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Nasser R, Rakedzon S, Dickstein Y, Mousa A, Solt I, Peterisel N, Feldman T, Neuberger A. Are all vaccines safe for the pregnant traveller? A systematic review and meta-analysis. J Travel Med 2020; 27:5588086. [PMID: 31616947 DOI: 10.1093/jtm/taz074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
Abstract
Pregnant travellers and their offspring are vulnerable to severe outcomes following a wide range of infections. Vaccine-preventable diseases can have a particularly severe course in pregnant women, but little is known about the safety of travel vaccines in pregnant women. We performed a systematic review of all published literature concerning the safety of vaccines frequently given to travellers such as yellow fever, MMR (mumps, measles and rubella), influenza, Tdap (tetanus, diphtheria and pertussis), meningococcus, hepatitis A and B, rabies, polio, typhoid fever, tick-borne encephalitis and Japanese encephalitis vaccines. We included case series, cohort studies and randomized controlled trials (RCTs). For the meta-analysis, we included only RCTs that compared the administration of a vaccine to placebo or to no vaccine. Outcome measures included severe systemic adverse events, maternal outcomes related to the course of pregnancy, neonatal outcomes and local adverse events. We calculated the risk ratio and its 95% confidence interval as the summary measure. The safety of influenza vaccine is supported by high-quality evidence. For Tdap vaccine, no evidence of any harm was found in the meta-analysis of RCTs. A slight increase in chorioamnionitis rate was reported in 3 out of 12 observational studies. However, this small possible risk is far outweighed by a much larger benefit in terms of infant morbidity and mortality. Meningococcal vaccines are probably safe during pregnancy, as supported by RCTs comparing meningococcal vaccines to other vaccines. Data from observational studies support the safety of hepatitis A, hepatitis B and rabies vaccines, as well as that of the live attenuated yellow fever vaccine. We found little or no data about the safety of polio, typhoid, Japanese encephalitis, tick-borne encephalitis and MMR vaccines during pregnancy.
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Affiliation(s)
- Roni Nasser
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Stav Rakedzon
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstein
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Amjad Mousa
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | - Ido Solt
- The Rappaport's Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.,Department of Gynaecology and Obstetrics, Rambam Healthcare Campus, Haifa, Israel
| | - Neta Peterisel
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.,Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Tzah Feldman
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Ami Neuberger
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.,Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,The Rappaport's Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Li J, Shao Z, Liu G, Bai X, Borrow R, Chen M, Guo Q, Han Y, Li Y, Taha MK, Xu X, Xu X, Zheng H. Meningococcal disease and control in China: Findings and updates from the Global Meningococcal Initiative (GMI). J Infect 2018; 76:429-437. [PMID: 29406154 DOI: 10.1016/j.jinf.2018.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
The Global Meningococcal Initiative (GMI) is a global expert group, including scientists, clinicians and public health officials from a wide range of specialities. The goal of the GMI is to prevent meningococcal disease worldwide through education, research, and co-operation. The Chinese GMI roundtable meeting was held in June 2017. The GMI met with local experts to gain insight into the meningococcal disease burden in China and current prevention and vaccination strategies in place. China experienced five epidemics of serogroup A meningococcal disease (MenA) between 1938 and 1977, with peak incidence of 403/100,000 recorded in 1967. MenA incidence rates have significantly declined following the universal introduction of the MenA polysaccharide vaccine in China in the 1980s. Further, surveillance data indicates changing meningococcal epidemiology in China with the emergence of new clones of serogroup B from serogroup C clonal complex (cc) 4821 due to capsular switching, and the international spread of serogroup W cc11. The importance of carriage and herd protection for controlling meningococcal disease was highlighted with the view to introduce conjugate vaccines and serogroup B vaccines into the national immunization schedule. Improved disease surveillance and standardized laboratory techniques across and within provinces will ensure optimal epidemiological monitoring.
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Affiliation(s)
- Junhong Li
- National Immunisation Programme Department, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Zhujun Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Gang Liu
- Department of Infectious Disease, Beijing Children's Hospital, Beijing, China.
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK.
| | - Min Chen
- Department of Microbiology, Center for Disease Control and Prevention, Shanghai, China.
| | - Qinglan Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yue Han
- Department of Immunology, Center for Disease Control and Prevention, Liaoning, China.
| | - Yixing Li
- National Immunisation Programme Department, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Muhamed-Kheir Taha
- National Reference Centre for Meningococci, Institute Pasteur, Paris, France.
| | - Xihai Xu
- Department of Infectious Diseases, the First Affiliated Hospital of Anhui Medical University, China.
| | - Xin Xu
- Department of Immunization Programme, Center for Disease Control and Prevention, Guangdong, China.
| | - Huizhen Zheng
- Department of Immunization Programme, Center for Disease Control and Prevention, Guangdong, China.
