed by experience and the main publications.

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“…Similarly, the adsorbed anthrax vaccine is recommended as a component of post-exposure prophylaxis in pregnant women exposed to aerosolized Bacillus anthracis spores [89]. Finally, results from pneumococcal maternal immunization studies are encouraging so far but insufficient to determine whether infections are reduced in infants born to vaccinated women [90].…”

Section: Other Available Vaccinesmentioning

confidence: 99%

Maternal immunization: where are we now and how to move forward?

et al. 2018

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Pregnancy and the postpartum period are associated with elevated risks to both mother and infant from infectious disease. Vaccination of pregnant women, also called maternal immunization, has the potential to protect pregnant women, foetuses and infants from several vaccinepreventable diseases. Maternal immunoglobulin G antibodies are actively transferred through the placenta to provide passive immunity to new-borns during the first months of life, until the time for infant vaccinations or until the period of greatest susceptibility has passed. Currently, inactivated influenza, tetanus, and pertussis vaccines are recommended during pregnancy in many countries, but other vaccines may also be administered to pregnant women when risk factors are present. Several new vaccines with a specific indication for use during pregnancy are under development (e.g. respiratory syncytial virus and group B streptococcus vaccines). Years of experience suggest that maternal immunization against influenza, tetanus or pertussis has an acceptable safety profile, is well tolerated, effective and confers significant benefits to pregnant women and their infants. This review describes the principles of maternal immunization and provides an update of the recent evidence regarding the use and timing of maternal immunization. Finally, the barriers preventing wider vaccination coverage and the current limitations in addressing these are also described (Supplementary Material). KEY MESSAGESMaternal immunization gives pregnant women greater protection against infectious diseases; induces high levels of maternal antibodies that can be transferred to the foetus; and helps protect new-borns during their first months of life, until they are old enough to be vaccinated. Pregnant women and new-borns are more vulnerable to infectious diseases than the overall population; nevertheless, vaccination rates are often low in pregnant women. This review provides an update of the recent evidence regarding the use and timing of maternal immunization and describes the barriers preventing wider vaccination uptake and the current limitations in addressing these. ARTICLE HISTORY

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Pneumococcal vaccination during pregnancy for preventing infant infection

Cited by 22 publications

References 31 publications

Specific antibodies against vaccine-preventable infections: a mother–infant cohort study

Specific antibodies against vaccine-preventable infections: a mother–infant cohort study

Can infants be protected by means of maternal vaccination?

Maternal immunization: where are we now and how to move forward?

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