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Davies HG, Thorley EV, Al-Bahadili R, Sutton N, Burt J, Hookham L, Karampatsas K, Lambach P, Muñoz F, Cutland CL, Omer S, Le Doare K. Defining and reporting adverse events of special interest in comparative maternal vaccine studies: a systematic review. Vaccine X 2024; 18:100464. [PMID: 38495929 PMCID: PMC10943481 DOI: 10.1016/j.jvacx.2024.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction The GAIA (Global Alignment on Immunisation Safety Assessment in Pregnancy) consortium was established in 2014 with the aim of creating a standardised, globally coordinated approach to monitoring the safety of vaccines administered in pregnancy. The consortium developed twenty-six standardised definitions for classifying obstetric and infant adverse events. This systematic review sought to evaluate the current state of adverse event reporting in maternal vaccine trials following the publication of the case definitions by GAIA, and the extent to which these case definitions have been adopted in maternal vaccine safety research. Methods A comprehensive search of published literature was undertaken to identify maternal vaccine research studies. PubMed, EMBASE, Web of Science, and Cochrane were searched using a combination of MeSH terms and keyword searches to identify observational or interventional studies that examined vaccine safety in pregnant women with a comparator group. A two-reviewer screening process was undertaken, and a narrative synthesis of the results presented. Results 14,737 titles were identified from database searches, 435 titles were selected as potentially relevant, 256 were excluded, the remaining 116 papers were included. Influenza vaccine was the most studied (25.0%), followed by TDaP (20.7%) and SARS-CoV-2 (12.9%).Ninety-one studies (78.4%) were conducted in high-income settings. Forty-eight (41.4%) utilised electronic health-records. The majority focused on reporting adverse events of special interest (AESI) in pregnancy (65.0%) alone or in addition to reactogenicity (27.6%). The most frequently reported AESI were preterm birth, small for gestational age and hypertensive disorders. Fewer than 10 studies reported use of GAIA definitions. Gestational age assessment was poorly described; of 39 studies reporting stillbirths 30.8% provided no description of the gestational age threshold. Conclusions Low-income settings remain under-represented in comparative maternal vaccine safety research. There has been poor uptake of GAIA case definitions. A lack of harmonisation and standardisation persists limiting comparability of the generated safety data.
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Affiliation(s)
- Hannah G Davies
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
- MRC, UVRI & LSHTM Uganda Research Centre, Entebbe, Uganda
- Makerere University John Hopkins Research Unit, Kampala, Uganda
| | - Emma V Thorley
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Rossul Al-Bahadili
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Natalina Sutton
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Jessica Burt
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Lauren Hookham
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | - Kostas Karampatsas
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
| | | | - Flor Muñoz
- Paediatric Infectious Diseases Department, Baylor College of Medicine, Houston, TX, USA
| | - Clare L Cutland
- Wits African Leadership in Vaccinology Expertise (Wits-Alive), School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Saad Omer
- O’Donnell School of Public Health, UT Southwestern Medical Center, Texas, USA
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, Institute of Infection & Immunity, St George’s, University of London, Cranmer Terrace, Tooting, London, United Kingdom
- Makerere University John Hopkins Research Unit, Kampala, Uganda
- World Health Organization, Geneva, Switzerland
