The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: systematic review and meta-analysis

Objectives: To determine the effectiveness of influenza vaccination during pregnancy on child health outcomes. Design: Systematic review/meta-analysis. Data sources: Clinical 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. Methods: Randomised 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. Results: 19 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. Conclusions: This 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. Registration: PROSPERO CRD42018102776.

Children, Immunisation, Infant, Influenza, Influenza-like illness, Maternal, Meta-analysis, Pregnancy, Systematic review, Vaccine

10.1016/j.vaccine.2019.12.056

0264-410X

1601-1613

Jarvis, Jessica Ruth

6fc755d6-a8bc-417d-a94c-ffee852c1944

Dorey, Robert B.

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Warricker, Frazer D.M.

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Alwan, Nisreen

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Jones, Christine E.

48229079-8b58-4dcb-8374-d9481fe7b426

11 February 2020

Jarvis, Jessica Ruth

6fc755d6-a8bc-417d-a94c-ffee852c1944

Dorey, Robert B.

8d4b042f-1659-4e76-99c2-23cde78ca4f5

Warricker, Frazer D.M.

57296e2b-40de-43ce-bf95-007af1bae9e7

Alwan, Nisreen

0d37b320-f325-4ed3-ba51-0fe2866d5382

Jones, Christine E.

48229079-8b58-4dcb-8374-d9481fe7b426

Jarvis, Jessica Ruth, Dorey, Robert B., Warricker, Frazer D.M., Alwan, Nisreen and Jones, Christine E. (2020) The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: systematic review and meta-analysis. Vaccine, 38 (7), 1601-1613. (doi:10.1016/j.vaccine.2019.12.056).

Record type: Review

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Accepted/In Press date: 20 December 2019

e-pub ahead of print date: 10 January 2020

Published date: 11 February 2020

Additional Information: Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: NAA, RBD, CEJ declare no support from any organisation for the submitted work; whilst undertaking this work JRJ was funded by the University of Southampton National Institute of Health Research (NIHR) and Health Education England; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Funding Information: We would like to thank Paula Sands, medical librarian at the University of Southampton for all her support with designing the literature searches. We would also like to thank both the University of Southampton, National Institute of Health Research (NIHR) and Health Education England who supported JRJ both as an Academic Clinical Fellow and a Public Health Registrar in Wessex Deanery. Funding Information: JRJ was supported by the University of Southampton , National Institute of Health Research ( NIHR ) as an Academic Clinical Fellow and through Health Education England as a Public Health Registrar in Wessex Deanery. JRJs views expressed in this paper are independent of that of her funders. The funders had no involvement in the conduct of the research (including study design, collection, analysis and interpretation of data), preparation of the article or decision to submit for publication. Publisher Copyright: © 2020 The Authors

Keywords: Children, Immunisation, Infant, Influenza, Influenza-like illness, Maternal, Meta-analysis, Pregnancy, Systematic review, Vaccine