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Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal

BACKGROUND: Maternal influenza vaccination protects mothers and their infants in low resource settings, but little is known about whether the protection varies by gestational age at vaccination. METHODS: Women of childbearing age in rural southern Nepal were surveilled for pregnancy, consented and r...

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Autores principales: Katz, Joanne, Englund, Janet A, Steinhoff, Mark C, Khatry, Subarna K, Shrestha, Laxman, Kuypers, Jane, Mullany, Luke C, Chu, Helen Y, LeClerq, Steven C, Kozuki, Naoko, Tielsch, James M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051462/
https://www.ncbi.nlm.nih.gov/pubmed/29452372
http://dx.doi.org/10.1093/cid/ciy090
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author Katz, Joanne
Englund, Janet A
Steinhoff, Mark C
Khatry, Subarna K
Shrestha, Laxman
Kuypers, Jane
Mullany, Luke C
Chu, Helen Y
LeClerq, Steven C
Kozuki, Naoko
Tielsch, James M
author_facet Katz, Joanne
Englund, Janet A
Steinhoff, Mark C
Khatry, Subarna K
Shrestha, Laxman
Kuypers, Jane
Mullany, Luke C
Chu, Helen Y
LeClerq, Steven C
Kozuki, Naoko
Tielsch, James M
author_sort Katz, Joanne
collection PubMed
description BACKGROUND: Maternal influenza vaccination protects mothers and their infants in low resource settings, but little is known about whether the protection varies by gestational age at vaccination. METHODS: Women of childbearing age in rural southern Nepal were surveilled for pregnancy, consented and randomized to receive maternal influenza vaccination or placebo, with randomization stratified on gestational age (17–25 or 26–34 weeks). Enrollment occurred in 2 annual cohorts, and vaccinations occurred from April 2011 through September 2013. RESULTS: In sum, 3693 women consented and enrolled, resulting in 3646 live births. Although cord blood antibody titers and the rise in maternal titers were generally greater when women were vaccinated later in pregnancy, this was not statistically significant. The incidence risk ratio (IRR) for maternal influenza in pregnancy through 6 months postpartum was 0.62 (95% confidence interval [CI]: 0.35, 1.10) for those vaccinated 17–25 weeks gestation and 0.89 (95% CI: 0.39, 2.00) for those 26–34 weeks. Infant influenza IRRs were 0.73 (95% CI: 0.51, 1.05) for those whose mothers were vaccinated earlier in gestation, and 0.63 (95% CI: 0.37, 1.08) for those later. Relative risks (RR) for low birthweight were 0.83 (95% CI: 0.71, 0.98) and 0.90 (95% CI: 0.72, 1.12) for 17–25 and 26–34 weeks gestation at vaccination, respectively. IRRs did not differ for small-for-gestational age or preterm. No RRs were statistically different by timing of vaccine receipt. CONCLUSIONS: Vaccine efficacy did not vary by gestational age at vaccination, making maternal influenza immunization programs easier to implement where women present for care late in pregnancy. CLINICAL TRIALS REGISTRATION: NCT01034254
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spelling pubmed-60514622018-07-23 Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal Katz, Joanne Englund, Janet A Steinhoff, Mark C Khatry, Subarna K Shrestha, Laxman Kuypers, Jane Mullany, Luke C Chu, Helen Y LeClerq, Steven C Kozuki, Naoko Tielsch, James M Clin Infect Dis Articles and Commentary BACKGROUND: Maternal influenza vaccination protects mothers and their infants in low resource settings, but little is known about whether the protection varies by gestational age at vaccination. METHODS: Women of childbearing age in rural southern Nepal were surveilled for pregnancy, consented and randomized to receive maternal influenza vaccination or placebo, with randomization stratified on gestational age (17–25 or 26–34 weeks). Enrollment occurred in 2 annual cohorts, and vaccinations occurred from April 2011 through September 2013. RESULTS: In sum, 3693 women consented and enrolled, resulting in 3646 live births. Although cord blood antibody titers and the rise in maternal titers were generally greater when women were vaccinated later in pregnancy, this was not statistically significant. The incidence risk ratio (IRR) for maternal influenza in pregnancy through 6 months postpartum was 0.62 (95% confidence interval [CI]: 0.35, 1.10) for those vaccinated 17–25 weeks gestation and 0.89 (95% CI: 0.39, 2.00) for those 26–34 weeks. Infant influenza IRRs were 0.73 (95% CI: 0.51, 1.05) for those whose mothers were vaccinated earlier in gestation, and 0.63 (95% CI: 0.37, 1.08) for those later. Relative risks (RR) for low birthweight were 0.83 (95% CI: 0.71, 0.98) and 0.90 (95% CI: 0.72, 1.12) for 17–25 and 26–34 weeks gestation at vaccination, respectively. IRRs did not differ for small-for-gestational age or preterm. No RRs were statistically different by timing of vaccine receipt. CONCLUSIONS: Vaccine efficacy did not vary by gestational age at vaccination, making maternal influenza immunization programs easier to implement where women present for care late in pregnancy. CLINICAL TRIALS REGISTRATION: NCT01034254 Oxford University Press 2018-08-01 2018-02-14 /pmc/articles/PMC6051462/ /pubmed/29452372 http://dx.doi.org/10.1093/cid/ciy090 Text en © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Articles and Commentary
Katz, Joanne
Englund, Janet A
Steinhoff, Mark C
Khatry, Subarna K
Shrestha, Laxman
Kuypers, Jane
Mullany, Luke C
Chu, Helen Y
LeClerq, Steven C
Kozuki, Naoko
Tielsch, James M
Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal
title Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal
title_full Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal
title_fullStr Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal
title_full_unstemmed Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal
title_short Impact of Timing of Influenza Vaccination in Pregnancy on Transplacental Antibody Transfer, Influenza Incidence, and Birth Outcomes: A Randomized Trial in Rural Nepal
title_sort impact of timing of influenza vaccination in pregnancy on transplacental antibody transfer, influenza incidence, and birth outcomes: a randomized trial in rural nepal
topic Articles and Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051462/
https://www.ncbi.nlm.nih.gov/pubmed/29452372
http://dx.doi.org/10.1093/cid/ciy090
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