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Zhong G, Zhuang C, Hu X, Chen Q, Bi Z, Jia X, Peng S, Li Y, Huang Y, Zhang Q, Hong Y, Qiao Y, Su Y, Pan H, Wu T, Wei L, Huang S, Zhang J, Xia N. Safety of hepatitis E vaccination for pregnancy: a post-hoc analysis of a randomized, double-blind, controlled phase 3 clinical trial. Emerg Microbes Infect 2023; 12:2185456. [PMID: 36877135 PMCID: PMC10026809 DOI: 10.1080/22221751.2023.2185456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Special attention has been paid to Hepatitis E (HE) prophylaxis for pregnant women due to poor prognosis of HE in this population. We conducted a post-hoc analysis based on the randomized, double-blind, HE vaccine (Hecolin)-controlled phase 3 clinical trial of human papillomavirus (HPV) vaccine (Cecolin) conducted in China. Eligible healthy women aged 18-45 years were randomly assigned to receive three doses of Cecolin or Hecolin and were followed up for 66 months. All the pregnancy-related events throughout the study period were closely followed up. The incidences of adverse events, pregnancy complications, and adverse pregnancy outcomes were analysed based on the vaccine group, maternal age, and interval between vaccination and pregnancy onset. During the study period, 1263 Hecolin receivers and 1260 Cecolin receivers reported 1684 and 1660 pregnancies, respectively. The participants in the two vaccine groups showed similar maternal and neonatal safety profiles, regardless of maternal age. Among the 140 women who were inadvertently vaccinated during pregnancy, the incidences of adverse reactions had no statistical difference between the two groups (31.8% vs 35.1%, p = 0.6782). The proximal exposure to HE vaccination was not associated with a significantly higher risk of abnormal foetal loss (OR 0.80, 95% CI 0.38-1.70) or neonatal abnormality (OR 2.46, 95% CI 0.74-8.18) than that to HPV vaccination, as did distal exposure. Significant difference was not noted between pregnancies with proximal and distal exposure to HE vaccination. Conclusively, HE vaccination during or shortly before pregnancy is not associated with increased risks for both the pregnant women and pregnancy outcomes.
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Affiliation(s)
- Guohua Zhong
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Chunlan Zhuang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Xiaowen Hu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Qi Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Zhaofeng Bi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Xinhua Jia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Siying Peng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Yufei Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Yue Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
- Xiang'an Biomedicine Laboratory, Xiamen, People's Republic of China
| | - Qiufen Zhang
- Xiamen Innovax Biotech Company, Xiamen, People's Republic of China
| | - Ying Hong
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Youlin Qiao
- National Cancer Center, National Center for Cancer Clinical Research, the Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, People's Republic of China
| | - Yingying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
- Xiang'an Biomedicine Laboratory, Xiamen, People's Republic of China
| | - Huirong Pan
- Xiamen Innovax Biotech Company, Xiamen, People's Republic of China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
- Xiang'an Biomedicine Laboratory, Xiamen, People's Republic of China
| | - Lihui Wei
- Peking University People's Hospital, Beijing, People's Republic of China
| | - Shoujie Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
- Xiang'an Biomedicine Laboratory, Xiamen, People's Republic of China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
- Xiang'an Biomedicine Laboratory, Xiamen, People's Republic of China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, People's Republic of China
- Xiang'an Biomedicine Laboratory, Xiamen, People's Republic of China
- The Research Unit of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, Xiamen University, Xiamen, People's Republic of China
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3
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Hills SL, Wong JM, Staples JE. Arboviral vaccines for use in pregnant travelers. Travel Med Infect Dis 2023; 55:102624. [PMID: 37517630 DOI: 10.1016/j.tmaid.2023.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
Pregnant women traveling abroad can be exposed to a variety of arboviruses, primarily spread by mosquitoes or ticks. Some arboviral infections can be of particular concern for pregnant women or their fetuses. Vaccination is one preventive measure that can reduce the risk for infection. Several arboviral vaccines have been licensed for many years and can be used to prevent infection in travelers, namely Japanese encephalitis, yellow fever, and tick-borne encephalitis vaccines. Recommendations on use of these vaccines in pregnancy vary. Other arboviral vaccines have been licensed but are not indicated for use in pregnant travelers (e.g., dengue vaccines) or are in development (e.g., chikungunya, Zika vaccines). This review describes arboviral vaccines for travelers, focusing on women who are pregnant and those planning travel during pregnancy.
