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Prevention of vaccine-preventable diseases through immunization is one of the greatest public health achievements in the United States and worldwide.
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Pregnant women are at risk for the same infections as their nonpregnant peers and, in some cases, have increased morbidity and mortality.
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Maternal immunization provides maternal, fetal (preterm birth, fetal growth restriction, and fetal demise), and infant benefit (infection during early life).
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Future research should focus on maternal vaccine
Maternal Immunization to Benefit the Mother, Fetus, and Infant
Section snippets
Key points
Maternal benefits of immunization
During pregnancy there are physiologic and immunologic changes that increase a woman’s susceptibility to infection, making prevention and, thus, vaccination a highly important component of routine prenatal care. The immune response is modified to decrease inflammatory immune responses and diminish fetal rejection.16 In addition, there is a shift from a T-helper 1 (Th1) response toward a more Th2-favored response, allowing for fetal antigen tolerance, but potentially increasing maternal
Fetal benefits of maternal immunization
One commonly cited barrier to maternal vaccination is parental and provider fear of causing fetal harm.40 Given the theoretical risks associated with antepartum vaccination, the safety of recommended vaccines in pregnancy has been looked at extensively. As discussed previously, only inactivated vaccines are considered for use during pregnancy. Moreover, inadvertent administration of live attenuated vaccines in early pregnancy, specifically measles-mumps-rubella and varicella vaccines, has never
Infant benefits of maternal immunization
Early infant immunity is fairly immature, complex, and highly dependent on maternal immunity because of the phenomenon of transplacental transfer of maternal antibodies to the developing fetus. First studied in the 1800s, it was observed that infants born to mothers who had survived pertussis were less likely to contract pertussis early in life.52 In the 1970s, antibody levels of women colonized with group B Streptococcus (GBS) were found to correlate with neonatal infection, such that infants
Summary
Prevention of VPDs through immunization is one of the greatest public health achievements in the United States and worldwide. Immunizing women during pregnancy with recommended vaccines provides direct maternal benefit. In addition, maternal immunization has potential fetal benefits by preventing adverse pregnancy outcomes (preterm birth, fetal growth restriction, and fetal demise), and potential infant benefit by preventing infection during early life. Research should continue to focus on
References (100)
- et al.
Deaths from Asian influenza associated with pregnancy
Am J Obstet Gynecol
(1959) - et al.
H1N1 2009 influenza virus infection during pregnancy in the USA
Lancet
(2009) Th1-type immunity is incompatible with successful pregnancy
Immunol Today
(1997)- et al.
Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis
Horm Behav
(2012) - et al.
Influenza vaccination of recommended adult populations, U.S., 1989-2005
Vaccine
(2008) - et al.
Antibody persistence in mothers one year after pneumococcal immunization in pregnancy
Vaccine
(2012) - et al.
Serum, breast milk, and infant antibody after maternal immunisation with pneumococcal vaccine
Lancet
(1995) - et al.
A review of fetal and infant protection associated with antenatal influenza immunization
Am J Obstet Gynecol
(2012) The influence of maternal immunization on infant immune responses
J Comp Pathol
(2007)Ex vivo human placenta models: transport of immunoglobulin G and its subclasses
Vaccine
(2003)
Placental transport of immunoglobulin G
Vaccine
Maternal immunization with pneumococcal polysaccharide vaccine in the third trimester of gestation
Vaccine
Tetanus in developing countries: an update on the maternal and neonatal tetanus elimination initiative
Vaccine
Clinical and laboratory features of pertussis in infants at the onset of a California epidemic
J Pediatr
Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels
Am J Obstet Gynecol
A maternal vaccine against group B Streptococcus: past, present, and future
Vaccine
Cost-effectiveness of a potential group B streptococcal vaccine program for pregnant women in South Africa
Vaccine
Strategic priorities for respiratory syncytial virus (RSV) vaccine development
Vaccine
Ten great public health achievements—United States, 2001-2010
MMWR Morb Mortal Wkly Rep
Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States
JAMA
General recommendations on immunization - recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR Recomm Rep
Severe 2009 H1N1 influenza in pregnant and postpartum women in California
N Engl J Med
Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women
Am J Epidemiol
Influenza occurring in pregnant women: a statistical study of thirteen hundred and fifty cases
JAMA
Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States
JAMA
Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women
CMAJ
Maternal, fetal, and neonatal outcomes associated with measles during pregnancy: Namibia, 2009-2010
Clin Infect Dis
Risk of invasive Haemophilus influenzae infection during pregnancy and association with adverse fetal outcomes
JAMA
Vaccine-preventable diseases in pregnancy
Am J Perinatol
Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR Recomm Rep
Immunogenicity of an inactivated monovalent 2009 H1N1 influenza vaccine in pregnant women
J Infect Dis
Pregnancy modifies the antibody response to trivalent influenza immunization
J Infect Dis
Maternal immunization with influenza or tetanus toxoid vaccine for passive antibody protection in young infants
J Infect Dis
Influenza immunization in pregnancy—antibody responses in mothers and infants
N Engl J Med
Maternal immune response and neonatal seroprotection from a single dose of a monovalent nonadjuvanted 2009 influenza A(H1N1) vaccine: a single-group trial
Ann Intern Med
Pandemic influenza A H1N1 2009 infection versus vaccination: a cohort study comparing immune responses in pregnancy
PLoS One
Effectiveness of maternal influenza immunization in mothers and infants
N Engl J Med
Influenza vaccination among pregnant women–Massachusetts, 2009-2010
MMWR Morb Mortal Wkly Rep
Seasonal influenza vaccination coverage among women who delivered a live-born infant - 21 states and New York City, 2009-10 and 2010-11 influenza seasons
MMWR Morb Mortal Wkly Rep
Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial
JAMA
Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women–Advisory Committee on Immunization Practices (ACIP), 2012
MMWR Morb Mortal Wkly Rep
Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR Recomm Rep
A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults
MMWR Recomm Rep
Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23)
MMWR Morb Mortal Wkly Rep
Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR Recomm Rep
Cited by (0)
Dr. Swamy has received past support from GlaxoSmithKline, Inc. for consultant and speaker activities which ended March 2012. Dr. Swamy has received funding from the National Institutes of Health, the Centers for Disease Control and Prevention, the American College of Obstetrics & Gynecology,and GlaxoSmithKline, Inc. to conduct vaccine-related research.
Dr. Garcia-Putnam - none.