Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Maternal and Child Health Journal
Published in: Maternal and Child Health Journal 7/2014

01-09-2014

Efficacy and Effectiveness of Maternal Influenza Vaccination During Pregnancy: A Review of the Evidence

Author: Jill M. Manske

Published in: Maternal and Child Health Journal | Issue 7/2014

Login to get access

Abstract

Influenza vaccine is universally recommended for pregnant women during any trimester of pregnancy. In light of this recommendation, a comprehensive literature review was conducted to examine the available evidence regarding influenza vaccine efficacy and effectiveness during pregnancy. A comprehensive Medline search identified potentially relevant articles published between January 1, 1964 and February 1, 2013. Articles were selected that specifically evaluated the efficacy and effectiveness of maternal influenza vaccine in protecting women and infants from influenza infection. These were reviewed with a particular focus on the methods used to confirm influenza infection. Ten of 476 articles met the inclusion criteria. None of the six studies evaluating maternal outcomes were randomized controlled studies using a laboratory-confirmed influenza diagnosis to measure vaccine efficacy. Two studies included reverse-transcriptase polymerase chain reaction confirmation; four relied solely on clinical outcomes. The reported vaccine effectiveness (VE) ranged from −15 to 70 %. Seven studies examined the potential for maternal vaccination to protect infants. Four of these applied some form of laboratory confirmation, with VE ranging from 41 to 91 %. Vaccination against infectious disease is an unparalleled public health success. However, studies to date demonstrate that influenza vaccine provides only moderate protection from influenza infection in pregnant women. This review found broad heterogeneity among studies, with no uniform outcome measured and little data based on laboratory-confirmed influenza, leading to wide-ranging estimates of effectiveness. Rigorously designed studies assessing clearly defined outcomes are needed to support the development of reasoned public health policy about influenza prevention in this population.
Literature
1.
Tamma, P. D., Steinhoff, M. C., & Omer, S. B. (2010). Influenza infection and vaccination in pregnant women. Expert Review of Respiratory Medicine, 4(3), 321–328.CrossRefPubMed
2.
Schanzer, D. L., Langley, J. M., & Tam, T. W. (2007). Influenza-attributed hospitalization rates among pregnant women in Canada 1994–2000. Journal of Obstetrics and Gynaecology Canada, 29(8), 622–629.PubMed
3.
4.
Laibl, V. R., & Sheffield, J. S. (2005). Influenza and pneumonia in pregnancy. Clinics in Perinatology, 32(3), 727–738.CrossRefPubMed
5.
Griffiths, P. D., Ronalds, C. J., & Heath, R. B. (1980). A prospective study of influenza infections during pregnancy. Journal of Epidemiology and Community Health, 34(2), 124–128.CrossRefPubMedCentralPubMed
6.
Lindsay, L., Jackson, L. A., Savitz, D. A., et al. (2006). Community influenza activity and risk of acute influenza-like illness episodes among healthy unvaccinated pregnant and postpartum women. American Journal of Epidemiology, 163(9), 838–848.CrossRefPubMed
7.
Dodds, L., McNeil, S. A., Fell, D. B., et al. (2007). Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ, 176(4), 463–468.CrossRefPubMedCentralPubMed
8.
Cox, S., Posner, S. F., McPheeters, M., Jamieson, D. J., Kourtis, A. P., & Meikle, S. (2006). Hospitalizations with respiratory illness among pregnant women during influenza season. Obstetrics and Gynecology, 107(6), 1315–1322.CrossRefPubMed
9.