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Affiliation(s)
- S L Hills
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.
| | - J M Wong
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - J E Staples
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Hussain Z, Rani S, Ma F, Li W, Shen W, Gao T, Wang J, Pei R. Dengue determinants: Necessities and challenges for universal dengue vaccine development. Rev Med Virol 2023; 33:e2425. [PMID: 36683235 DOI: 10.1002/rmv.2425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
Dengue illness can range from mild illness to life-threatening haemorrhage. It is an Aedes-borne infectious disease caused by the dengue virus, which has four serotypes. Each serotype acts as an independent infectious agent. The antibodies against one serotype confer homotypic immunity but temporary protection against heterotypic infection. Dengue has become a growing health concern for up to one third of the world's population. Currently, there is no potent anti-dengue medicine, and treatment for severe dengue relies on intravenous fluid management and pain medications. The burden of dengue dramatically increases despite advances in vector control measures. These factors underscore the need for a vaccine. Various dengue vaccine strategies have been demonstrated, that is, live attenuated vaccine, inactivated vaccine, DNA vaccine, subunit vaccine, and viral-vector vaccines, some of which are at the stage of clinical testing. Unfortunately, the forefront candidate vaccine is less than satisfactory, and its performance depends on serostatus and age factors. The lessons from clinical studies depicted ambiguity concerning the efficacy of dengue vaccine. Our study highlighted that viral structural heterogeneity, epitope accessibility, autoimmune complications, genetic variants, genetic diversities, antigen competition, virulence variation, host-pathogen specific interaction, antibody-dependent enhancement, cross-reactive immunity among Flaviviruses, and host-susceptibility determinants not only influence infection outcomes but also hampered successful vaccine development. This review integrates dengue determinants allocated necessities and challenges, which would provide insight for universal dengue vaccine development.
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Affiliation(s)
- Zahid Hussain
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China.,Molecular Virology Laboratory, Department of Biosciences, Comsats University Islamabad (CUI), Islamabad, Pakistan
| | - Saima Rani
- Molecular Virology Laboratory, Department of Biosciences, Comsats University Islamabad (CUI), Islamabad, Pakistan
| | - Fanshu Ma
- CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Wenjing Li
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Wenqi Shen
- CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Tian Gao
- CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Jine Wang
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Renjun Pei
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
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5
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Arthropod-Borne Flaviviruses in Pregnancy. Microorganisms 2023; 11:microorganisms11020433. [PMID: 36838398 PMCID: PMC9959669 DOI: 10.3390/microorganisms11020433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Flaviviruses are a diverse group of enveloped RNA viruses that cause significant clinical manifestations in the pregnancy and postpartum periods. This review highlights the epidemiology, pathophysiology, clinical features, diagnosis, and prevention of the key arthropod-borne flaviviruses of concern in pregnancy and the neonatal period-Zika, Dengue, Japanese encephalitis, West Nile, and Yellow fever viruses. Increased disease severity during pregnancy, risk of congenital malformations, and manifestations of postnatal infection vary widely amongst this virus family and may be quite marked. Laboratory confirmation of infection is complex, especially due to the reliance on serology for which flavivirus cross-reactivity challenges diagnostic specificity. As such, a thorough clinical history including relevant geographic exposures and prior vaccinations is paramount for accurate diagnosis. Novel vaccines are eagerly anticipated to ameliorate the impact of these flaviviruses, particularly neuroinvasive disease manifestations and congenital infection, with consideration of vaccine safety in pregnant women and children pivotal. Moving forward, the geographical spread of flaviviruses, as for other zoonoses, will be heavily influenced by climate change due to the potential expansion of vector and reservoir host habitats. Ongoing 'One Health' engagement across the human-animal-environment interface is critical to detect and responding to emergent flavivirus epidemics.
