Maternal Immunization

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MATERNAL
IMMUNIZATION
Copyright
Contributors
Editors’ biography
Part I: Concepts of maternal immunization
1
The history of maternal immunization
	Introduction
	The need from a historical perspective: Pregnancy
	The need from a historical perspective: Early childhood
	History of immunization in pregnant women
	Examples of recent work in select vaccines
		Tetanus toxoid vaccine
		Diphtheria vaccine
		Influenza vaccine
		Pertussis vaccine
	Current work
	Future work
	Historical perspective on women’s inclusion in research
	Current challenges
	Conclusion
	Acknowledgments
	Conflict of interest
	References
2
Vaccination of women in the pre-conception and post-partum periods
	Introduction
	Assessment of vaccination status and vaccination in the pre-conceptual period
		Hepatitis B
		Varicella
		Rubella
		Influenza
	Vaccination in the post-partum period
		Administration of inactivated vaccines
			Pertussis vaccine
			Hepatitis B
		Administration of live viral vaccines
			Varicella vaccine
			Rubella vaccine
			Measles vaccine
			Yellow fever vaccine
	Conclusion
	References
3
Immunobiological aspects of vaccines in pregnancy: Maternal perspective
	Introduction
	Susceptibility to infectious diseases in pregnancy
		Influenza and other respiratory viruses
		Varicella zoster virus
		Hepatitis E
		Listeria monocytogenes
		Malaria ( Plasmodium falciparum)
		Other pathogens transmitted from the mother to the fetus and newborn infant
			Herpes simplex virus
			Cytomegalovirus
			Zika virus
	Innate and adaptive immune responses in pregnancy
	Effect of pregnancy on vaccine responses
	Transfer of maternal antibodies to the newborn infant
	Timing of maternal immunization
	Impact of chronic maternal infections on antibody transfer
	Maternal antibody transfer through breastmilk
	Conclusion
	References
4
Immunobiological aspects of vaccines in pregnancy: Infant perspective
	Introduction
	Interference with infant responses to vaccination
		Interference with infant responses to pertussis antigens
		Interference with infant responses to other vaccine antigens
		What are the underlying mechanisms for this interference?
		What is the clinical significance of these findings?
	Breastfeeding after antenatal vaccination: Potential for additional protection for the newborn?
		Secretory immunoglobulin A (sIgA)
		Other immunologically active components of breastmilk
	Conclusion
	References
5
Global considerations on maternal vaccine introduction and implementation
	Introduction
	Implementation
		The importance of careful planning and national strategies/leadership
		The importance of burden of diseases data in informing the introduction of maternal immunization
		The importance of identifying optimal service delivery and defining optimal timing of vaccine administration during pregnan ...
		Information needs for the introduction of new vaccines for pregnant women including RSV
		Cross cutting issues for implementation of any maternal vaccine
	Understanding and addressing factors affecting vaccine acceptance during pregnancy
		Factors influencing vaccine acceptance
			The role of information and its sources
			The role of addressing safety concerns
			The role of the healthcare provider
		Strategies to increase confidence and uptake of vaccines in pregnancy
	Conclusion
	Conflict of interest
	References
Part II: Vaccines with current recommendations for use in pregnancy
6
Tetanus
	Introduction
	Clinical burden of disease for women and infants, and epidemiology
	Current recommendations tetanus vaccination in pregnancy, and evidence of effectiveness/efficacy in women and infants
	Evidence of safety of tetanus vaccination in pregnancy
	Future prospects
	Conclusion
	References
7
Influenza
	Introduction
	Influenza virus
	Clinical burden of disease and epidemiology
		Clinical burden of influenza illness during pregnancy
		Clinical burden of influenza illness among infants under 6 months of age
			Laboratory-confirmed influenza illness in ambulatory care settings
			Laboratory-confirmed influenza hospitalization
			Laboratory-confirmed influenza and intensive care unit admissions
			Laboratory-confirmed influenza death
		Influenza during pregnancy and birth outcomes
	Current recommendations for influenza vaccination during pregnancy
	Evidence of effectiveness of influenza vaccination in pregnancy
		Efficacy of influenza vaccination during pregnancy against influenza in women
		Efficacy of influenza vaccination during pregnancy against influenza in infants
	Immunogenicity of influenza vaccines during pregnancy
		Transplacental antibody transfer
		Duration of protection
	Safety of influenza vaccination during pregnancy
		Safety of influenza vaccination and birth outcomes
		Safety of influenza vaccination and pediatric health outcomes
