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Meta-Analysis
. 2015 Jun 9;2015(6):CD009982.
doi: 10.1002/14651858.CD009982.pub2.

Impact of Haemophilus influenzae type B (Hib) and viral influenza vaccinations in pregnancy for improving maternal, neonatal and infant health outcomes

Rehana A Salam  1 , Jai K Das, Chesarahmia Dojo Soeandy, Zohra S Lassi, Zulfiqar A Bhutta
Affiliations
Meta-Analysis

Impact of Haemophilus influenzae type B (Hib) and viral influenza vaccinations in pregnancy for improving maternal, neonatal and infant health outcomes

Rehana A Salam et al. Cochrane Database Syst Rev. .

Abstract

Background: Infections during pregnancy confers increased risk of maternal and perinatal morbidity and mortality. However, the case for advocating Haemophilus influenzae type B (Hib) and viral Influenza vaccinations in pregnancy is still debatable.

Objectives: To assess the impact of Hib and viral Influenza vaccinations during pregnancy on maternal, neonatal and infant health outcomes compared to placebo/control.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 January 2015) and reference lists of retrieved studies.

Selection criteria: All randomised controlled clinical trials (including cluster-randomised trials) and quasi-randomised trials evaluating Hib or viral influenza vaccination during pregnancy compared with no vaccination or placebo.

Data collection and analysis: Two review authors independently assessed trials for inclusion, risk of bias and extracted data. Data were checked for accuracy.

Main results: Two trials were included this review. One (involving 213 women and 213 neonates) evaluated the impact of Hib vaccination during pregnancy and the other study (involving 2116 women and 2049 neonates) evaluated the impact of viral influenza vaccination during pregnancy. Overall, the HiB vaccination trial was judged to be at 'high risk of bias' due to inadequate randomisation while the other trial was judged to be at 'low risk of bias'. Hib vaccination during pregnancy versus placeboOne trial involving 213 women and 213 neonates evaluating the impact of Hib vaccination during pregnancy was included under this comparison. The study did not report on any of this review's prespecified primary outcomes (including mortality, respiratory tract infection and sepsis) or secondary outcomes (including adverse events) except preterm delivery. There was no clear difference between the Hib vaccination and placebo control groups in terms of preterm delivery (risk ratio (RR) 1.28, 95% confidence interval (CI) 0.12 to 13.86, one study, 213 participants), fetal distress (RR 1.23, 95% CI 0.67 to 2.26, one study, 213 infants), intubation (RR 1.03, 95% CI 0.55 to 1.95, one study, 213 infants) and neonatal jaundice (RR 1.01, 95% CI 0.52 to 1.97, one study, 213 infants). We could not grade the evidence for quality due to lack of outcome data. Viral influenza vaccination during pregnancy versus placeboOne trial involving 2116 women and 2049 infants evaluating the impact of trivalent inactivated influenza vaccine (IIV3) during pregnancy was included under this comparison.There was no clear difference between the viral influenza and placebo control group in terms of most of this review's primary outcomes: maternal death (RR 4.96, 95% CI 0.24 to 103.24, moderate quality evidence), infant death up to 175 days after birth (RR 0.71, 95% CI 0.37 to 1.37, moderate quality evidence), perinatal death (stillbirth and death in the first week of life) (RR 1.32, 95% CI 0.73 to 2.38, moderate quality evidence), influenza-like illness in women (RR 0.96, 95% CI 0.79 to 1.16) or their babies (RR 1.02, 95% CI 0.94 to 1.09), any respiratory illness in women (RR 0.97, 95% CI 0.91 to 1.04, high quality evidence) or their babies (RR 1.01, 95% CI 0.95 to 1.07, high quality evidence). There were also no clear differences between vaccination and placebo control groups in terms of maternal hospitalisation for any infection (RR 2.27, 95% CI 0.94 to 5.49; 2116 women, moderate quality evidence), and neonatal hospitalisation for sepsis (RR 1.60, 95% CI 0.73 to 3.50; 2049 infants, moderate quality evidence). However, viral influenza vaccination during pregnancy was associated with a reduction in reverse-transcriptase-polymerase-chain-reaction (RT-PCR) confirmed influenza among infants (RR 0.51, 95% CI 0.30 to 0.88, one study, 2049 infants) and women (RR 0.50, 95% CI 0.29 to 0.86, one study, 2116 women).In terms of this review's secondary outcomes, there were no clear differences in terms of the impact on pregnancy outcomes (miscarriage, preterm labour and stillbirth), hospitalisation for respiratory infection among women and infants. Similarly, there was no difference between the viral influenza vaccine and placebo control groups in terms of any adverse systemic reactions.

Authors' conclusions: There is limited evidence (from one small trial at a high risk of bias) on the effectiveness on Hib during pregnancy for improving maternal, neonatal and infant health outcomes.Evidence from one large high quality trial on the effectiveness of viral influenza vaccine during pregnancy suggests reduced RT-PCR confirmed influenza among women and their babies, suggesting the potential of this strategy for scale up but further evidence from varying contexts is required.Further trials for both Hib and viral influenza vaccines with appropriate study designs and suitable comparison groups are required. There are currently two 'ongoing' studies - these will be incorporated into the review in future updates.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Haemophilus influenzae type b vaccine versus control, Outcome 1 Preterm delivery.
1.2
1.2. Analysis
Comparison 1 Haemophilus influenzae type b vaccine versus control, Outcome 2 Fetal distress.
1.3
1.3. Analysis
Comparison 1 Haemophilus influenzae type b vaccine versus control, Outcome 3 Neonatal jaundice.
1.4
1.4. Analysis
Comparison 1 Haemophilus influenzae type b vaccine versus control, Outcome 4 Intubation.
2.1
2.1. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 1 Maternal death.
2.2
2.2. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 2 Infant death (up to 175 days).
2.3
2.3. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 3 Perinatal death (stillbirth + death in first week of life).
2.4
2.4. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 4 RT‐PCR confirmed influenza in infants.
2.5
2.5. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 5 RT‐PCR confirmed influenza in women.
2.6
2.6. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 6 Influenza‐like illness in infants.
2.7
2.7. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 7 Any respiratory illness in women.
2.8
2.8. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 8 Any respiratory illness in infants.
2.9
2.9. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 9 Influenza‐like illness in women.
2.10
2.10. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 10 Maternal hospitalisation for respiratory infection.
2.11
2.11. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 11 Infant hospitalisation for respiratory infection.
2.12
2.12. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 12 Preterm labour.
2.13
2.13. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 13 Miscarriage (24‐28 weeks).
2.14
2.14. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 14 Stillbirth.
2.15
2.15. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 15 Adverse events: at least one systemic reaction.
2.16
2.16. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 16 Maternal hospitalisation for any infection.
2.17
2.17. Analysis
Comparison 2 Viral influenza vaccine versus control, Outcome 17 Neonatal hospitalisation due to sepsis within 28 days of birth.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009982

References

References to studies included in this review

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