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Simionescu AA, Streinu-Cercel A, Popescu FD, Stanescu AMA, Vieru M, Danciu BM, Miron VD, Săndulescu O. Comprehensive Overview of Vaccination during Pregnancy in Europe. J Pers Med 2021; 11:jpm11111196. [PMID: 34834548 PMCID: PMC8623700 DOI: 10.3390/jpm11111196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 12/18/2022] Open
Abstract
Vaccinations during pregnancy can protect the mother from several infections, thus blocking vertical transmission. Furthermore, through passive antibody transfer, the newborn can be protected against some infections in the first months of life until their own vaccination regimen is initiated and completed at the appropriate age. Pregnancy can be considered a high-risk condition that increases vulnerability to infectious diseases with potentially unfavorable evolution. We present the current knowledge on vaccination during pregnancy in Europe as a useful information source for different health workers involved in prenatal care. Many European countries implement vaccination policies specifically designed for pregnant women, but there is great heterogeneity among programs. Recommendations on vaccination during pregnancy must be based on current high-quality scientific data. The decisions must be made for each individual case, depending on the associated conditions or special circumstances, with a concomitant assessment of the potential benefits and risks to both the pregnant patient and the fetus. Many vaccines are well-tolerated in pregnant women, with no clinically meaningful injection site reactions, systemic symptoms, or vaccine-related serious adverse events.
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Affiliation(s)
- Anca Angela Simionescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Florin-Dan Popescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- Department of Allergology and Clinical Immunology, Nicolae Malaxa Clinical Hospital, 022441 Bucharest, Romania
- Correspondence: or
| | - Ana Maria Alexandra Stanescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
| | - Mariana Vieru
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- Department of Allergology and Clinical Immunology, Nicolae Malaxa Clinical Hospital, 022441 Bucharest, Romania
| | - Bianca Mihaela Danciu
- National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 127715 Bucharest, Romania;
| | - Victor Daniel Miron
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 127715 Bucharest, Romania;
| | - Oana Săndulescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
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de St Maurice A, Ervin E, Chu A. Ebola, Dengue, Chikungunya, and Zika Infections in Neonates and Infants. Clin Perinatol 2021; 48:311-329. [PMID: 34030816 DOI: 10.1016/j.clp.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging infectious diseases, including Ebola, chikungunya, Zika, and dengue, may have significant impacts on maternal-fetal dyads and neonatal outcomes. Pregnant women infected with Ebola demonstrate high mortality and very low evidence of neonatal survival. Maternal chikungunya infection can result in high rates of perinatal transmission, and infected neonates demonstrate variable disease severity. Dengue can be transmitted to neonates via vertical transmission or perinatal transmission. Zika is characterized by mild disease in pregnant women, but congenital infection can be severe. Treatment largely is supportive for these diseases, and vaccine development remains under way, with promising recent advances, notably for Ebola.
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Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Los Angeles, 924 Westwood Boulevard, Suite 900, CA 90095, USA.
| | - Elizabeth Ervin
- Post-baccalaureate Premedical Program, University of Michigan, Office of Graduate and Postdoctoral Studies, 2960 Taubman Health Science Library, 1135 Catherine Street, Ann Arbor, MI 48109, USA
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, 10833 Le Conte Avenue, MDCC B2-411, Los Angeles, CA 90095, USA
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Maternal vaccines-safety in pregnancy. Best Pract Res Clin Obstet Gynaecol 2021; 76:23-40. [PMID: 33773923 PMCID: PMC7992376 DOI: 10.1016/j.bpobgyn.2021.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/18/2020] [Accepted: 02/06/2021] [Indexed: 12/13/2022]
Abstract
Vaccination during pregnancy is important for active immunity of the mother against serious infectious diseases, and also for passive immunity of the neonate to infectious diseases with high morbidity and mortality. As a rule, live vaccines are contraindicated during pregnancy as they may cause fetal viremia/bacteremia. Inactivated vaccines are generally safe. Vaccines safe to be administered to all pregnant ladies are tetanus toxoid (TT; tetanus, diphtheria, acellular pertussis (Tdap) and Flu vaccines. During pre-pregnancy counselling, vaccination for MMR (measles, mumps, and rubella) should be offered, with an advice to avoid pregnancy for a month. All pregnant mothers should receive TT and Tdap vaccination during the third trimester. Flu vaccine can be given to all mothers at any gestation, and if not offered during pregnancy, it can be given postpartum. Vaccinations that should be offered to women if at high risk of exposure are for hepatitis A and B, pneumococcal, meningococcal, yellow fever, Japanese encephalitis (JE), polio, typhoid, and cholera infections. Vaccines to be given only for post-exposure prophylaxis (PEP) are smallpox, rabies, and anthrax. Postpartum women should be offered human papillomavirus (HPV) vaccination. If not immunized earlier, they should be offered MMR, Tdap, and Flu vaccines. Future vaccines being developed are for malaria, Zika virus, respiratory syncytial virus (RSV), group B streptococcus, CMV, and COVID-19 (SARS-Cov-2).