Hartert, T. V., Neuzil, K. M., Shintani, A. K., et al. (2003). Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season. American Journal of Obstetrics and Gynecology, 189(6), 1705–1712.CrossRefPubMed
10.
Kort, B. A., Cefalo, R. C., & Baker, V. V. (1986). Fatal influenza A pneumonia in pregnancy. American Journal of Perinatology, 3(3), 179–182.CrossRefPubMed
11.
Panda, B., Panda, A., & Riley, L. E. (2010). Selected viral infections in pregnancy. Obstetrics and Gynecology Clinics of North America, 37(2), 321–331.CrossRefPubMed
12.
Mosby, L. G., Rasmussen, S. A., & Jamieson, D. J. (2011). 2009 Pandemic influenza A (H1N1) in pregnancy: A systematic review of the literature. American Journal of Obstetrics and Gynecology, 205(1), 10–18.
13.
14.
CDC. (2012). Influenza vaccination coverage among pregnant women—2010–11 influenza season. Morbidity and Mortality Weekly Report, 60(32), 1078–1082.
15.
Kennedy, E. D., Ahluwalia, I. B., Ding, H., Lu, P. J., Singleton, J. A., & Bridges, C. B. (2012). Monitoring seasonal influenza vaccination coverage among pregnant women in the United States. American Journal of Obstetrics and Gynecology, 207(3 Suppl), S9–S16.CrossRefPubMed
16.
CDC. (2012). Influenza vaccination coverage among pregnant women—2011–12 influenza season, United States. Morbidity and Mortality Weekly Report, 61, 758–763.
17.
18.
CDC. (2004). Updated interim influenza vaccination recommendations–2004–05 influenza season. Morbidity and Mortality Weekly Report (MMWR), 53(50), 1183–1184.
19.
Fiore, A. E., Shay, D. K., Broder, K., et al. (2009). Prevention, control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and Reports, 58(RR-8), 1–52.
20.
Harper, S. A., Fukuda, K., Uyeki, T. M., Cox, N. J., & Bridges, C. B. (2004). Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and Reports, 53(RR-6), 1–40.
21.
Fiore, A. E., Uyeki, T. M., Broder, K., et al. (2010). Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and Reports, 59(RR-8), 1–62.
22.
WHO. (2005). WHO position paper on influenza vaccine.
23.
CDC. (2009). Updated interim recommendations for obstetric health care providers related to the use of antiviral medications in the treatment and prevention of influenza for the 2009–2010 season.
24.
Reingold, A. L. (2012). Proposed revisions to the 2005 WHO position paper on influenza vaccines, 2012.
25.
Osterholm, M. T., Kelley, N. S., Sommer, A., & Belongia, E. A. (2012). Efficacy and effectiveness of influenza vaccines: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12(1), 36–44.CrossRefPubMed
26.
27.
CDC. (2013). Early estimates of seasonal influenza vaccine effectiveness—United States, January 2013. MMWR Morbidity and Mortality Weekly Report, 62, 32–35.
28.
CDC. (2013). Interim adjusted estimates of seasonal influenza vaccine effectiveness—United States, February 2013. Morbidity and Mortality Weekly Report, 62(07), 119–123.
29.
Skowronski, D. M., & De Serres, G. (2009). Is routine influenza immunization warranted in early pregnancy? Vaccine, 27(35), 4754–4770.CrossRefPubMed
30.
Long, P. H. (1964). Recommendations for influenza immunization and control: 1964–1965. Medical Times, 92, 1203–1205.PubMed
31.
Black, S. B., Shinefield, H. R., France, E. K., Fireman, B. H., Platt, S. T., & Shay, D. (2004). Effectiveness of influenza vaccine during pregnancy in preventing hospitalizations and outpatient visits for respiratory illness in pregnant women and their infants. American Journal of Perinatology, 21(6), 333–339.CrossRefPubMed
32.
Hulka, J. F. (1964). Effectiveness of polyvalent influenza vaccine in pregnancy. Report of a Controlled Study during an Outbreak of Asian Influenza. Obstetrics and Gynecology, 23, 830–837.PubMed
33.
