title: Influenza vaccine for pregnant women in resource-constrained countries: a review of the evidence to inform policy decisions.
abstract: Seasonal influenza is responsible for three to five million severe cases of disease annually, and up to 500,000 deaths worldwide. Pregnant women and infants suffer disproportionately from severe outcomes of influenza. The excellent safety profile and reliable immunogenicity of inactivated influenza vaccine support WHO recommendations that pregnant women be vaccinated to decrease complications of influenza disease during pregnancy. Nevertheless, influenza vaccine is not routinely used in most low-and middle-income countries and is not widely used in pregnant women worldwide. Two recent prospective, controlled trials of maternal influenza vaccination in Bangladesh and US Native American reservations demonstrated that inactivated influenza vaccine given to pregnant women can decrease laboratory-confirmed influenza virus infection in their newborn children. These studies support consideration of the feasibility of targeted influenza vaccine programs in resource-constrained countries. Platforms exist for the delivery of influenza vaccine to pregnant women worldwide. Even in the least developed countries, an estimated 70% of women receive antenatal care, providing an opportunity for targeted influenza vaccination. Challenges to the introduction of maternal influenza vaccination in resource-constrained countries exist, including issues regarding vaccine formulation, availability, and cost. Nonetheless, maternal influenza vaccination remains an important and potentially cost-effective approach to decrease influenza morbidity in two high-risk groups - pregnant women and young infants.
authors.affiliation: Vaccine Development Global Program, PATH, Seattle, WA, United States. jortiz@path.org
authors.forename: Justin R
authors.initials: JR
authors.lastname: Ortiz
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Neuzil
mesh_terms: D003906:Developing Countries; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D007251:Influenza, Human / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D008429:Maternal Welfare; D009975:Orthomyxoviridae / Q000276:immunology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines