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

The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: systematic review and meta-analysis
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 a 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
0264-410X
1601-1613
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
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: Article

Abstract

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 a 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.

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Vaccine_submission_accepted_20.12.19 - Accepted Manuscript
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More information

Accepted/In Press date: 20 December 2019
e-pub ahead of print date: 10 January 2020
Keywords: Children, Immunisation, Infant, Influenza, Influenza-like illness, Maternal, Meta-analysis, Pregnancy, Systematic review, Vaccine

Identifiers

Local EPrints ID: 436786
URI: http://eprints.soton.ac.uk/id/eprint/436786
ISSN: 0264-410X
PURE UUID: 5a92ed03-740a-45e9-bb8b-75e1b8b7f870
ORCID for Nisreen Alwan: ORCID iD orcid.org/0000-0002-4134-8463
ORCID for Christine E. Jones: ORCID iD orcid.org/0000-0003-1523-2368

Catalogue record

Date deposited: 08 Jan 2020 17:33
Last modified: 10 Jan 2022 06:24

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Contributors

Author: Jessica Ruth Jarvis
Author: Robert B. Dorey
Author: Frazer D.M. Warricker
Author: Nisreen Alwan ORCID iD

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