		Safety of influenza vaccination and maternal health outcomes
		Influenza vaccination during pregnancy and fetal outcomes
			Evidence from randomized controlled trials
			Evidence from observational epidemiological studies
	Influenza vaccination in pregnant women living with HIV
	Conclusion
	References
8
Pertussis
	Introduction
	Clinical burden of disease and epidemiology
		Clinical burden of pertussis in children and adults
		Epidemiology of pertussis
	Pertussis vaccines
	Current recommendations for the use of pertussis vaccines in pregnant women
	Evidence of effectiveness of pertussis vaccination in pregnancy
	Evidence of safety of pertussis vaccination in pregnancy
	Future prospects
	Conclusion
	Conflict of interest statement
	References
9
Vaccination in pregnancy in specific circumstances
	Introduction
	Vaccines for Streptococcus pneumoniae and Haemophilus influenzae type b
		Pneumococcal vaccines
		Haemophilus influenzae vaccine
	Vaccines in an outbreak situation
		Meningococcal vaccines
	Travel vaccines
		Rabies vaccine
			Post-exposure rabies immunization
			Pre-exposure rabies vaccination
		Typhoid vaccine
		Japanese encephalitis vaccine
		Yellow fever vaccine
		Hepatitis A vaccine
		Cholera vaccine
		Tick borne encephalitis virus (TBEV) vaccine
	Vaccines for those at increased risk of infection
		Hepatitis B vaccine
		Q fever vaccine
	Vaccines after exposure to infection
		Anthrax vaccine
	Conclusion
	References
Part III: Future vaccines for use in pregnancy
10
Respiratory syncytial virus
	Introduction
	Clinical burden of disease and epidemiology
		Clinical burden of RSV in children
		Clinical burden of RSV in pregnant women
	Protection against RSV
		Maternally-derived antibody
		The structure of RSV and immunity
		Monoclonal antibody prophylaxis to protect young infants against RSV
		RSV F-protein and novel monoclonal antibodies
	RSV vaccines
		Maternal immunization for the prevention of RSV in infants
	Conclusion
	References
11
Group B Streptococcus
	Group B Streptococcus
	Risk factors for Group B Streptococcus disease
	Epidemiology of Group B Streptococcus in young infants
	Maternal prevention strategies against Group B Streptococcus infection
		Maternal Group B Streptococcus vaccination
	Group B Streptococcus vaccine development
	Pathways for licensure of maternal Group B Streptococcus vaccine
	Conclusion
	References
12
Cytomegalovirus
	Introduction to CMV virology and structure
	Clinical burden of CMV disease
	Epidemiology of CMV
	Vaccines in development
		Passive immunization: Anti-CMV IgG
		Active immunization: Candidate CMV vaccines
		Live, attenuated or disabled, single cycle (DISC) vaccines
		Subunit (recombinant/vectored) vaccines
			Purified recombinant gB subunit vaccines
			Enveloped virus-like particles vaccines
			Vectored CMV vaccines
			Nucleic acid-based CMV vaccines
			Peptide vaccines
		Available evidence of effectiveness/efficacy of CMV vaccines
		Evidence of safety of CMV vaccines
	Future prospects
	Acknowledgments
	References
13
Zika virus
	Introduction
	Zika virus virology and structure
		Classification and structure
		Phylogeny and genetics
	Epidemiology
	Clinical aspects of ZIKV infection
		Acute infection
		Potential complications following acute ZIKV infection
		Congenital ZIKV infection
	ZIKV vaccine development
		Challenges to vaccine development
	Evidence of vaccine safety and efficacy
		Nucleic acid vaccines
		Inactivated whole virus vaccines
		Live attenuated recombinant measles vector vaccine
		Universal mosquito-borne disease vaccine
	Conclusion
	References
14
Malaria
	Introduction
	Malaria parasitology and mechanisms of placental malaria
	Clinical burden of disease and epidemiology
	Challenges of developing a vaccine for malaria during pregnancy
	Malaria vaccines in development
		Efficacy endpoints for clinical trials of malaria vaccines
		Available evidence of effectiveness/efficacy in pregnant women
	Ideal timing of vaccination (infant/adolescent/pre-conception/early pregnancy)
	Conclusion
	References
Part IV: Conclusion
15
Conclusion
	Maternal immunization: Past, present and future
	Immunobiological aspects of vaccines in pregnancy
		Maternal perspective
		Infant perspective
	Conducting research in maternal immunization
	Global implementation and acceptance of maternal immunization
	Vaccination of women in the pre-conception and post-partum periods
	Currently recommended vaccines for use in pregnancy
		Tetanus
		Influenza
		Pertussis
	Vaccines recommended in specific circumstances
	Future vaccines which may be recommended for use pre-conception or during pregnancy
		Respiratory syncytial virus
		Group B Streptococcus
		Cytomegalovirus
		Zika virus
		Malaria
	Conclusion
	Acknowledgments
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	Y
	Z
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