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Published in: Drug Safety 6/2013

01-06-2013 | Original Research Article

The PREGVAXGRIP Study: a Cohort Study to Assess Foetal and Neonatal Consequences of In Utero Exposure to Vaccination Against A(H1N1)v2009 Influenza

Authors: F. Chavant, I. Ingrand, A. P. Jonville-Bera, C. Plazanet, V. Gras-Champel, L. Lagarce, M. Zenut, A. Disson-Dautriche, S. Logerot, M. Auffret, A. Coubret-Dumas, M. L. Bruel, M. Boyer, M. A. Bos-Thompson, G. Veyrac, P. Carlier, M. N. Beyens, S. Lates, C. Damase-Michel, A. Castot, C. Kreft-Jaïs, M. C. Pérault-Pochat

Published in: Drug Safety | Issue 6/2013

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Abstract

Background

In October 2009, in the context of an A(H1N1)v2009 influenza pandemic, a vaccination campaign was launched in France, in which one of the priority groups was pregnant women, on account of the high risk of developing complications following infection by this virus.

Objective

The aim of this multicentric, prospective, observational study was to assess safety and pregnancy outcomes in a cohort of pregnant women when receiving the A(H1N1)v2009 influenza pandemic vaccine.

Methods

This was a prospective study that followed up pregnant women recruited mainly in vaccination centres and maternity departments. Following the expected delivery date, follow-up data were collected concerning the delivery, the infant, and, if appropriate, the reasons why the pregnancy did not reach its term.

Results

Between 1 November 2009 and 31 March 2010, 2,415 pregnant women were included at the time of vaccination; 97.6 % of women received a vaccine without adjuvant and 2.4 % received an adjuvanted vaccine. Ninety-two (3.9 %) women were vaccinated during the first trimester of pregnancy, 1,090 (46.5 %) during the second trimester, and 1,162 (49.6 %) during the third trimester. One hundred and thirty-three adverse events (5.5 % of women) were reported, of which 12 were unexpected or serious. There were 2,246 (93.0 %) known pregnancy outcomes with 12 spontaneous abortions (0.5 %), 6 stillbirths (0.3 %), and 4 therapeutic abortions (0.2 %). There were 65 neonates with congenital anomalies, among which 31 were major. But only one congenital malformation (1.4 %) was reported for the 92 women vaccinated in their first trimester. Of the women, 93.3 % were delivered full term and 6.7 % preterm. For 96 (4.2 %) neonates, a disorder was reported in the neonatal period and 130 (5.6 %) were transferred to the neonatology department.

