Marie Furuta1, Jacqueline Sin2, Edmond S W Ng3, Kay Wang4. 1. Department of Human Health Sciences, Kyoto University, Graduate School of Medicine, 53 Kawara-cho Shogo-in, Sakyo-ku, Kyoto, 606-8507, Japan. furuta.marie.8r@kyoto-u.ac.jp. 2. University of Reading, School of Psychology & Clinical Language Sciences, Earley Gate, Reading, RG6 6AL, UK. 3. Director's Office, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK. 4. Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK.
Abstract
BACKGROUND: Worldwide, pertussis remains a major health problem among children. During the recent outbreaks of pertussis, maternal antenatal immunisation was introduced in several industrial countries. This systematic review aimed to synthesize evidence for the efficacy and safety of the pertussis vaccination that was given to pregnant women to protect infants from pertussis infection. METHODS: We searched literature in the Cochrane Central Register of Controlled Trials, Medline, Embase, and OpenGrey between inception of the various databases and 16 May 2016. The search terms included 'pertussis', 'whooping cough', 'pertussis vaccine,' 'tetanus, diphtheria and pertussis vaccines' and 'pregnancy' and 'perinatal'. RESULTS: We included 15 articles in this review, which represented 12 study populations, involving a total of 203,835 mother-infant pairs from the US, the UK, Belgium, Israel, and Vietnam. Of the included studies, there were two randomised controlled trials (RCTs) and the rest were observational studies. Existing evidence suggests that vaccinations administered during 19-37 weeks of gestation are associated with significantly increased antibody levels in the blood of both mothers and their newborns at birth compared to placebo or no vaccination. However, there is a lack of robust evidence to suggest whether these increased antibodies can also reduce the incidence of pertussis (one RCT, n = 48, no incidence in either group) and pertussis-related severe complications (one observational study) or mortality (no study) in infants. Meanwhile, there is no evidence of increased risk of serious complications such as stillbirth (e.g. one RCT, n = 103, RR = 0, meaning no case in the vaccine group), or preterm birth (two RCTs, n = 151, RR = 0.86, 95%CI: 0.14-5.21) related to administration of the vaccine during pregnancy. CONCLUSION: Given that pertussis infection is increasing in many countries and that newborn babies are at greatest risk of developing severe complications from pertussis, maternal vaccination in the later stages of pregnancy should continue to be supported while further research should fill knowledge gaps and strengthen evidence of its efficacy and safety.
BACKGROUND: Worldwide, pertussis remains a major health problem among children. During the recent outbreaks of pertussis, maternal antenatal immunisation was introduced in several industrial countries. This systematic review aimed to synthesize evidence for the efficacy and safety of the pertussis vaccination that was given to pregnant women to protect infants from pertussis infection. METHODS: We searched literature in the Cochrane Central Register of Controlled Trials, Medline, Embase, and OpenGrey between inception of the various databases and 16 May 2016. The search terms included 'pertussis', 'whooping cough', 'pertussis vaccine,' 'tetanus, diphtheria and pertussis vaccines' and 'pregnancy' and 'perinatal'. RESULTS: We included 15 articles in this review, which represented 12 study populations, involving a total of 203,835 mother-infant pairs from the US, the UK, Belgium, Israel, and Vietnam. Of the included studies, there were two randomised controlled trials (RCTs) and the rest were observational studies. Existing evidence suggests that vaccinations administered during 19-37 weeks of gestation are associated with significantly increased antibody levels in the blood of both mothers and their newborns at birth compared to placebo or no vaccination. However, there is a lack of robust evidence to suggest whether these increased antibodies can also reduce the incidence of pertussis (one RCT, n = 48, no incidence in either group) and pertussis-related severe complications (one observational study) or mortality (no study) in infants. Meanwhile, there is no evidence of increased risk of serious complications such as stillbirth (e.g. one RCT, n = 103, RR = 0, meaning no case in the vaccine group), or preterm birth (two RCTs, n = 151, RR = 0.86, 95%CI: 0.14-5.21) related to administration of the vaccine during pregnancy. CONCLUSION: Given that pertussis infection is increasing in many countries and that newborn babies are at greatest risk of developing severe complications from pertussis, maternal vaccination in the later stages of pregnancy should continue to be supported while further research should fill knowledge gaps and strengthen evidence of its efficacy and safety.
