Vaccination during pregnancy: current and possible future recommendations

Abstract

Immunizing pregnant women to protect the mother, fetus and infant from infection has increasingly been used over the last decade. Protection against infectious diseases in neonates is mainly provided by maternal antibodies transferred from mother to infant during pregnancy through transplacental transport or after delivery via breastfeeding. Both the transplacental-and breast milk-derived maternal antibodies function as the primary source of protection against infectious diseases in neonates during the first vulnerable weeks of life. During recent infectious disease outbreaks (influenza, pertussis, Zika…) and for other infectious diseases (CMV, GBS…), pregnant women are increasingly identified as an important target for vaccination. For some of these diseases, vaccines are already on the market, and recommended during pregnancy. For others, vaccines are currently under development; furthermore, some are even specifically designed to be administered during pregnancy. Conclusion: This review article provides an overview on the rationale and main mechanism of the maternal vaccination strategy and gives a summary about the current and possible future recommendations for maternal vaccination. What is Known: • Maternal vaccination has a far-reaching potential in the protection of both women and offspring. • Currently, tetanus, pertussis and influenza vaccination during pregnancy is recommended in some countries. Several new vaccines specifically designed for use in pregnancy are currently under development. What is New: • Review providing a timely overview of the rationale and main mechanisms of the maternal vaccination strategy • Up-to-date summary of the current and possible future recommendations for maternal vaccination

Preventive Allergen-Specific Vaccination Against Allergy: Mission Possible?

“…The concept of maternal vaccination is in fact quite well-accepted in the field of infectious diseases. Maternal vaccination is considered particularly in the field of influenza ( 104 , 105 ), group B streptococcus diseases ( 106 ), pertussis ( 107 ), and several other infectious diseases as safe and effective ( 108 – 110 ).…”

Maternal Vaccination in Uganda: Exploring Pregnant Women, Community Leaders and Healthcare Workers’ Perceptions

“…Maternal vaccination has the potential to protect pregnant women and their infants by enabling the transfer of antibodies from mother to child via the placenta and in breastmilk [4]. Currently, the WHO recommends maternal vaccination against tetanus, pertussis, and influenza, as well as other vaccines such as pneumococcus [5].…”

The Path to New Pediatric Vaccines against Pertussis

“…The most effective strategy to prevent severe pertussis in young infants is maternal immunization in the second or third trimester of each pregnancy. Many studies have shown that tetanus-diphtheria-acellular pertussis (Tdap) vaccination is safe for both mother and child and highly effective in preventing severe and deadly pertussis in the new-born (for a recent review, see [ 30 ]). Protection in the new-born is due to the active transplacental transport of the maternal aP-induced antibodies to the fetus.…”

“…Barriers to pregnancy vaccination include the perception of low prevalence and severity of the disease, lack of information about vaccine recommendations, concerns about safety for mother and child, as well as economic status and educational levels [ 31 ]. Furthermore, studies have shown that maternal antibodies may interfere with the immune responses to wP in the infants [ 33 , 34 ], although less so with the responses to aP [ 30 ]. However, since today most children in the world receive wP for their primary immunization series, the clinical consequences of blunting by maternal aP-induced antibodies need to be carefully evaluated.…”