Cited by 556Influenza Virus Research StudiesRespiratory viral infections researchVaccine Coverage and Hesitancy

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Influenza Vaccination of Pregnant Women and Protection of Their Infants

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Madhi, Shabir A., Cutland, Clare L., Kuwanda, Locadiah, Weinberg, Adriana, Hugo, Andrea, Jones, Stephanie, Adrian, Peter V., van Niekerk, Nadia, Treurnicht, Florette, Ortiz, Justin R., Venter, Marietjie, Violari, Avy, Neuzil, Kathleen M., Simões, Eric A.F., Klugman, Keith P., Nunes, Marta C.·2014·New England Journal of Medicine

DOI 10.1056/nejmoa1401480

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Abstract

BACKGROUND: There are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency virus (HIV) infection and protection of their infants. METHODS: We conducted two double-blind, randomized, placebo-controlled trials of trivalent inactivated influenza vaccine (IIV3) in South Africa during 2011 in pregnant women infected with HIV and during 2011 and 2012 in pregnant women who were not infected. The immunogenicity, safety, and efficacy of IIV3 in pregnant women and their infants were evaluated until 24 weeks after birth. Immune responses were measured with a hemagglutination inhibition (HAI) assay, and influenza was diagnosed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays of respiratory samples. RESULTS: The study cohorts included 2116 pregnant women who were not infected with HIV and 194 pregnant women who were infected with HIV. At 1 month after vaccination, seroconversion rates and the proportion of participants with HAI titers of 1:40 or more were higher among IIV3 recipients than among placebo recipients in both cohorts. Newborns of IIV3 recipients also had higher HAI titers than newborns of placebo recipients. The attack rate for RT-PCR-confirmed influenza among both HIV-uninfected placebo recipients and their infants was 3.6%. The attack rates among HIV-uninfected IIV3 recipients and their infants were 1.8% and 1.9%, respectively, and the respective vaccine-efficacy rates were 50.4% (95% confidence interval [CI], 14.5 to 71.2) and 48.8% (95% CI, 11.6 to 70.4). Among HIV-infected women, the attack rate for placebo recipients was 17.0% and the rate for IIV3 recipients was 7.0%; the vaccine-efficacy rate for these IIV3 recipients was 57.7% (95% CI, 0.2 to 82.1). CONCLUSIONS: Influenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov numbers, NCT01306669 and NCT01306682.).

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Authors: Madhi, S. A., Cutland, C. L., Kuwanda, L., Weinberg, A., Hugo, A., Jones, S., Adrian, P. V., van Niekerk, N., Treurnicht, F., Ortiz, J. R., Venter, M., Violari, A., Neuzil, K. M., Simões, E. A. F., Klugman, K. P., & Nunes, M. C.
Affiliations: National Health Laboratory Service (ZA)
Respiratory and Meningeal Pathogens Research Unit (ZA)
University of Colorado Anschutz (US)
University of Washington (US)
Colorado School of Public Health (US)
Emory University (US)
ORCID: Madhi, Shabir A.
Cutland, Clare L.
Weinberg, Adriana
Treurnicht, Florette
Ortiz, Justin R.
Venter, Marietjie
Violari, Avy
Neuzil, Kathleen M.
Simões, Eric A.F.
Klugman, Keith P.
Nunes, Marta C.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2014-09-04
Volume: 371
Issue: 10
Pages: 918-931
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1401480
OpenAlex: W2151524246
Cited by: 556
References: 34
Citations by year: 2026: 16 · 2025: 26 · 2024: 22 · 2023: 35 · 2022: 25 · 2021: 53 · 2020: 59 · 2019: 80 · 2018: 58 · 2017: 66 · 2016: 59 · 2015: 44 · 2014: 9
FWCI: 44.83
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
UpSpace Institutional Repository (University of Pretoria) (submittedVersion)
Funders: Bill and Melinda Gates Foundation (OPP1002747)
Pfizer
GlaxoSmithKline
Sanofi
Gilead Sciences
National Research Foundation
Drugs for Neglected Diseases initiative
National Institutes of Health (UL1TR000154, TR000154)
Sanofi Pasteur
Medical Research Council
National Center for Advancing Translational Sciences (TR000154)
Colorado Clinical and Translational Sciences Institute (UL1 TR000154, TR000154)
Topics: Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
Social Sciences › Health › Vaccine Coverage and Hesitancy
Keywords: influenza vaccination, pregnancy, HIV infection, trivalent inactivated influenza vaccine, infant protection, vaccine efficacy, seroconversion, hemagglutination inhibition, mother-to-child transmission, South Africa, maternal and child health, infant HIV prevention, maternal morbidity, maternal morbidity reduction
MeSH terms: Adult, Double-Blind Method, Female, Humans, Infant, Infant, Newborn, Infant, Premature, Influenza, Human, Influenza Vaccines, Male, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, South Africa, Vaccines, Inactivated, HIV Infections, Kaplan-Meier Estimate, Young Adult

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Influenza Vaccination of Pregnant Women and Protection of Their Infants

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