Strategies To Boost Maternal Immunization To Achieve Further Gains In Improved Maternal And Newborn Health

Bordetella pertussis -related Respiratory Deaths in Infants From 4 Days to 6 Months of Age, Results From a 3-Year, Prospective Postmortem Surveillance Study in Lusaka, Zambia

BACKGROUND

Since the 1990s, a remarkable decline in infant and child mortality has occurred. Continued progress in reducing mortality will need to focus on early infant and neonatal mortality and on less common diseases than pneumonia, diarrhea and malnutrition. One of the candidate diseases for focus is Bordetella pertussis , the principal cause of "whooping cough."

METHODS

We conducted a study to measure the burden of deaths and calculate the population-attributable fraction of deaths due to B. pertussis . We collected postmortem nasopharyngeal swabs from subjects who died at the University Teaching Hospital or in the community and were brought to the University Teaching Hospital morgue 4 days to < 6 months of age. Infection with B. pertussis was determined with polymerase chain reaction testing. We assigned respiratory cause of death from the medical record or from a verbal autopsy collected from caregivers.

RESULTS

From August 2017 to August 2020, we collected nasopharyngeal samples from 2236 deceased subjects. Respiratory deaths were assigned to 29.0% of the deaths; 39.5% of community deaths were attributed to respiratory causes. Using 2 definitions of polymerase chain reaction positivity, the prevalence of B. pertussis in infant deaths was between 5.69 per 1000 deaths (95% confidence interval, 2.57-8.80) and 25.81 per 1000 deaths (95% confidence interval, 19.24-32.38). Pertussis accounted for between 0.22% and 0.81% of all infant deaths.

CONCLUSIONS

In this population of infants, B. pertussis was a minor source of all-cause infant mortality. Our analysis does not support the need for further steps for population-level preventive strategies for the control of B. pertussis .

Examining the Effect of Parental COVID-19 Vaccination Prior to Birth and the Association Between COVID-19 and Cancer in Children Under Six

INTRODUCTION

The biology of COVID-19 has intricate links to childhood cancer, exacerbated by pandemic disturbances. This research aims to explore the association between childhood cancer in children under 6 years old and COVID-19 immunisation, in addition to the effects of vaccination on parents before delivery.

METHOD

The study employs a case-control approach, gathering informed consent and matching factors like age, marital status, and socioeconomic status between cases and controls. A survey was distributed, culminating in 191 children under six, with data from 136 diagnosed cancer cases collected in 2023, adhering to methodological standards in epidemiological research. The analysis utilised SPSS28, employing chi-square testing and logistic regression.

RESULT

Chi-square testing confirmed a significant rise in childhood cancer rates post-COVID-19 pandemic compared to pre-pandemic rates. Key factors influencing cancer incidence include the mother's age at childbirth, parental vaccination history before pregnancy, maternal vaccination details during pregnancy, the child's COVID-19 infection status, and maternal marriage age. Notably, younger mothers faced higher COVID-19 infection risks, but vaccination appears to mitigate paediatric cancer risk.

CONCLUSION

The post-pandemic surge in childhood cancer underscores a complex interplay of early exposures and maternal viral infections. Emphasising vaccination's protective effects before and during pregnancy, the study advocates integrating vaccination into maternal health programs. Public health measures should promote immunisation and address socioeconomic inequalities to lower paediatric cancer risk, aligning with previous studies linking parental health behaviours to childhood cancer incidence.

Spatiotemporal trends and geographic disparities in spatial accessibility to maternal and child health services in Nanning, China: impact of two-child policies

BACKGROUND

China's family planning policies have experienced stages of one-child policy, partial two-child policy, and universal two-child policy. However, the impact of these policy shifts on the spatial accessibility to maternal and child health (MCH) services for women and children remains uncertain. This study aimed to evaluate the spatiotemporal trends and geographic disparities in spatial accessibility to MCH services in the context of two-child polices.

METHODS

This study was conducted in Nanning prefecture, China, from 2013 to 2019. Data on the transportation networks, MCH institutes, the annual number of newborns, and the annual number of pregnant women in Nanning prefecture were collected. Gaussian two-step floating catchment area (Ga2SFCA) method was employed to measure the spatial accessibility to MCH services at county, township, and village levels. Temporal trends in spatial accessibility were analyzed using Joinpoint regression analysis. Geographic disparities in spatial accessibility were identified using geographic information system (GIS) mapping techniques.

RESULTS

Overall, the spatial accessibility to MCH services showed an upward trend from 2013 to 2019 at county, town, and village levels, with the average annual percent change (AAPC) being 5.04, 4.73, and 5.39, respectively. Specifically, the spatial accessibility experienced a slight downward trend during the period of partial two-child policy for both parents only children (i.e., 2013-2014), a slight upward trend during the period of partial two-child policy for either parent only child (i.e., 2014-2016) and the early stages of universal two-child policy (i.e., 2016-2018), and a large upward trend in the later stages of universal two-child policy (i.e., 2018-2019). Spatial accessibility to MCH services gradually decreased from central urban areas to surrounding rural areas. Regions with low spatial accessibility were predominantly located in remote rural areas.

CONCLUSION

With the gradual opening of the two-child policies, the spatial accessibility to MCH services for women and children has generally improved. However, significant geographic disparities have persisted throughout the stages of the two-child policies. Comprehensive measures should be considered to improve equity in MCH services for women and children.

Coverage and predictors of influenza and pertussis vaccination during pregnancy: a whole of population-based study

BACKGROUND

Respiratory infections including influenza and pertussis are associated with significant morbidity and mortality in mothers and newborns. Vaccination during pregnancy against influenza and pertussis is recommended for all women but data on uptake in Australia is limited.