Munoz, F. M., Greisinger, A. J., Wehmanen, O. A., et al. (2005). Safety of influenza vaccination during pregnancy. American Journal of Obstetrics and Gynecology, 192(4), 1098–1106.CrossRefPubMed
34.
Zaman, K., Roy, E., Arifeen, S. E., et al. (2008). Effectiveness of maternal influenza immunization in mothers and infants. New England Journal of Medicine, 359(15), 1555–1564.CrossRefPubMed
35.
Haberg, S. E., Trogstad, L., Gunnes, N., et al. (2013). Risk of fetal death after pandemic influenza virus infection or vaccination. The New England Journal of Medicine, 368(4), 333–340.CrossRefPubMedCentralPubMed
36.
Richards, J. L., Hansen, C., & Bredfeldt, C., et al. (2013). Neonatal outcomes after antenatal influenza immunization during the 2009 H1N1 influenza pandemic: Impact on preterm birth, birth weight, and small for gestational age birth. Clinical Infectious Diseases, 56(9), 1216–1222.
37.
France, E. K., Smith-Ray, R., McClure, D., et al. (2006). Impact of maternal influenza vaccination during pregnancy on the incidence of acute respiratory illness visits among infants. Archives of Pediatrics and Adolescent Medicine, 160(12), 1277–1283.CrossRefPubMed
38.
Benowitz, I., Esposito, D. B., Gracey, K. D., Shapiro, E. D., & Vazquez, M. (2010). Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clinical Infectious Diseases, 51(12), 1355–1361.CrossRefPubMedCentralPubMed
39.
Eick, A. A., Uyeki, T. M., Klimov, A., et al. (2011). Maternal influenza vaccination and effect on influenza virus infection in young infants. Archives of Pediatrics and Adolescent Medicine, 165(2), 104–111.CrossRefPubMed
40.
Anderson, S. G., Donnelley, M., French, E. L., Kalra, S. L., & White, J. (1953). Influenza in Victoria, 1950 and 1951. The Medical Journal of Australia, 2(2), 44–47.PubMed
41.
Ortiz, J. R., Englund, J. A., & Neuzil, K. M. (2011). Influenza vaccine for pregnant women in resource-constrained countries: A review of the evidence to inform policy decisions. Vaccine, 29(27), 4439–4452.CrossRefPubMed
42.
Henkle, E., Steinhoff, M. C., & Omer, S. B., et al. (2013). The effect of exclusive breastfeeding on respiratory illness in young infants in a maternal immunization trial in Bangladesh. The Pediatric Infectious Disease Journal, 32(5), 431–435.
43.
Poehling, K. A., Szilagyi, P. G., Staat, M. A., et al. (2011). Impact of maternal immunization on influenza hospitalizations in infants. American Journal of Obstetrics and Gynecology, 204(6 Suppl 1), S141–S148.CrossRefPubMedCentralPubMed
44.
Pano-Pardo, J. R., Martinez-Sanchez, N., & Martin-Quiros, A., et al. (2011). Influenza-like illness in pregnant women during summertime: Clinical, epidemiological and microbiological features. European Journal of Clinical Microbiology Infectious Diseases, 30(12), 1497–1502.
45.
Potter, C. W., & Jennings, R. (2003). Effect of priming on subsequent response to inactivated influenza vaccine. Vaccine, 21(9–10), 940–945.CrossRefPubMed
46.
Couch, R. B., Keitel, W. A., & Cate, T. R. (1997). Improvement of inactivated influenza virus vaccines. The Journal of Infectious Diseases, 176(Suppl 1), S38–S44.CrossRefPubMed
47.
Epstein, S. L. (2006). Prior H1N1 influenza infection and susceptibility of Cleveland Family Study participants during the H2N2 pandemic of 1957: An experiment of nature. The Journal of Infectious Diseases, 193(1), 49–53.CrossRefPubMed
48.
Blanchard-Rohner, G., & Siegrist, C. A. (2011). Vaccination during pregnancy to protect infants against influenza: Why and why not? Vaccine, 29(43), 7542–7550.CrossRefPubMed
49.
Englund, J. A., Mbawuike, I. N., Hammill, H., Holleman, M. C., Baxter, B. D., & Glezen, W. P. (1993). Maternal immunization with influenza or tetanus toxoid vaccine for passive antibody protection in young infants. Journal of Infectious Diseases, 168(3), 647–656.CrossRefPubMed
