The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: Systematic review and meta-analysis |
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| Affiliation: | 1. University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom;2. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, C Level West Wing, Mailpoint 218, Southampton General Hospital, Southampton SO16 6YD, United Kingdom;3. Salisbury NHS Foundation Trust, Department of Gastroenterology, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, United Kingdom;4. School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, AC18, Level C, South Academic Block, University Hospital of Southampton, Southampton SO16 6YD, United Kingdom;5. University of Southampton, Faculty of Medicine Health and Life Sciences, Tremona Road, Southampton SO16 6YD, United Kingdom |
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| Abstract: | ObjectivesTo determine the effectiveness of influenza vaccination during pregnancy on child health outcomes.DesignSystematic review/meta-analysis.Data sourcesClinical Trials.gov, Cochrane Library, EMBASE, Medline, Medline in process, PubMed and Web of Science, from 1st January 1996 to 29th June 2018. An updated Medline search was performed 30th June 2018 to 31st October 2019.MethodsRandomised controlled trials (RCTs) and observational studies reporting health outcomes of infants and children born to women who received inactivated influenza vaccine during pregnancy. The primary outcome was infant laboratory confirmed influenza (LCI). Secondary outcomes included influenza-like illness (ILI), other respiratory illnesses, primary care, clinic visit or hospitalisations due to influenza illness and long-term respiratory childhood outcomes.Results19 studies were included; 15 observational studies and 4 primary RCTs with an additional 3 papers reporting secondary outcomes of these RCTs. In a random effects meta-analysis of 2 RCTs including 5742 participants, maternal influenza vaccination was associated with an overall reduction of LCI in infants of 34% (95% confidence interval 15–50%). However, there was no effect of maternal influenza vaccination on ILI in infants ≤6 months old. Two RCTs were excluded from the meta-analysis for the outcome of LCI in infants (different controls used). Both of these studies showed a protective effect for infants from LCI, with a vaccine efficacy of up to 70%.Overall observational studies showed an inverse (protective) association between maternal influenza vaccination and infant LCI, hospitalisation and clinic visits due to LCI or ILI in infants and other respiratory illness in infants ≤6 months old.ConclusionsThis systematic review supports maternal influenza vaccination as a strategy to reduce LCI and influenza-related hospitalisations in young infants. Communicating these benefits to pregnant women may support their decision to accept influenza vaccination in pregnancy and increase vaccine coverage in pregnant women.RegistrationPROSPERO CRD42018102776. |
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| Keywords: | Influenza Influenza-like illness Vaccine Immunisation Maternal Pregnancy Infant Children Meta-analysis Systematic review |
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