Human Vaccines & Immunotherapeutics
ISSN: 2164-5515 (Print) 2164-554X (Online) Journal homepage: http://www.tandfonline.com/loi/khvi20
Antenatal immunization Chrissie Jones & Paul Heath To cite this article: Chrissie Jones & Paul Heath (2014) Antenatal immunization, Human Vaccines & Immunotherapeutics, 10:7, 2118-2122, DOI: 10.4161/hv.29610 To link to this article: http://dx.doi.org/10.4161/hv.29610
Published online: 11 Jul 2014.
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Date: 06 November 2015, At: 06:22
ReviewReview Human Vaccines & Immunotherapeutics 10:7, 2118–2122; July 2014; © 2014 Landes Bioscience
Antenatal immunization Concepts and challenges Chrissie Jones* and Paul Heath Paediatric Infectious Diseases Research Group (PIDRG); St George’s, University of London; London, UK
Downloaded by [68.189.108.187] at 06:22 06 November 2015
Abbreviations: DTaP, diphtheria, tetanus, and acellular pertussis vaccination; DTwP, diphtheria, tetanus, and whole-cell pertussis combined vaccine; FHA, filamentous hemagglutinin; FIM, fimbriae antibodies; GBS, Group B Streptococcus; GP, general practitioner; Hib, Haemophilus influenzae type b; HIV, human immunodeficiency virus; IAP, intrapartum antibiotic prophylaxis; IgG, immunoglobulin G; VAERS, Vaccine Adverse Event Reporting System
Pregnancy and early infancy are periods of relative immune suppression and increased vulnerability to infection. In these circumstances infections are associated with high morbidity and mortality. In particular, infants have high rates of invasive disease, higher than at any other stage of life with rates of 100 per 100 000 population. The concept of maternal vaccination is that maternal levels of pathogen-specific antibody are boosted and provide protection to the infant until the infant is able to mount an effective immune response to immunization. However, an important concern for women and healthcare providers is the safety of receiving vaccines during pregnancy. There are challenges associated with assessing safety in pregnant women. This review discusses the rationale for maternal vaccination, the concepts and mechanisms used. An assessment is made of the safety of vaccination during pregnancy, and the challenges associated with this are considered. In general terms, it is considered that the risk from disease far outweighs the small risk associated with vaccination during pregnancy and that they offer a new platform for preventing significant and serious infections in mothers and young infants.
Introduction The protective role of maternally derived immunity in infants was first observed in 1846 during a measles outbreak on the Faroe Islands. It was noted that if pregnant mothers survived the disease, their babies did not then become infected. In 1879, maternal immunization with vaccinia was found to protect infants against smallpox. In 1938 whole cell pertussis vaccine was used in pregnancy and later in 1961 tetanus toxoid. In Papua New Guinea during 1959–61 women received 3 injections of fluid formalinized tetanus toxoid during pregnancy, the third given in the last trimester, the incidence of neonatal tetanus was 10% in those where the mother received either no or only 1 injection, 3.42% in those that received 2 injections and 0.57% in those that received 3 injections.12
*Correspondence to: Chrissie Jones; Email: [email protected] Published Online: 07/11/2014 http://dx.doi.org/10.4161/hv.29610 2118
Rationale Pregnancy and early infancy are periods of relative immune suppression and increased vulnerability to infection. In these circumstances infections are associated with high morbidity and mortality. Infants have extremely high rates of invasive disease, higher than at any other stage of life with rates of 100 per 100 000 population suggesting that 0.1% of infants are affected by an invasive bacterial infection.1 Figure 1 shows the period between birth and 6 mo are the most vulnerable for infants in terms of infectious disease.11 An example of this can be seen with pertussis in the UK (Fig. 2). The incidence of pertussis infection tends to peak every 3–4 y however there was a clear peak occurring in 2013, this peak is much higher than any previous peak year. Highest rates are observed in infants
ISSN: 2164-5515 (Print) 2164-554X (Online) Journal homepage: http://www.tandfonline.com/loi/khvi20
Antenatal immunization Chrissie Jones & Paul Heath To cite this article: Chrissie Jones & Paul Heath (2014) Antenatal immunization, Human Vaccines & Immunotherapeutics, 10:7, 2118-2122, DOI: 10.4161/hv.29610 To link to this article: http://dx.doi.org/10.4161/hv.29610
Published online: 11 Jul 2014.