Authors: Abbey J Hardy-Fairbanks; Stephanie J Pan; Michael D Decker; David R Johnson; David P Greenberg; Kathryn B Kirkland; Elizabeth A Talbot; Henry H Bernstein Journal: Pediatr Infect Dis J Date: 2013-11 Impact factor: 2.129
Authors: Gayatri Amirthalingam; Nick Andrews; Helen Campbell; Sonia Ribeiro; Edna Kara; Katherine Donegan; Norman K Fry; Elizabeth Miller; Mary Ramsay Journal: Lancet Date: 2014-07-15 Impact factor: 79.321
Authors: Julie H Shakib; Kent Korgenski; Xiaoming Sheng; Michael W Varner; Andrew T Pavia; Carrie L Byington Journal: J Pediatr Date: 2013-07-26 Impact factor: 4.406
Authors: Ha Thi Thu Hoang; Elke Leuridan; Kirsten Maertens; Trung Dac Nguyen; Niel Hens; Ngoc Ha Vu; Raissa Nadège Caboré; Hong Thi Duong; Kris Huygen; Pierre Van Damme; Anh Duc Dang Journal: Vaccine Date: 2015-10-31 Impact factor: 3.641
Authors: Elyse Olshen Kharbanda; Gabriela Vazquez-Benitez; Heather S Lipkind; Nicola P Klein; T Craig Cheetham; Allison L Naleway; Grace M Lee; Simon Hambidge; Michael L Jackson; Saad B Omer; Natalie McCarthy; James D Nordin Journal: Vaccine Date: 2016-01-04 Impact factor: 3.641
Authors: Lakshmi Sukumaran; Natalie L McCarthy; Elyse O Kharbanda; Michael M McNeil; Allison L Naleway; Nicola P Klein; Michael L Jackson; Simon J Hambidge; Marlene M Lugg; Rongxia Li; Eric S Weintraub; Robert A Bednarczyk; Jennifer P King; Frank DeStefano; Walter A Orenstein; Saad B Omer Journal: JAMA Date: 2015-10-20 Impact factor: 56.272
Authors: Christine E Jones; Flor M Munoz; Hans M L Spiegel; Ulrich Heininger; Patrick L F Zuber; Kathryn M Edwards; Philipp Lambach; Pieter Neels; Katrin S Kohl; Jane Gidudu; Steven Hirschfeld; James M Oleske; Najwa Khuri-Bulos; Jorgen Bauwens; Linda O Eckert; Sonali Kochhar; Jan Bonhoeffer; Paul T Heath Journal: Vaccine Date: 2016-07-29 Impact factor: 3.641
Authors: Petra Zimmermann; Kirsten P Perrett; Nicole L Messina; Susan Donath; Nicole Ritz; Fiona R M van der Klis; Nigel Curtis Journal: EClinicalMedicine Date: 2019-07-26
Authors: Christopher R Wilcox; Rebecca Rowe; Deborah C Mobley; Merlin Willcox; Christine E Jones Journal: Br J Gen Pract Date: 2020-02-27 Impact factor: 5.386
Authors: Juana Del Valle-Mendoza; Wilmer Silva-Caso; Miguel Angel Aguilar-Luis; Cristina Del Valle-Vargas; Erico Cieza-Mora; Johanna Martins-Luna; Ronald Aquino-Ortega; Andrea Silva-Vásquez; Jorge Bazán-Mayra; Pablo Weilg Journal: BMC Res Notes Date: 2018-05-18