50.
Zuccotti, G., Pogliani, L., Pariani, E., Amendola, A., & Zanetti, A. (2010). Transplacental antibody transfer following maternal immunization with a pandemic 2009 influenza A(H1N1) MF59-adjuvanted vaccine. JAMA, 304(21), 2360–2361.CrossRefPubMed
51.
Puleston, R. L., Bugg, G., Hoschler, K., et al. (2010). Observational study to investigate vertically acquired passive immunity in babies of mothers vaccinated against H1N1v during pregnancy. Health Technology Assessment, 14(55), 1–82.PubMed
52.
Fisher, B. M., Van Bockern, J., Hart, J., et al. (2012). Pandemic influenza A H1N1 2009 infection versus vaccination: A cohort study comparing immune responses in pregnancy. PLoS One, 7(3), e33048.CrossRefPubMedCentralPubMed
53.
Tsatsaris, V., Capitant, C., Schmitz, T., et al. (2011). Maternal immune response and neonatal seroprotection from a single dose of a monovalent nonadjuvanted 2009 influenza A(H1N1) vaccine: A single-group trial. Annals of Internal Medicine, 155(11), 733–741.CrossRefPubMed
54.
Jackson, L. A., Patel, S. M., Swamy, G. K., et al. (2011). Immunogenicity of an inactivated monovalent 2009 H1N1 influenza vaccine in pregnant women. The Journal of Infectious Diseases, 204(6), 854–863.CrossRefPubMedCentralPubMed
55.
Puck, J. M., Glezen, W. P., Frank, A. L., & Six, H. R. (1980). Protection of infants from infection with influenza A virus by transplacentally acquired antibody. Journal of Infectious Diseases, 142(6), 844–849.CrossRefPubMed
56.
Reuman, P. D., Ayoub, E. M., & Small, P. A. (1987). Effect of passive maternal antibody on influenza illness in children: A prospective study of influenza A in mother-infant pairs. The Pediatric Infectious Disease Journal, 6(4), 398–403.CrossRefPubMed
57.
Steinhoff, M. C., Omer, S. B., Roy, E., et al. (2010). Influenza immunization in pregnancy—Antibody responses in mothers and infants. New England Journal of Medicine, 362(17), 1644–1646.CrossRefPubMed
58.
Steinhoff, M. C., Omer, S. B., Roy, E., et al. (2012). Neonatal outcomes after influenza immunization during pregnancy: A randomized controlled trial. Canadian Medical Association Journal (CMAJ), 184(6), 645–653.CrossRef
59.
Fell, D. B., Sprague, A. E., Liu, N., et al. (2012). H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes. American Journal of Public Health, 102(6), e33–e40.
60.
Omer, S. B., Goodman, D., Steinhoff, M. C., et al. (2011). Maternal influenza immunization and reduced likelihood of prematurity and small for gestational age births: A retrospective cohort study. PLoS Medicine, 8(5), e1000441.CrossRefPubMedCentralPubMed
Metadata
Title
Efficacy and Effectiveness of Maternal Influenza Vaccination During Pregnancy: A Review of the Evidence
Author
Jill M. Manske
Publication date
01-09-2014
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 7/2014
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-013-1399-2

Other articles of this Issue 7/2014

Maternal and Child Health Journal 7/2014 Go to the issue

OriginalPaper

Improving Care for Women with a History of Gestational Diabetes: A Provider Perspective

OriginalPaper

Grandmothers’ Smoking in Pregnancy and Grandchildren’s Birth Weight: Comparisons by Grandmother Birth Cohort

Notes from the Field

Using the Principles of Complex Systems Thinking and Implementation Science to Enhance Maternal and Child Health Program Planning and Delivery

OriginalPaper

Understanding the Continuum of Maternal Morbidity in Accra, Ghana

OriginalPaper

Similarities and Differences in the Epidemiology of Pyloric Stenosis and SIDS

ReviewPaper

Prenatal and Postnatal Maternal Mental Health and School-Age Child Development: A Systematic Review