Maternal immunization
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
Immunization prevents illness, disability and death from vaccine-preventable diseases. Vaccines are useful to reduce childhood mortality and morbidity. Vaccination schedule starts at early infancy and it's not complete by age of 6 months. Therefore, most of the children do not have coverage during the early infancy with adequate protection which may predispose them to infections. This gap may result in higher infection related hospitalization and disease complications in early infancy than in older children. Maternal vaccination has became to consideration to cover this gap. However it can protect mother from acquiring infection it is also effective for infant protection.
Immunology
Maternal immunity changes during the pregnancy under influence of hormonal changes. Increased level of estrogen and progesterone are the most important factors for these changes. Increased level of estradiol is associated with increased level of T-helper type 2 cell response compared to type 1 T-cells.[1][2] However, increased level of progesterone may result in decrease in immune response and alteration in immune system.[3][4] Other aspect of immune response such as, phagocytosis and number of neutrophils and monocytes remains unchanged.[4]
These changes (alteration in cell mediated immunity) explain sub-optimal immune response to some certain viral infections such as influenza. Furthermore, it justifies the need for immunization against these infections.[5] Other parts of immune system remains intact during pregnancy and immunosuppresion does not encounter during pregnancy.
Clinical effectiveness of vaccination during pregnancy is maintained and changes in immune balance does not influence their effectiveness.[6][7][8]
Maternal immunization recommendation
Inactivated influenza and combined tetanus-diphteria-acellular pertussis (TDaP) are recommended for pregnant women in the U.S. Hepatitis B and hepatitis E vaccines are recommended in some other countries.
The following table summarize the vaccines and current recommendations for their administration during pregnancy.
| Vaccine | Type | Recommendation for pregnant women | Specific consideration | |
|---|---|---|---|---|
| Category | Comment | |||
| Anthrax | Inactivated | May be used in women with high risk of exposure; not recommended for
those with low risk of exposure. |
Travel and other | |
Refernces
- ↑ Lindheimer MD, Cunningham FG (2014). "Pregnancy and infection". N. Engl. J. Med. 371 (11): 1076–7. doi:10.1056/NEJMc1408436#SA3. PMID 25207785.
- ↑ Straub RH (2007). "The complex role of estrogens in inflammation". Endocr. Rev. 28 (5): 521–74. doi:10.1210/er.2007-0001. PMID 17640948.
- ↑ Szekeres-Bartho J, Wegmann TG (1996). "A progesterone-dependent immunomodulatory protein alters the Th1/Th2 balance". J. Reprod. Immunol. 31 (1–2): 81–95. PMID 8887124.
- ↑ 4.0 4.1 Robinson DP, Klein SL (2012). "Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis". Horm Behav. 62 (3): 263–71. doi:10.1016/j.yhbeh.2012.02.023. PMC 3376705. PMID 22406114.
- ↑ Pazos M, Sperling RS, Moran TM, Kraus TA (2012). "The influence of pregnancy on systemic immunity". Immunol. Res. 54 (1–3): 254–61. doi:10.1007/s12026-012-8303-9. PMID 22447351.
- ↑ Schlaudecker EP, McNeal MM, Dodd CN, Ranz JB, Steinhoff MC (2012). "Pregnancy modifies the antibody response to trivalent influenza immunization". J. Infect. Dis. 206 (11): 1670–3. doi:10.1093/infdis/jis592. PMID 22984116.
- ↑ Sperling RS, Engel SM, Wallenstein S, Kraus TA, Garrido J, Singh T, Kellerman L, Moran TM (2012). "Immunogenicity of trivalent inactivated influenza vaccination received during pregnancy or postpartum". Obstet Gynecol. 119 (3): 631–9. doi:10.1097/AOG.0b013e318244ed20. PMC 3327739. PMID 22353963.
- ↑ Munoz FM, Bond NH, Maccato M, Pinell P, Hammill HA, Swamy GK, Walter EB, Jackson LA, Englund JA, Edwards MS, Healy CM, Petrie CR, Ferreira J, Goll JB, Baker CJ (2014). "Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial". JAMA. 311 (17): 1760–9. doi:10.1001/jama.2014.3633. PMC 4333147. PMID 24794369.