Conclusions

This study suggests that exposure to the A(H1N1)v2009 pandemic influenza vaccine during pregnancy does not increase the risk of adverse pregnancy outcomes. However, because of the relatively small number of women exposed during the first trimester, other studies are needed to exclude an increased risk of malformation.
Literature
2.
go back to reference Bone A, Guthmann JP, Nicolau J, Levy-Bruhl D. Population and risk group uptake of H1N1 influenza vaccine in mainland France 2009–2010: results of a national vaccination campaign. Vaccine. 2010;28(51):8157–61.PubMedCrossRef Bone A, Guthmann JP, Nicolau J, Levy-Bruhl D. Population and risk group uptake of H1N1 influenza vaccine in mainland France 2009–2010: results of a national vaccination campaign. Vaccine. 2010;28(51):8157–61.PubMedCrossRef
3.
go back to reference Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009;374(9688):451–8.PubMedCrossRef Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009;374(9688):451–8.PubMedCrossRef
4.
go back to reference Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303(15):1517–25.PubMedCrossRef Siston AM, Rasmussen SA, Honein MA, Fry AM, Seib K, Callaghan WM, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303(15):1517–25.PubMedCrossRef
5.
go back to reference Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol. 1998;148(11):1094–102.PubMedCrossRef Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol. 1998;148(11):1094–102.PubMedCrossRef
6.
go back to reference Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, et al. Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ. 2007;176(4):463–8.PubMed Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, et al. Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ. 2007;176(4):463–8.PubMed
7.
go back to reference Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April–June 2009. N Engl J Med. 2009;361(20):1935–44.PubMedCrossRef Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April–June 2009. N Engl J Med. 2009;361(20):1935–44.PubMedCrossRef
8.
go back to reference Mosby LG, Rasmussen SA, Jamieson DJ. 2009 Pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol. 2011;205:10–8. Mosby LG, Rasmussen SA, Jamieson DJ. 2009 Pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol. 2011;205:10–8.
9.
go back to reference Dubar G, Azria E, Tesniere A, Dupont H, Le Ray C, Baugnon T, et al. French experience of 2009 A/H1N1v influenza in pregnant women. PLoS One. 2010;5(10). Dubar G, Azria E, Tesniere A, Dupont H, Le Ray C, Baugnon T, et al. French experience of 2009 A/H1N1v influenza in pregnant women. PLoS One. 2010;5(10).
10.
go back to reference Hewagama S, Walker SP, Stuart RL, Gordon C, Johnson PD, Friedman ND, et al. 2009 H1N1 influenza A and pregnancy outcomes in Victoria, Australia. Clin Infect Dis. 2010;50(5):686–90.PubMedCrossRef Hewagama S, Walker SP, Stuart RL, Gordon C, Johnson PD, Friedman ND, et al. 2009 H1N1 influenza A and pregnancy outcomes in Victoria, Australia. Clin Infect Dis. 2010;50(5):686–90.PubMedCrossRef
11.
go back to reference Creanga AA, Johnson TF, Graitcer SB, Hartman LK, Al-Samarrai T, Schwarz AG, et al. Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol. 2010;115(4):717–26.PubMedCrossRef Creanga AA, Johnson TF, Graitcer SB, Hartman LK, Al-Samarrai T, Schwarz AG, et al. Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol. 2010;115(4):717–26.PubMedCrossRef
12.
go back to reference The ANZIC Influenza Investigators and Australian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ. 2010;340:c1279. The ANZIC Influenza Investigators and Australian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ. 2010;340:c1279.
13.
go back to reference Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009;201(6):547–52.PubMedCrossRef Tamma PD, Ault KA, del Rio C, Steinhoff MC, Halsey NA, Omer SB. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2009;201(6):547–52.PubMedCrossRef
14.
go back to reference Perthus I, Amar E, De Vigan C, Doray B, Francannet C. Registries of congenital malformations in France: situation in 2008. BEH. 2008;28–29:246–8. Perthus I, Amar E, De Vigan C, Doray B, Francannet C. Registries of congenital malformations in France: situation in 2008. BEH. 2008;28–29:246–8.
15.
