. 2017 Oct 13;35(43):5738-5750.

doi: 10.1016/j.vaccine.2017.08.037. Epub 2017 Sep 1.

Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group

Deshayne B Fell¹, Eduardo Azziz-Baumgartner², Michael G Baker³, Maneesh Batra⁴, Julien Beauté⁵, Philippe Beutels⁶, Niranjan Bhat⁷, Zulfiqar A Bhutta⁸, Cheryl Cohen⁹, Bremen De Mucio¹⁰, Bradford D Gessner¹¹, Michael G Gravett¹², Mark A Katz¹³, Marian Knight¹⁴, Vernon J Lee¹⁵, Mark Loeb¹⁶, Johannes M Luteijn¹⁷, Helen Marshall¹⁸, Harish Nair¹⁹, Kevin Pottie²⁰, Rehana A Salam²¹, David A Savitz²², Suzanne J Serruya²³, Becky Skidmore²⁴, Justin R Ortiz²⁵; WHO taskforce to evaluate influenza data to inform vaccine impact and economic modelling

Affiliations

¹ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa and Children's Hospital of Eastern Ontario (CHEO) Research Institute, Canada. Electronic address: dfell@cheo.on.ca.
² Influenza Division, Centers for Disease Control and Prevention, USA. Electronic address: eha9@cdc.gov.
³ Department of Public Health, University of Otago, New Zealand. Electronic address: michael.baker@otago.ac.nz.
⁴ Department of Pediatrics-Neonatology, University of Washington School of Medicine, USA. Electronic address: maneesh.batra@seattlechildrens.org.
⁵ European Centre for Disease Prevention and Control (ECDC), Sweden. Electronic address: julien.beaute@ecdc.europa.eu.
⁶ Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Belgium. Electronic address: philippe.beutels@uantwerpen.be.
⁷ Center for Vaccine Innovation and Access, PATH, USA. Electronic address: nbhat@path.org.
⁸ Centre for Global Child Health, Hospital for Sick Children, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan. Electronic address: Zulfiqar.bhutta@sickkkids.ca.
⁹ National Institute for Communicable Diseases, National Health Laboratory Service, South Africa; School of Public Health, University of the Witwatersrand, South Africa. Electronic address: cherylc@nicd.ac.za.
¹⁰ Latin American Center for Perinatology, Women and Reproductive Health, Panamerican Health Organization, Uruguay. Electronic address: demuciob@paho.org.
¹¹ Agence de Médecine Préventive, France. Electronic address: bgessner@aamp.org.
¹² Department of Obstetrics and Gynecology, University of Washington, USA. Electronic address: gravettm@uw.edu.
¹³ Medical School for International Health and Department of Health Systems Management, Ben Gurion University of the Negev, Israel; School of Public Health, University of Michigan, USA. Electronic address: katzmar@post.bgu.ac.il.
¹⁴ National Perinatal Epidemiology Unit, University of Oxford, UK. Electronic address: marian.knight@npeu.ox.ac.uk.
¹⁵ Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Electronic address: vernonljm@hotmail.com.
¹⁶ Institute for Infectious Disease Research, McMaster University, Canada. Electronic address: loebm@mcmaster.ca.
¹⁷ Queen Mary, University of London, UK. Electronic address: j.m.luteijn@qmul.ac.uk.
¹⁸ Robinson Research Institute and Adelaide Medical School, University of Adelaide and Women's and Children's Health Network, Australia. Electronic address: helen.marshall@adelaide.edu.au.
¹⁹ Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK. Electronic address: harish.nair@ed.ac.uk.
²⁰ Department of Family Medicine, University of Ottawa, Canada. Electronic address: kpottie@uottawa.ca.
²¹ South Australian Health and Medical Research Institute, University of Adelaide, Australia; Division of Women and Child Health, Aga Khan University, Pakistan. Electronic address: rehana.salam@aku.edu.
²² Departments of Epidemiology and Obstetrics and Gynecology, Brown University, USA. Electronic address: david_savitz@brown.edu.
²³ Latin American Center for Perinatology, Women and Reproductive Health, Panamerican Health Organization, Uruguay. Electronic address: serruyas@paho.org.
²⁴ Independent Information Specialist, Canada. Electronic address: bskidmore@rogers.com.
²⁵ Initiative for Vaccine Research, World Health Organization, Switzerland. Electronic address: ortizj@who.int.