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O'Kelly B, Lambert JS. Vector-borne diseases in pregnancy. Ther Adv Infect Dis 2020; 7:2049936120941725. [PMID: 32944240 PMCID: PMC7469740 DOI: 10.1177/2049936120941725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Vector-borne infections cause a significant proportion of world-wide morbidity and mortality and many are increasing in incidence. This is due to a combination of factors, primarily environmental change, encroachment of human habitats from urban to peri-urban areas and rural to previously uninhabited areas, persistence of poverty, malnutrition and resource limitation in geographical areas where these diseases are endemic. Pregnant women represent the single largest ‘at risk’ group, due to immune-modulation and a unique physiological state. Many of these diseases have not benefitted from the same level of drug development as other infectious and medical domains, a factor attributing to the ‘neglected tropical disease’ title many vector-borne diseases hold. Pregnancy compounds this issue as data for safety and efficacy for many drugs is practically non-existent, precluding exposure in pregnancy to many first-line therapeutic agents for ‘fear of the unknown’ or overstated adverse pregnancy-foetal outcomes. In this review, major vector-borne diseases, their impact on pregnancy outcomes, current treatment, vaccination and short-comings of current medical practice for pregnant women will be discussed.
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Affiliation(s)
- Brendan O'Kelly
- Infectious Diseases Specialist Registrar, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John S Lambert
- Consultant in Infectious Diseases, Medicine and Sexual Health (GUM), Mater, Rotunda and UCD, Mater Misericordiae University Hospital, Clinic 6, Eccles St, Inns Quay, Dublin, D07 R2WY University College Dublin Rotunda Maternity Hospital
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Laris-González A, Bernal-Serrano D, Jarde A, Kampmann B. Safety of Administering Live Vaccines During Pregnancy: A Systematic Review and Meta-Analysis of Pregnancy Outcomes. Vaccines (Basel) 2020; 8:E124. [PMID: 32168941 PMCID: PMC7157743 DOI: 10.3390/vaccines8010124] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 01/18/2023] Open
Abstract
Live-attenuated vaccines (LAV) are currently contraindicated during pregnancy, given uncertain safety records for the mother-infant pair. LAV might, however, play an important role to protect them against serious emerging diseases, such as Ebola and Lassa fever. For this systematic review we searched relevant databases to identify studies published up to November 2019. Controlled observational studies reporting pregnancy outcomes after maternal immunization with LAV were included. The ROBINS-I tool was used to assess risk of bias. Pooled odds ratios (OR) were obtained under a random-effects model. Of 2831 studies identified, fifteen fulfilled inclusion criteria. Smallpox, rubella, poliovirus, yellow fever and dengue vaccines were assessed in these studies. No association was found between vaccination and miscarriage (OR 0.98, 95% CI 0.87-1.10), stillbirth (OR 1.04, 95% CI 0.74-1.48), malformations (OR 1.09, 95% CI 0.98-1.21), prematurity (OR 0.99, 95% CI 0.90-1.08) or neonatal death (OR 1.06, 95% CI 0.68-1.65) overall. However, increased odds of malformations (OR 1.24; 95% CI 1.03-1.49) and miscarriage after first trimester immunization (OR 4.82; 95% CI 2.38-9.77) was found for smallpox vaccine. Thus, we did not find evidence of harm related to LAV other than smallpox with regards to pregnancy outcomes, but quality of evidence was very low. Overall risks appear to be small and have to be balanced against potential benefits for the mother-infant pair.