go back to reference Vendittelli F, Riviere O, Crenn-Hebert C, Claris O, Tessier V, Pinquier D, et al. Audipog perinatal network. Part 1: principal perinatal health indicators, 2004–2005. Gynecol Obstet Fertil. 2008;36(11):1091–100.PubMedCrossRef Vendittelli F, Riviere O, Crenn-Hebert C, Claris O, Tessier V, Pinquier D, et al. Audipog perinatal network. Part 1: principal perinatal health indicators, 2004–2005. Gynecol Obstet Fertil. 2008;36(11):1091–100.PubMedCrossRef
16.
go back to reference Caillet C, Durrieu G, Jacquet A, Faucher A, Ouaret S, Perrault-Pochat MC, et al. Safety surveillance of influenza A(H1N1)v monovalent vaccines during the 2009–2010 mass vaccination campaign in France. Eur J Clin Pharmacol. 2011;67(6):649–51.PubMedCrossRef Caillet C, Durrieu G, Jacquet A, Faucher A, Ouaret S, Perrault-Pochat MC, et al. Safety surveillance of influenza A(H1N1)v monovalent vaccines during the 2009–2010 mass vaccination campaign in France. Eur J Clin Pharmacol. 2011;67(6):649–51.PubMedCrossRef
17.
go back to reference Hwang SM, Choe KW, Cho SH, Yoon SJ, Park DE, Kang JS, et al. The adverse events of influenza A (H1N1) vaccination and its risk factors in healthcare personnel in 18 military healthcare units in Korea. Jpn J Infect Dis. 2011;64(3):183–9.PubMed Hwang SM, Choe KW, Cho SH, Yoon SJ, Park DE, Kang JS, et al. The adverse events of influenza A (H1N1) vaccination and its risk factors in healthcare personnel in 18 military healthcare units in Korea. Jpn J Infect Dis. 2011;64(3):183–9.PubMed
18.
go back to reference Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P. Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring. Vaccine. 2009;27(15):2114–20.PubMedCrossRef Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P. Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring. Vaccine. 2009;27(15):2114–20.PubMedCrossRef
19.
go back to reference Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010;59(RR-8):1–62. Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010;59(RR-8):1–62.
20.
go back to reference Wilcox AJ. Surveillance of pregnancy loss in human populations. Am J Ind Med. 1983;4(1–2):285–91.PubMedCrossRef Wilcox AJ. Surveillance of pregnancy loss in human populations. Am J Ind Med. 1983;4(1–2):285–91.PubMedCrossRef
21.
go back to reference Zinaman MJ, Clegg ED, Brown CC, O’Connor J, Selevan SG. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996;65(3):503–9.PubMed Zinaman MJ, Clegg ED, Brown CC, O’Connor J, Selevan SG. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996;65(3):503–9.PubMed
22.
go back to reference Saraiya M, Berg CJ, Shulman H, Green CA, Atrash HK. Estimates of the annual number of clinically recognized pregnancies in the United States, 1981–1991. Am J Epidemiol. 1999;149(11):1025–9.PubMedCrossRef Saraiya M, Berg CJ, Shulman H, Green CA, Atrash HK. Estimates of the annual number of clinically recognized pregnancies in the United States, 1981–1991. Am J Epidemiol. 1999;149(11):1025–9.PubMedCrossRef
23.
go back to reference Goldhaber MK, Fireman BH. Re: “Estimates of the annual number of clinically recognized pregnancies in the United States, 1981–1991”. Am J Epidemiol. 2000;152(3):287–9.PubMedCrossRef Goldhaber MK, Fireman BH. Re: “Estimates of the annual number of clinically recognized pregnancies in the United States, 1981–1991”. Am J Epidemiol. 2000;152(3):287–9.PubMedCrossRef
24.
go back to reference Nybo AA, Wohlfahrt J, Christens P, Olsen J, Melbye M. Is maternal age an independent risk factor for fetal loss? West J Med. 2000;173(5):331.PubMedCrossRef Nybo AA, Wohlfahrt J, Christens P, Olsen J, Melbye M. Is maternal age an independent risk factor for fetal loss? West J Med. 2000;173(5):331.PubMedCrossRef
25.
go back to reference Lacroix I, Damase-Michel C, Kreft-Jais C, Castot A, Montastruc JL. 2009 H1N1 influenza vaccines in pregnant women: the French Pharmacovigilance survey. Vaccine. 2011;29(7):1357–8.PubMedCrossRef Lacroix I, Damase-Michel C, Kreft-Jais C, Castot A, Montastruc JL. 2009 H1N1 influenza vaccines in pregnant women: the French Pharmacovigilance survey. Vaccine. 2011;29(7):1357–8.PubMedCrossRef
26.
