Open AccessOptimal timing of influenza vaccine during pregnancy: A systematic review and meta‐analysis
Author(s) -
Cuningham Will,
Geard Nicholas,
Fielding James E.,
Braat Sabine,
Madhi Shabir A.,
Nunes Marta C.,
Christian Lisa M.,
Lin ShinYu,
Lee ChienNan,
Yamaguchi Koushi,
Bisgaard Hans,
Chawes Bo,
Chao AnShine,
BlanchardRohner Geraldine,
Schlaudecker Elizabeth P.,
Fisher Barbra M.,
McVer Jodie,
Moss Robert
Publication year - 2019
Publication title -
influenza and other respiratory viruses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.743
H-Index - 57
eISSN - 1750-2659
pISSN - 1750-2640
DOI - 10.1111/irv.12649
Subject(s) - medicine , vaccination , pregnancy , influenza vaccine , meta analysis , immunization , obstetrics , breastfeeding , immunology , immunogenicity , pediatrics , immune system , genetics , biology
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.