Influenza virus infection in pregnancy: a review

Meijer, Wouter J.; Noortwijk, Aleid G.A. van; Bruinse, Hein W.; Wensing, Annemarie M. J.

doi:10.1111/aogs.12680

Cited by 113 publications

(86 citation statements)

References 139 publications

(432 reference statements)

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“…Influenza virus infection during pregnancy is associated with an increased frequency of preterm birth and neonatal death [14]. Some observational studies have demonstrated a protective effect of influenza vaccination on adverse birth outcomes [15, 16], while others have shown no effect [17] and 2 randomized controlled trials showed different effects [8, 18].…”

mentioning

confidence: 99%

The Effect of Influenza Vaccination on Birth Outcomes in a Cohort of Pregnant Women in Lao PDR, 2014–2015

Olsen

Mirza

Vonglokham³

et al. 2016

Clin Infect Dis.

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Background Some studies suggest that maternal influenza vaccination can improve birth outcomes. However, there are limited data from tropical settings, particularly Southeast Asia. We conducted an observational study in Laos to assess the effect of influenza vaccination in pregnant women on birth outcomes. Methods We consented and enrolled a cohort of pregnant woman who delivered babies at 3 hospitals during April 2014–February 2015. We collected demographic and clinical information on mother and child. Influenza vaccination status was ascertained by vaccine card. Primary outcomes were the proportion of live births born small for gestational age (SGA) or preterm and mean birth weight. Multivariate models controlled for differences between vaccinated and unvaccinated women and influenza virus circulation. Results We enrolled 5103 women (2172 [43%] were vaccinated). Among the 4854 who had a live birth, vaccinated women were statistically significantly less likely than unvaccinated women to have an infant born preterm during the period of high influenza virus circulation (risk ratio [RR] = 0.56, 95% confidence interval [CI], .45–.70), and the effect remained after adjusting for covariates (adjusted RR, 0.69; 95% CI, .55–.87). There was no effect of vaccine on SGA or mean birth weight. The population-prevented fraction was 18.0%. Conclusions In this observational study, we found indirect evidence of influenza vaccine safety during pregnancy, and women who received vaccine had a reduced risk of delivering a preterm infant during times of high influenza virus circulation. Vaccination may prevent 1 in 5 preterm births that occur during periods of high influenza circulation.

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confidence: 99%

The Effect of Influenza Vaccination on Birth Outcomes in a Cohort of Pregnant Women in Lao PDR, 2014–2015

Olsen

Mirza

Vonglokham³

et al. 2016

Clin Infect Dis.

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“…Increasingly, infectious and inflammatory diseases are being attributed to combinations of different infectious kingdoms (21), including pregnancy complications like preterm birth (61). Furthermore, the impact viruses may have on pregnancy outcomes are beginning to be appreciated (31, 62, 63). The current study set out to test the impact a polymicrobial infection could have on human fetal membrane innate immune responses and the mechanisms involved.…”

Section: Discussionmentioning

confidence: 99%

Viral Infection Sensitizes Human Fetal Membranes to Bacterial Lipopolysaccharide by MERTK Inhibition and Inflammasome Activation

Cross

Potter

Aldo

et al. 2017

The Journal of Immunology

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Chorioamnionitis, premature rupture of fetal membranes (FM), and subsequent preterm birth are associated with local infection and inflammation, particularly interleukin 1 beta (IL-1β) production. While bacterial infections are commonly identified, other microorganisms may play a role in the pathogenesis. Since viral pandemics, such as influenza, Ebola and Zika are becoming more common, and pregnant women are at increased risk of associated complications, this study evaluated the impact viral infection had on human FM innate immune responses. This study shows that a herpes viral infection of FMs sensitizes the tissue to low levels of bacterial lipopolysaccharide (LPS), giving rise to an exaggerated IL-1β response. Using an ex vivo human FM explant system and an in vivo mouse model of pregnancy, we report that the mechanism by which this aggravated inflammation arises is through the inhibition of the TAM receptor, MERTK, and activation of the inflammasome. The TAM receptor ligand, growth arrest specific 6 (GAS6), re-establishes the normal FM response to LPS by restoring and augmenting TAM receptor and ligand expression, and by preventing the exacerbated IL-1β processing and secretion. These findings indicate a novel mechanism by which viruses alter normal FM immune responses to bacteria, potentially giving rise to adverse pregnancy outcomes.

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“…6,7 As pregnant women and premature infants are at particular risk of severe influenza, vaccinating HCWs who care for them is especially important. [8][9][10][11][12][13][14] While pregnant women are recommended to receive the vaccine during pregnancy uptake is variable and as the influenza vaccination is not recommended until after 6 months of age, 15 hospitalized neonates and young infants are not directly protected through immunisation and are therefore at risk of transmission of infection. The Australian Immunisation Handbook 15 recommends that HCWs directly involved in patient care or the handling of human tissue be immunised for a number of diseases such as hepatitis B, influenza, mumps, measles and rubella, pertussis and varicella.…”

Section: Introductionmentioning

confidence: 99%

Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia

Tuckerman

Shrestha

Collins

et al. 2016

Human Vaccines & Immunotherapeutics

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Influenza virus infection in pregnancy: a review

Abstract: There is level 2b evidence that maternal health and pregnancy outcome can be severely affected by influenza virus infection. Antiviral treatment may diminish these effects and vaccination protects pregnant women and neonates from infection (level of evidence 2b and 1b, respectively).

Cited by 113 publications

References 139 publications

The Effect of Influenza Vaccination on Birth Outcomes in a Cohort of Pregnant Women in Lao PDR, 2014–2015

The Effect of Influenza Vaccination on Birth Outcomes in a Cohort of Pregnant Women in Lao PDR, 2014–2015

Viral Infection Sensitizes Human Fetal Membranes to Bacterial Lipopolysaccharide by MERTK Inhibition and Inflammasome Activation

Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia

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