title: Maternal vaccination: moving the science forward.
abstract: BACKGROUND
  Infections remain one of the leading causes of morbidity in pregnant women and newborns, with vaccine-preventable infections contributing significantly to the burden of disease. In the past decade, maternal vaccination has emerged as a promising public health strategy to prevent and combat maternal, fetal and neonatal infections. Despite a number of universally recommended maternal vaccines, the development and evaluation of safe and effective maternal vaccines and their wide acceptance are hampered by the lack of thorough understanding of the efficacy and safety in the pregnant women and the offspring.
  
  
  METHODS
  An outline was synthesized based on the current status and major gaps in the knowledge of maternal vaccination. A systematic literature search in PUBMED was undertaken using the key words in each section title of the outline to retrieve articles relevant to pregnancy. Articles cited were selected based on relevance and quality. On the basis of the reviewed information, a perspective on the future directions of maternal vaccination research was formulated.
  
  
  RESULTS
  Maternal vaccination can generate active immune protection in the mother and elicit systemic immunoglobulin G (IgG) and mucosal IgG, IgA and IgM responses to confer neonatal protection. The maternal immune system undergoes significant modulation during pregnancy, which influences responsiveness to vaccines. Significant gaps exist in our knowledge of the efficacy and safety of maternal vaccines, and no maternal vaccines against a large number of old and emerging pathogens are available. Public acceptance of maternal vaccination has been low.
  
  
  CONCLUSIONS
  To tackle the scientific challenges of maternal vaccination and to provide the public with informed vaccination choices, scientists and clinicians in different disciplines must work closely and have a mechanistic understanding of the systemic, reproductive and mammary mucosal immune responses to vaccines. The use of animal models should be coupled with human studies in an iterative manner for maternal vaccine experimentation, evaluation and optimization. Systems biology approaches should be adopted to improve the speed, accuracy and safety of maternal vaccine targeting.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, MI 48201, USA.
authors.forename: Azure N
authors.initials: AN
authors.lastname: Faucette
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, MI 48201, USA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Unger
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Gonik
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, MI 48201, USA Tumor Biology and Microenvironment Program, Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, USA Department of Immunology and Microbiology, Wayne State University, Detroit, MI 48201, USA Department of Oncology, Wayne State University, Detroit, MI 48201, USA Mucosal Immunology Studies Team, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA kchen@med.wayne.edu.
authors.forename: Kang
authors.initials: K
authors.lastname: Chen
mesh_terms: D000818:Animals; D001942:Breast Feeding; D005260:Female; D005333:Fetus / Q000276:immunology; D006801:Humans; D007113:Immunity, Innate; D007112:Immunity, Maternally-Acquired; D007136:Immunoglobulins / Q000032:analysis / Q000276:immunology; D010920:Placenta / Q000276:immunology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control*; D011295:Prenatal Care; D011634:Public Health; D014611:Vaccination / Q000592:standards
chemical_list: D007136:Immunoglobulins
keywords: animal model; antibody; immunology; pregnancy; vaccine