Optimal timing of influenza vaccine during pregnancy

A systematic review and meta-analysis

Will Cuningham, Nicholas Geard, James E. Fielding, Sabine Braat, Shabir A. Madhi, Marta C. Nunes, Lisa M. Christian, Shin Yu Lin, Chien Nan Lee, Koushi Yamaguchi, Hans Bisgaard, Bo Chawes, An Shine Chao, Geraldine Blanchard-Rohner, Elizabeth P. Schlaudecker, Barbra M. Fisher, Jodie McVernon, Robert Moss

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)438-452
Number of pages15
JournalInfluenza and Other Respiratory Viruses
Volume13
Issue number5
Early online date5 Jun 2019
DOIs
Publication statusPublished - Sep 2019
Externally publishedYes

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Influenza Vaccines
Meta-Analysis
Vaccination
Pregnancy
Hemagglutination
Human Influenza
Pregnant Women
Mothers
Newborn Infant
Fetal Blood
Pregnancy Trimesters
Climate
PubMed
Hospitalization
Fetus
Vaccines
Databases

Cite this

Cuningham, W., Geard, N., Fielding, J. E., Braat, S., Madhi, S. A., Nunes, M. C., ... Moss, R. (2019). Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis. Influenza and Other Respiratory Viruses, 13(5), 438-452. https://doi.org/10.1111/irv.12649
Cuningham, Will ; Geard, Nicholas ; Fielding, James E. ; Braat, Sabine ; Madhi, Shabir A. ; Nunes, Marta C. ; Christian, Lisa M. ; Lin, Shin Yu ; Lee, Chien Nan ; Yamaguchi, Koushi ; Bisgaard, Hans ; Chawes, Bo ; Chao, An Shine ; Blanchard-Rohner, Geraldine ; Schlaudecker, Elizabeth P. ; Fisher, Barbra M. ; McVernon, Jodie ; Moss, Robert. / Optimal timing of influenza vaccine during pregnancy : A systematic review and meta-analysis. In: Influenza and Other Respiratory Viruses. 2019 ; Vol. 13, No. 5. pp. 438-452.
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abstract = "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.",
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Cuningham, W, Geard, N, Fielding, JE, Braat, S, Madhi, SA, Nunes, MC, Christian, LM, Lin, SY, Lee, CN, Yamaguchi, K, Bisgaard, H, Chawes, B, Chao, AS, Blanchard-Rohner, G, Schlaudecker, EP, Fisher, BM, McVernon, J & Moss, R 2019, 'Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis', Influenza and Other Respiratory Viruses, vol. 13, no. 5, pp. 438-452. https://doi.org/10.1111/irv.12649

Optimal timing of influenza vaccine during pregnancy : A systematic review and meta-analysis. / Cuningham, Will; Geard, Nicholas; Fielding, James E.; Braat, Sabine; Madhi, Shabir A.; Nunes, Marta C.; Christian, Lisa M.; Lin, Shin Yu; Lee, Chien Nan; Yamaguchi, Koushi; Bisgaard, Hans; Chawes, Bo; Chao, An Shine; Blanchard-Rohner, Geraldine; Schlaudecker, Elizabeth P.; Fisher, Barbra M.; McVernon, Jodie; Moss, Robert.

In: Influenza and Other Respiratory Viruses, Vol. 13, No. 5, 09.2019, p. 438-452.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Optimal timing of influenza vaccine during pregnancy

T2 - A systematic review and meta-analysis

AU - Cuningham, Will

AU - Geard, Nicholas

AU - Fielding, James E.

AU - Braat, Sabine

AU - Madhi, Shabir A.

AU - Nunes, Marta C.

AU - Christian, Lisa M.

AU - Lin, Shin Yu

AU - Lee, Chien Nan

AU - Yamaguchi, Koushi

AU - Bisgaard, Hans

AU - Chawes, Bo

AU - Chao, An Shine

AU - Blanchard-Rohner, Geraldine

AU - Schlaudecker, Elizabeth P.

AU - Fisher, Barbra M.

AU - McVernon, Jodie

AU - Moss, Robert

PY - 2019/9

Y1 - 2019/9

N2 - 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.

AB - 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.

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KW - influenza

KW - pregnancy

KW - timing

KW - trimester

KW - vaccination

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U2 - 10.1111/irv.12649

DO - 10.1111/irv.12649

M3 - Review article

VL - 13

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JO - Influenza and Other Respiratory Viruses

JF - Influenza and Other Respiratory Viruses

SN - 1750-2640

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ER -