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Abstract
The introduction of a serogroup A meningococcal conjugate vaccine in the African meningitis belt has been a remarkable success. Meningitis due to the serogroup A meningococcus, previously responsible for most epidemics, has fallen by 99% in vaccinated countries. Success must, however, not distract from the continuing burden of meningitis in this region of Africa. The number of all meningitis epidemics at health district level has fallen by 60% following vaccination, but epidemics due to other meningococcal serogroups continue and may be increasing. The introduction of low cost multivalent conjugate vaccines must be given high public health priority.
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Affiliation(s)
- James M Stuart
- a London School of Hygiene and Tropical Medicine , London , UK
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Trotter CL, Lingani C, Fernandez K, Cooper LV, Bita A, Tevi-Benissan C, Ronveaux O, Préziosi MP, Stuart JM. Impact of MenAfriVac in nine countries of the African meningitis belt, 2010-15: an analysis of surveillance data. Lancet Infect Dis 2017; 17:867-872. [PMID: 28545721 DOI: 10.1016/s1473-3099(17)30301-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In preparation for the introduction of MenAfriVac, a meningococcal group A conjugate vaccine developed for the African meningitis belt, an enhanced meningitis surveillance network was established. We analysed surveillance data on suspected and confirmed cases of meningitis to quantify vaccine impact. METHODS We compiled and analysed surveillance data for nine countries in the meningitis belt (Benin, Burkina Faso, Chad, Côte d'Ivoire, Ghana, Mali, Niger, Nigeria, and Togo) collected and curated by the WHO Inter-country Support Team between 2005 and 2015. The incidence rate ratios (IRRs) of suspected and confirmed cases in vaccinated and unvaccinated populations were estimated with negative binomial regression models. The relative risk of districts reaching the epidemic threshold of ten per 100 000 per week was estimated according to district vaccination status. FINDINGS The incidence of suspected meningitis cases declined by 57% (95% CI 55-59) in vaccinated compared with unvaccinated populations, with some heterogeneity observed by country. We observed a similar 59% decline in the risk of a district reaching the epidemic threshold. In fully vaccinated populations, the incidence of confirmed group A disease was reduced by more than 99%. The IRR for non-A serogroups was higher after completion of MenAfriVac campaigns (IRR 2·76, 95% CI 1·21-6·30). INTERPRETATION MenAfriVac introduction has led to substantial reductions in the incidence of suspected meningitis and epidemic risk, and a substantial effect on confirmed group A meningococcal meningitis. It is important to continue strengthening surveillance to monitor vaccine performance and remain vigilant against threats from other meningococcal serogroups and other pathogens. FUNDING World Health Organization.
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Affiliation(s)
- Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
| | - Clément Lingani
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Katya Fernandez
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Laura V Cooper
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - André Bita
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Carol Tevi-Benissan
- Immunization and Vaccine Development Unit, Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Olivier Ronveaux
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Marie-Pierre Préziosi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - James M Stuart
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
Neisseria meningitidis, a gram-negative diplococcal bacterium, is a common asymptomatic nasopharyngeal colonizer that may infrequently lead to invasive disease in the form of meningitis or bacteremia. Six serogroups (A, B, C, W, X and Y) are responsible for the majority of invasive infections. Increased risk of disease occurs in specific population groups including infants, adolescents, those with asplenia or complement deficiencies, and those residing in crowded living conditions such as in college dormitories. The incidence of invasive meningococcal disease varies geographically with some countries (e.g., in the African meningitis belt) having both high endemic disease rates and ongoing epidemics, with annual rates reaching 1000 cases per 100,000 persons. Given the significant morbidity and mortality associated with meningococcal disease, it remains a major global health threat best prevented by vaccination. Several countries have implemented vaccination programs with the selection of specific vaccine(s) based on locally prevalent serogroup(s) of N. meningitidis and targeting population groups at highest risk. Polysaccharide meningococcal vaccines became available over 40 years ago, but are limited by their inability to produce immunologic memory responses, poor immunogenicity in infants/children, hyporesponsiveness after repeated doses, and lack of efficacy against nasopharyngeal carriage. In 1999, the first meningococcal conjugate vaccines were introduced and have been successful in overcoming many of the shortcomings of polysaccharide vaccines. The implementation of meningococcal conjugate vaccination programs in many areas of the world (including the massive campaign in sub-Saharan Africa using a serogroup A conjugate vaccine) has led to dramatic reductions in the incidence of meningococcal disease by both individual and population protection. Progressive advances in vaccinology have led to the recent licensure of two effective vaccines against serogroup B [MenB-4C (Bexsero) and MenB-FHbp (Trumenba)]. Overall, the evolution of novel meningococcal vaccines and the effective implementation of targeted vaccination programs has led to a substantial decrease in the burden of disease worldwide representing a major public health accomplishment.
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Affiliation(s)
- Nancy Crum-Cianflone
- Infectious Diseases, Scripps Mercy Hospital, San Diego, CA, USA.
- Naval Medical Center San Diego, San Diego, CA, USA.
| | - Eva Sullivan
- Infectious Diseases, Scripps Mercy Hospital, San Diego, CA, USA
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