Pneumococcal vaccination during pregnancy for preventing infant infection.
BACKGROUND
Each year at least one million children worldwide die of pneumococcal infections. The development of bacterial resistance to antimicrobials adds to the difficulty of treatment of diseases and emphasizes the need for a preventive approach. Newborn vaccination schedules could substantially reduce the impact of pneumococcal disease in immunized children, but does not have an effect on the morbidity and mortality of infants less than three months of age. Pneumococcal vaccination during pregnancy may be a way of preventing pneumococcal disease during the first months of life before the pneumococcal vaccine administered to the infant starts to produce protection.


OBJECTIVE
To assess the effect of pneumococcal vaccination during pregnancy for preventing infant infection.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to June 2004), EMBASE (January 1985 to June 2004), and reference lists of articles.


METHODS
Randomized controlled trials in pregnant women comparing pneumococcal vaccine with placebo or doing nothing or with another vaccine to prevent infant infections.


METHODS
Two authors independently assessed methodological quality and extracted data using a data collection form. Study authors were contacted for additional information.


RESULTS
Three trials (280 participants) were included. There was no evidence that pneumococcal vaccination during pregnancy reduces the risk of neonatal infection (one trial, 149 pregnancies, relative risk (RR) 0.51; 95% confidence interval (CI) 0.18 to 1.41). Although the data suggest an effect in reducing pneumococcal colonisation in infants by 16 months of age (one trial, 56 pregnancies, RR 0.33; 95% CI 0.11 to 0.98), there was no evidence of this effect in infants at two months of age (RR 0.28; 95% CI 0.02 to 5.11) or by seven months of age (RR 0.32; 95% CI 0.08 to 1.29).


CONCLUSIONS
There is insufficient evidence to support whether pneumococcal vaccination during pregnancy could reduce infant infections.
Chaithongwongwatthana
S
S
Chulalongkorn University, Department of Obstetrics and Gynecology, Faculty of Medicine, Rama IV Road, Pathumwan, Bangkok, Thailand, 10330. fmedscw@md.chula.ac.th
Yamasmit
W
W
Limpongsanurak
S
S
Lumbiganon
P
P
Desimone
J A
JA
Baxter
J
J
Tolosa
J E
JE
D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011008:Pneumococcal Infections / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D022242:Pneumococcal Vaccines