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Influenza Vaccine Efficacy and Effectiveness in Pregnant Women: Systematic Review and Meta-analysis

Abstract

Objective

Pregnant women have a high risk for complications from influenza infection, but vaccination rates within this group remain low in the US and other countries. The efficacy and effectiveness of the influenza vaccine are a key determinant of vaccine uptake. This review aimed to synthesize the available evidence on the protection of both seasonal and monovalent pandemic H1N1 (pdmH1N1) vaccine against laboratory-confirmed influenza (LCI), influenza-like illness (ILI), and respiratory illness (RI).

Methods

A search of the literature was undertaken from Pubmed, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials up to Aug 1, 2018. Both observational studies and clinical trials were considered.

Results

Nineteen studies were identified from 11 countries. Women with pdmH1N1 vaccination had a lower risk of getting LCI (Relative risk [RR] 0.3, 95% confidence interval [CI] 0.26–0.35) and ILI (RR 0.15, 95% CI 0.06–0.36)). The pooled estimate from three randomized clinical trials (RR 0.47, 95% CI 0.31–0.71) and two case control studies (OR 0.37, 95% CI 0.23–0.61) showed that the seasonal vaccine was protective against LCI. The seasonal vaccine was not protective against ILI (RR 0.95, 95% CI 0.88–1.03). This association was similar for the outcome of RI (RR 0.81, 95% CI 0.55–1.20).

Conclusion

This analysis bolsters existing evidence that influenza vaccines are effective among pregnant women. Additional public health efforts are needed to promote physician recommendations of influenza vaccination in pregnancy.

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Acknowledgements

We would like to thank the University of Georgia’s College of Public Health Epidemiology and Biostatistics Department. Additionally, we would like to acknowledge support from the University of Georgia’s Global Health Institute. We are grateful for the valuable suggestions made by Dr. Mark Ebell, UGA Professor of Epidemiology & Biostatistics. No funding was received to conduct this review.

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Correspondence to José F. Cordero.

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TQ and NAM declare that they have no conflict of interest. Dr. Cordero reports consulting for Sanofi Pasteur, outside the submitted work. All authors have submitted the ICMJE form for Disclosure of Potential Conflicts of Interest.

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Quach, T.H.T., Mallis, N.A. & Cordero, J.F. Influenza Vaccine Efficacy and Effectiveness in Pregnant Women: Systematic Review and Meta-analysis. Matern Child Health J 24, 229–240 (2020). https://doi.org/10.1007/s10995-019-02844-y

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  • DOI: https://doi.org/10.1007/s10995-019-02844-y

Keywords

  • Influenza
  • Pregnancy
  • Vaccine efficacy
  • Vaccine effectiveness
  • Meta-analysis