METHODS

We conducted a retrospective population-based cohort study in Australia's largest state, New South Wales (NSW), using a Perinatal Data Collection (PDC). Data included demographic, pregnancy, and birth details including pertussis and influenza vaccination during pregnancy for all women giving birth between 01 January 2016 and 31 December 2020. We used descriptive statistics to assess uptake of influenza and pertussis vaccination during pregnancy and Poisson loglinear regression to estimate associations between maternal characteristics and vaccine receipt.

RESULTS

During 2016-2020, there were 477,776 births (mean maternal age 32.25 years). In 176,255 (36.9%) births the mother received both vaccines; 202,922 (42.5%) influenza and 315,620 (66.1%) pertussis vaccine. From 2016 to 2020, reported coverage increased from 26.7% to 58.7% for influenza and 43.1% to 78.8% for pertussis, respectively. After adjustment, characteristics associated with lower likelihood of receiving influenza and pertussis vaccination included: younger age (<30 years), being born in Australia/New Zealand, from lower socio-economic strata, having previous pregnancies, being later to first antenatal care, utilising the public hospital care model, smoking, having chronic hypertension and BMI > 25 kg/m2.

CONCLUSIONS

While reported coverage of both influenza and pertussis vaccine in birthing women in NSW has increased over time, disparities in coverage exist and they highlight areas where evidence-based interventions to improve maternal vaccination could be targeted.

Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis

INTRODUCTION

Emerging evidence suggests young children are at greater risk of COVID-19 infection than initially predicted. However, a comprehensive understanding of epidemiology of COVID-19 infection in young children under five years, the most at-risk age-group for respiratory infections, remain unclear. We conducted a systematic review and meta-analysis of epidemiological and clinical characteristics of COVID-19 infection in children under five years.

METHOD

Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses , we searched several electronic databases (Pubmed, EMBASE, Web of Science, and Scopus) with no language restriction for published epidemiological studies and case-reports reporting laboratory-confirmed COVID-19 infection in children under five years until June 4, 2020. We assessed pooled prevalence for key demographics and clinical characteristics using Freeman-Tukey double arcsine random-effects model for studies except case-reports. We evaluated risk of bias separately for case-reports and other studies.

RESULTS

We identified 1,964 articles, of which, 65 articles were eligible for systematic review that represented 1,214 children younger than five years with laboratory-confirmed COVID-19 infection. The pooled estimates showed that 50% young COVID-19 cases were infants (95% CI: 36% - 63%, 27 studies); 53% were male (95% CI: 41% - 65%, 24 studies); 43% were asymptomatic (95% CI: 15% - 73%, 9 studies) and 7% (95% CI: 0% - 30%, 5 studies) had severe disease that required intensive-care-unit admission. Of 139 newborns from COVID-19 infected mothers, five (3.6%) were COVID-19 positive. There was only one death recorded.

DISCUSSION

This systematic review reports the largest number of children younger than five years with COVID-19 infection till date. Our meta-analysis shows nearly half of young COVID-19 cases were asymptomatic and half were infants, highlighting the need for ongoing surveillance to better understand the epidemiology, clinical pattern, and transmission of COVID-19 to develop effective preventive strategies against COVID-19 disease in young paediatric population.

Determinants of policy and uptake of national vaccine programs for pregnant women: results of mixed method study from Spain, Italy, and India

An important strategy for addressing maternal and newborn risks of disease is through vaccinating pregnant women. We conducted a mixed-methods study including a narrative literature review of drivers of maternal vaccination and key informant interviews in Spain, Italy, and India to characterize different approaches to national maternal immunization programs. Fifty-nine respondents participated in the study conducted between November 2018 and January 2019. Policies in Spain and Italy both reflect a life-course approach to vaccination, but recommendations and how they ensure uptake differs. Italy was focused on tracking of progress and mandates to ensure compliance in all regions, while Spain, an early adopter, relied more on advocacy and building provider acceptance. India includes Td in their national program, but the political will and advocacy for other vaccines are not seen. Needs for improving rates of maternal vaccination include education of health-care providers and pregnant women, use of central registries to track progress, stronger global guidance for use of vaccines, and engagement of champions, particularly obstetrician-gynecologists (ob-gyns). Health security concerns can also be leveraged to build political priority and needed platforms to detect disease and deliver vaccines in some countries. Understanding what drives a country’s maternal immunization program decisions and the success of implementation is useful in designing strategies to share best practices and guide support to strengthen platforms for maternal vaccination.

Maternal Immunization: Nature Meets Nurture

Vaccinating women in pregnancy (i.e., maternal immunization) has emerged as a promising tool to tackle infant morbidity and mortality worldwide. This approach nurtures a 'gift of nature,' whereby antibody is transferred from mother to fetus transplacentally during pregnancy, or postnatally in breast milk, thereby providing passive, antigen-specific protection against infections in the first few months of life, a period of increased immune vulnerability for the infant. In this review, we briefly summarize the rationale for maternal immunization programs and the landscape of vaccines currently in use or in the pipeline. We then direct the focus to the underlying biological phenomena, including the main mechanisms by which maternally derived antibody is transferred efficiently to the infant, at the placental interface or in breast milk; important research models and methodological approaches to interrogate these processes, particularly in the context of recent advances in systems vaccinology; the potential biological and clinical impact of high maternal antibody titres on neonatal ontogeny and subsequent infant vaccine responses; and key vaccine- and host-related factors influencing the maternal-infant dyad across different environments. Finally, we outline important gaps in knowledge and suggest future avenues of research on this topic, proposing potential strategies to ensure optimal testing, delivery and implementation of maternal vaccination programs worldwide.