PMID: 28867508
PMCID: PMC8274347
DOI: 10.1016/j.vaccine.2017.08.037

Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group

Deshayne B Fell et al. Vaccine. 2017.

. 2017 Oct 13;35(43):5738-5750.

doi: 10.1016/j.vaccine.2017.08.037. Epub 2017 Sep 1.

Authors

Affiliations

¹ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa and Children's Hospital of Eastern Ontario (CHEO) Research Institute, Canada. Electronic address: dfell@cheo.on.ca.
² Influenza Division, Centers for Disease Control and Prevention, USA. Electronic address: eha9@cdc.gov.
³ Department of Public Health, University of Otago, New Zealand. Electronic address: michael.baker@otago.ac.nz.
⁴ Department of Pediatrics-Neonatology, University of Washington School of Medicine, USA. Electronic address: maneesh.batra@seattlechildrens.org.
⁵ European Centre for Disease Prevention and Control (ECDC), Sweden. Electronic address: julien.beaute@ecdc.europa.eu.
⁶ Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Belgium. Electronic address: philippe.beutels@uantwerpen.be.
⁷ Center for Vaccine Innovation and Access, PATH, USA. Electronic address: nbhat@path.org.
⁸ Centre for Global Child Health, Hospital for Sick Children, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan. Electronic address: Zulfiqar.bhutta@sickkkids.ca.
⁹ National Institute for Communicable Diseases, National Health Laboratory Service, South Africa; School of Public Health, University of the Witwatersrand, South Africa. Electronic address: cherylc@nicd.ac.za.
¹⁰ Latin American Center for Perinatology, Women and Reproductive Health, Panamerican Health Organization, Uruguay. Electronic address: demuciob@paho.org.
¹¹ Agence de Médecine Préventive, France. Electronic address: bgessner@aamp.org.
¹² Department of Obstetrics and Gynecology, University of Washington, USA. Electronic address: gravettm@uw.edu.
¹³ Medical School for International Health and Department of Health Systems Management, Ben Gurion University of the Negev, Israel; School of Public Health, University of Michigan, USA. Electronic address: katzmar@post.bgu.ac.il.
¹⁴ National Perinatal Epidemiology Unit, University of Oxford, UK. Electronic address: marian.knight@npeu.ox.ac.uk.
¹⁵ Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Electronic address: vernonljm@hotmail.com.
¹⁶ Institute for Infectious Disease Research, McMaster University, Canada. Electronic address: loebm@mcmaster.ca.
¹⁷ Queen Mary, University of London, UK. Electronic address: j.m.luteijn@qmul.ac.uk.
¹⁸ Robinson Research Institute and Adelaide Medical School, University of Adelaide and Women's and Children's Health Network, Australia. Electronic address: helen.marshall@adelaide.edu.au.
¹⁹ Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK. Electronic address: harish.nair@ed.ac.uk.
²⁰ Department of Family Medicine, University of Ottawa, Canada. Electronic address: kpottie@uottawa.ca.
²¹ South Australian Health and Medical Research Institute, University of Adelaide, Australia; Division of Women and Child Health, Aga Khan University, Pakistan. Electronic address: rehana.salam@aku.edu.
²² Departments of Epidemiology and Obstetrics and Gynecology, Brown University, USA. Electronic address: david_savitz@brown.edu.
²³ Latin American Center for Perinatology, Women and Reproductive Health, Panamerican Health Organization, Uruguay. Electronic address: serruyas@paho.org.
²⁴ Independent Information Specialist, Canada. Electronic address: bskidmore@rogers.com.
²⁵ Initiative for Vaccine Research, World Health Organization, Switzerland. Electronic address: ortizj@who.int.

PMID: 28867508
PMCID: PMC8274347
DOI: 10.1016/j.vaccine.2017.08.037

Abstract

From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses challenges for robust estimation of the potential impact of maternal influenza immunization programs.

Keywords: Immunization; Infants; Influenza; Pregnancy.

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Figures

**Fig. 1.**
Organizational approach for systematic evidence reviews carried out by the WHO working group. ^aAll manuscripts were prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [86].

See this image and copyright information in PMC

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Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group

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Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group

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