Effectiveness of Influenza Vaccination of Pregnant Women for Prevention of Maternal and Early Infant Influenza-Associated Hospitalizations in South Africa: A Prospective Test-Negative Study.

influenza pregnancy vaccine

Journal

Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045

Informations de publication

Date de publication:
Nov 2022
Historique:
received: 12 08 2022
accepted: 17 10 2022
entrez: 30 11 2022
pubmed: 1 12 2022
medline: 1 12 2022
Statut: epublish

Résumé

Influenza vaccination during pregnancy reduces influenza-associated illness in the women and their infants, but effectiveness estimates against influenza-associated hospitalization are limited and lacking from settings with high human immunodeficiency virus (HIV) infection prevalence. We assessed the effect of maternal vaccination in HIV-uninfected women and women with HIV in preventing influenza-associated hospitalizations in infants and the women. During 2015-2018, influenza vaccination campaigns targeting pregnant women were augmented at selected antenatal clinics; these were coupled with prospective hospital-based surveillance for acute respiratory or febrile illness in infants aged <6 months and cardiorespiratory illness among pregnant or postpartum women. Vaccine effectiveness (VE) was assessed using a test-negative case-control study. Overall, 71 influenza-positive and 371 influenza-negative infants were included in the analysis; mothers of 26.8% of influenza-positive infants were vaccinated during pregnancy compared with 35.6% of influenza-negative infants, corresponding to an adjusted VE (aVE) of 29.0% (95% confidence interval [CI], -33.6% to 62.3%). When limited to vaccine-matched strains, aVE was 65.2% (95% CI, 11.7%-86.3%). For maternal hospitalizations, 56 influenza-positive and 345 influenza-negative women were included in the analysis, with 28.6% of influenza-positive women being vaccinated compared with 38.3% of influenza-negatives, for an aVE of 46.9% (95% CI, -2.8% to 72.5%). Analysis restricted to HIV-uninfected women resulted in 82.8% (95% CI, 40.7%-95.0%) aVE. No significant aVE (-32.5% [95% CI, -208.7% to 43.1%]) was detected among women with HIV. Influenza vaccination during pregnancy prevented influenza-associated hospitalizations among young infants when infected with vaccine strains and among HIV-uninfected women.

Sections du résumé

Background UNASSIGNED
Influenza vaccination during pregnancy reduces influenza-associated illness in the women and their infants, but effectiveness estimates against influenza-associated hospitalization are limited and lacking from settings with high human immunodeficiency virus (HIV) infection prevalence. We assessed the effect of maternal vaccination in HIV-uninfected women and women with HIV in preventing influenza-associated hospitalizations in infants and the women.
Methods UNASSIGNED
During 2015-2018, influenza vaccination campaigns targeting pregnant women were augmented at selected antenatal clinics; these were coupled with prospective hospital-based surveillance for acute respiratory or febrile illness in infants aged <6 months and cardiorespiratory illness among pregnant or postpartum women. Vaccine effectiveness (VE) was assessed using a test-negative case-control study.
Results UNASSIGNED
Overall, 71 influenza-positive and 371 influenza-negative infants were included in the analysis; mothers of 26.8% of influenza-positive infants were vaccinated during pregnancy compared with 35.6% of influenza-negative infants, corresponding to an adjusted VE (aVE) of 29.0% (95% confidence interval [CI], -33.6% to 62.3%). When limited to vaccine-matched strains, aVE was 65.2% (95% CI, 11.7%-86.3%). For maternal hospitalizations, 56 influenza-positive and 345 influenza-negative women were included in the analysis, with 28.6% of influenza-positive women being vaccinated compared with 38.3% of influenza-negatives, for an aVE of 46.9% (95% CI, -2.8% to 72.5%). Analysis restricted to HIV-uninfected women resulted in 82.8% (95% CI, 40.7%-95.0%) aVE. No significant aVE (-32.5% [95% CI, -208.7% to 43.1%]) was detected among women with HIV.
Conclusions UNASSIGNED
Influenza vaccination during pregnancy prevented influenza-associated hospitalizations among young infants when infected with vaccine strains and among HIV-uninfected women.

Identifiants

DOI: 10.1093/ofid/ofac552 PMID: 36447608 PMC: PMC9697604
pubmed: 36447608
doi: 10.1093/ofid/ofac552
pii: ofac552
pmc: PMC9697604
doi:

Types de publication

Journal Article

Langues

eng

Pagination

ofac552

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Déclaration de conflit d'intérêts

Potential conflicts of interest. M. C. N. reports grants to institution from BMGF, the European and Developing Countries Clinical Trials Partnership (EDCTP), Pfizer, AstraZeneca, and Sanofi, and personal honoraria received from Pfizer and Sanofi, unrelated to the manuscript. S. A. M. reports grants to institution from BMGF, the South African Medical Research Council, Novavax, Pfizer, Gritstone (PATH), Providence, Johnson & Johnson, AstraZeneca, EDCTP, GSK, and Minervax, and personal honoraria received from BMGF unrelated to the manuscript. C. C. reports grants to institution from Sanofi, Advanced Vaccine Initiative, and the CDC, and payment of travel costs from Parexel. H. J. Z. reports grants to institution from BMGF, the South African Medical Research Council, Novavax, Pfizer, AstraZeneca, MSD, and EDCTP. All other authors report no potential conflicts.

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Auteurs

Marta C Nunes (MC)

South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
ORCID: 0000-0003-3788-878X

Sibongile Walaza (S)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Susan Meiring (S)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.

Heather J Zar (HJ)

Department of Paediatrics and Child Health, and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.

Gary Reubenson (G)

Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Meredith McMorrow (M)

Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Stefano Tempia (S)

School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Liza Rossi (L)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.

Raphaela Itzikowitz (R)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.

Kate Bishop (K)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.

Azwifarwi Mathunjwa (A)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.

Amy Wise (A)

Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa.

Florette K Treurnicht (FK)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.

Orienka Hellferscee (O)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
ORCID: 0000-0001-9246-8927

Matt Laubscher (M)

South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.

Natali Serafin (N)

South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.

Clare L Cutland (CL)

South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Shabir A Madhi (SA)

South African Medical Research Council, Faculty of Health Sciences, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Department of Science and Technology/National Research Foundation, Faculty of Health Sciences, South African Research Chair Initiative in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Cheryl Cohen (C)

Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Classifications MeSH