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Affiliation(s)
- Almudena Laris-González
- Hospital Infantil de México Federico Gómez, Mexico 06720, Mexico;
- London School of Hygiene and Tropical Medicine (alumni), London WC1E 7HT, UK;
| | - Daniel Bernal-Serrano
- London School of Hygiene and Tropical Medicine (alumni), London WC1E 7HT, UK;
- Compañeros en Salud—Partners in Health México, Mexico 11800, Mexico
- Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico 14380, Mexico
| | - Alexander Jarde
- Disease Control Elimination Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, Gambia;
| | - Beate Kampmann
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Vaccines & Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, Gambia
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11
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Development of a Dengue Vaccine and Its Use in Pregnant Women. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Giraldo-García AM, Castaño-Osorio JC. Effects of Flavivirus Cross-Reactivity (Zika and Dengue) on the Development of Vaccines for Use in Pregnancy. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00191-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Bovbjerg ML. Current Resources for Evidence-Based Practice, March 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:230-248. [PMID: 30735623 DOI: 10.1016/j.jogn.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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14
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Klitting R, Fischer C, Drexler JF, Gould EA, Roiz D, Paupy C, de Lamballerie X. What Does the Future Hold for Yellow Fever Virus? (II). Genes (Basel) 2018; 9:E425. [PMID: 30134625 PMCID: PMC6162518 DOI: 10.3390/genes9090425] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023] Open
Abstract
As revealed by the recent resurgence of yellow fever virus (YFV) activity in the tropical regions of Africa and South America, YFV control measures need urgent rethinking. Over the last decade, most reported outbreaks occurred in, or eventually reached, areas with low vaccination coverage but that are suitable for virus transmission, with an unprecedented risk of expansion to densely populated territories in Africa, South America and Asia. As reflected in the World Health Organization's initiative launched in 2017, it is high time to strengthen epidemiological surveillance to monitor accurately viral dissemination, and redefine vaccination recommendation areas. Vector-control and immunisation measures need to be adapted and vaccine manufacturing must be reconciled with an increasing demand. We will have to face more yellow fever (YF) cases in the upcoming years. Hence, improving disease management through the development of efficient treatments will prove most beneficial. Undoubtedly, these developments will require in-depth descriptions of YFV biology at molecular, physiological and ecological levels. This second section of a two-part review describes the current state of knowledge and gaps regarding the molecular biology of YFV, along with an overview of the tools that can be used to manage the disease at the individual, local and global levels.
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Affiliation(s)
- Raphaëlle Klitting
- Unité des Virus Émergents (UVE: Aix-Marseille Univ⁻IRD 190⁻Inserm 1207⁻IHU Méditerranée Infection), 13385 Marseille CEDEX 05, France.
| | - Carlo Fischer
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, 10117 Berlin, Germany.
- German Center for Infection Research (DZIF), 38124 Braunschweig, Germany.
| | - Jan F Drexler
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, 10117 Berlin, Germany.
- German Center for Infection Research (DZIF), 38124 Braunschweig, Germany.
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, 119991 Moscow, Russia.
| | - Ernest A Gould
- Unité des Virus Émergents (UVE: Aix-Marseille Univ⁻IRD 190⁻Inserm 1207⁻IHU Méditerranée Infection), 13385 Marseille CEDEX 05, France.
| | - David Roiz
- UMR Maladies Infectieuses et Vecteurs: Écologie, Génétique Évolution et Contrôle (MIVEGEC: IRD, CNRS, Univ. Montpellier), 34394 Montpellier, France.
| | - Christophe Paupy
- UMR Maladies Infectieuses et Vecteurs: Écologie, Génétique Évolution et Contrôle (MIVEGEC: IRD, CNRS, Univ. Montpellier), 34394 Montpellier, France.
| | - Xavier de Lamballerie
- Unité des Virus Émergents (UVE: Aix-Marseille Univ⁻IRD 190⁻Inserm 1207⁻IHU Méditerranée Infection), 13385 Marseille CEDEX 05, France.
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