go back to reference Dlugacz Y, Fleischer A, Carney MT, Copperman N, Ahmed I, Ross Z, et al. 2009 H1N1 vaccination by pregnant women during the 2009–10 H1N1 influenza pandemic. Am J Obstet Gynecol. 2012;206(4):339 e1–8. Dlugacz Y, Fleischer A, Carney MT, Copperman N, Ahmed I, Ross Z, et al. 2009 H1N1 vaccination by pregnant women during the 2009–10 H1N1 influenza pandemic. Am J Obstet Gynecol. 2012;206(4):339 e1–8.
27.
go back to reference Tavares F, Nazareth I, Monegal JS, Kolte I, Verstraeten T, Bauchau V. Pregnancy and safety outcomes in women vaccinated with an AS03-adjuvanted split virion H1N1 (2009) pandemic influenza vaccine during pregnancy: a prospective cohort study. Vaccine. 2011;29:6358–65. Tavares F, Nazareth I, Monegal JS, Kolte I, Verstraeten T, Bauchau V. Pregnancy and safety outcomes in women vaccinated with an AS03-adjuvanted split virion H1N1 (2009) pandemic influenza vaccine during pregnancy: a prospective cohort study. Vaccine. 2011;29:6358–65.
28.
go back to reference Pasternak B, Svanstrom H, Molgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Vaccination against pandemic A/H1N1 2009 influenza in pregnancy and risk of fetal death: cohort study in Denmark. BMJ. 2012;344:e2794.PubMedCrossRef Pasternak B, Svanstrom H, Molgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Vaccination against pandemic A/H1N1 2009 influenza in pregnancy and risk of fetal death: cohort study in Denmark. BMJ. 2012;344:e2794.PubMedCrossRef
29.
go back to reference Pasternak B, Svanstrom H, Molgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Risk of adverse fetal outcomes following administration of a pandemic influenza A(H1N1) vaccine during pregnancy. JAMA. 2012;308(2):165–74.PubMedCrossRef Pasternak B, Svanstrom H, Molgaard-Nielsen D, Krause TG, Emborg HD, Melbye M, et al. Risk of adverse fetal outcomes following administration of a pandemic influenza A(H1N1) vaccine during pregnancy. JAMA. 2012;308(2):165–74.PubMedCrossRef
30.
go back to reference Fell DB, Sprague AE, Liu N, Yasseen AS 3rd, Wen SW, Smith G, et al. H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes. Am J Public Health. 2012;102(6):e33–40.PubMedCrossRef Fell DB, Sprague AE, Liu N, Yasseen AS 3rd, Wen SW, Smith G, et al. H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes. Am J Public Health. 2012;102(6):e33–40.PubMedCrossRef
31.
go back to reference Lin TH, Lin SY, Lin CH, Lin RI, Lin HC, Chiu TH, et al. AdimFlu-S((R)) influenza A (H1N1) vaccine during pregnancy: the Taiwanese Pharmacovigilance Survey. Vaccine. 2012;30(16):2671–5.PubMedCrossRef Lin TH, Lin SY, Lin CH, Lin RI, Lin HC, Chiu TH, et al. AdimFlu-S((R)) influenza A (H1N1) vaccine during pregnancy: the Taiwanese Pharmacovigilance Survey. Vaccine. 2012;30(16):2671–5.PubMedCrossRef
32.
go back to reference Moro PL, Tepper NK, Grohskopf LA, Vellozzi C, Broder K. Safety of seasonal influenza and influenza A (H1N1) 2009 monovalent vaccines in pregnancy. Expert Rev Vaccine. 2012;11(8):911–21.CrossRef Moro PL, Tepper NK, Grohskopf LA, Vellozzi C, Broder K. Safety of seasonal influenza and influenza A (H1N1) 2009 monovalent vaccines in pregnancy. Expert Rev Vaccine. 2012;11(8):911–21.CrossRef
33.
go back to reference Oppermann M, Fritzsche J, Weber-Schoendorfer C, Keller-Stanislawski B, Allignol A, Meister R, et al. A(H1N1)v2009: a controlled observational prospective cohort study on vaccine safety in pregnancy. Vaccine. 2012;30(30):4445–52.PubMedCrossRef Oppermann M, Fritzsche J, Weber-Schoendorfer C, Keller-Stanislawski B, Allignol A, Meister R, et al. A(H1N1)v2009: a controlled observational prospective cohort study on vaccine safety in pregnancy. Vaccine. 2012;30(30):4445–52.PubMedCrossRef
Metadata
Title
The PREGVAXGRIP Study: a Cohort Study to Assess Foetal and Neonatal Consequences of In Utero Exposure to Vaccination Against A(H1N1)v2009 Influenza
Authors
F. Chavant
I. Ingrand
A. P. Jonville-Bera
C. Plazanet
V. Gras-Champel
L. Lagarce
M. Zenut
A. Disson-Dautriche
S. Logerot
M. Auffret
A. Coubret-Dumas
M. L. Bruel
M. Boyer
M. A. Bos-Thompson
G. Veyrac
P. Carlier
M. N. Beyens
S. Lates
C. Damase-Michel
A. Castot
C. Kreft-Jaïs
M. C. Pérault-Pochat
Publication date
01-06-2013
Publisher
Springer International Publishing AG
Published in
Drug Safety / Issue 6/2013
Print ISSN: 0114-5916
Electronic ISSN: 1179-1942
DOI
https://doi.org/10.1007/s40264-013-0030-1

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