Submit your article to this journal
Article views: 75
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=khvi20 Download by: [68.189.108.187]
Date: 06 November 2015, At: 06:22
ReviewReview Human Vaccines & Immunotherapeutics 10:7, 2118–2122; July 2014; © 2014 Landes Bioscience
Antenatal immunization Concepts and challenges Chrissie Jones* and Paul Heath Paediatric Infectious Diseases Research Group (PIDRG); St George’s, University of London; London, UK
Downloaded by [68.189.108.187] at 06:22 06 November 2015
Abbreviations: DTaP, diphtheria, tetanus, and acellular pertussis vaccination; DTwP, diphtheria, tetanus, and whole-cell pertussis combined vaccine; FHA, filamentous hemagglutinin; FIM, fimbriae antibodies; GBS, Group B Streptococcus; GP, general practitioner; Hib, Haemophilus influenzae type b; HIV, human immunodeficiency virus; IAP, intrapartum antibiotic prophylaxis; IgG, immunoglobulin G; VAERS, Vaccine Adverse Event Reporting System
Pregnancy and early infancy are periods of relative immune suppression and increased vulnerability to infection. In these circumstances infections are associated with high morbidity and mortality. In particular, infants have high rates of invasive disease, higher than at any other stage of life with rates of 100 per 100 000 population. The concept of maternal vaccination is that maternal levels of pathogen-specific antibody are boosted and provide protection to the infant until the infant is able to mount an effective immune response to immunization. However, an important concern for women and healthcare providers is the safety of receiving vaccines during pregnancy. There are challenges associated with assessing safety in pregnant women. This review discusses the rationale for maternal vaccination, the concepts and mechanisms used. An assessment is made of the safety of vaccination during pregnancy, and the challenges associated with this are considered. In general terms, it is considered that the risk from disease far outweighs the small risk associated with vaccination during pregnancy and that they offer a new platform for preventing significant and serious infections in mothers and young infants.
Introduction The protective role of maternally derived immunity in infants was first observed in 1846 during a measles outbreak on the Faroe Islands. It was noted that if pregnant mothers survived the disease, their babies did not then become infected. In 1879, maternal immunization with vaccinia was found to protect infants against smallpox. In 1938 whole cell pertussis vaccine was used in pregnancy and later in 1961 tetanus toxoid. In Papua New Guinea during 1959–61 women received 3 injections of fluid formalinized tetanus toxoid during pregnancy, the third given in the last trimester, the incidence of neonatal tetanus was 10% in those where the mother received either no or only 1 injection, 3.42% in those that received 2 injections and 0.57% in those that received 3 injections.12
*Correspondence to: Chrissie Jones; Email: [email protected] Published Online: 07/11/2014 http://dx.doi.org/10.4161/hv.29610 2118
Rationale Pregnancy and early infancy are periods of relative immune suppression and increased vulnerability to infection. In these circumstances infections are associated with high morbidity and mortality. Infants have extremely high rates of invasive disease, higher than at any other stage of life with rates of 100 per 100 000 population suggesting that 0.1% of infants are affected by an invasive bacterial infection.1 Figure 1 shows the period between birth and 6 mo are the most vulnerable for infants in terms of infectious disease.11 An example of this can be seen with pertussis in the UK (Fig. 2). The incidence of pertussis infection tends to peak every 3–4 y however there was a clear peak occurring in 2013, this peak is much higher than any previous peak year. Highest rates are observed in infants
