Influenza Vaccination of Pregnant Women and Protection of Their Infants

In two trials of a trivalent inactivated influenza vaccine in pregnant women in South Africa, HIV-infected and HIV-uninfected vaccine recipients had increased influenza antibody titers and decreased influenza attack rates. Pregnant women are designated as a priority group for seasonal influenza vacc...

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Vydáno v:	The New England journal of medicine Ročník 371; číslo 10; s. 918 - 931
Hlavní autoři:	Madhi, Shabir A, Cutland, Clare L, Kuwanda, Locadiah, Weinberg, Adriana, Hugo, Andrea, Jones, Stephanie, Adrian, Peter V, van Niekerk, Nadia, Treurnicht, Florette, Ortiz, Justin R, Venter, Marietjie, Violari, Avy, Neuzil, Kathleen M, Simões, Eric A.F, Klugman, Keith P, Nunes, Marta C
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Waltham, MA Massachusetts Medical Society 04.09.2014
Témata:	Adult Babies Biological and medical sciences Double-Blind Method Female General aspects Hemagglutination inhibition HIV HIV Infections - complications HIV Infections - immunology Human immunodeficiency virus Human viral diseases Humans Immune response Immunization Immunogenicity Infant Infant, Newborn Infant, Premature Infants Infectious diseases Influenza Influenza Vaccines - immunology Influenza, Human - prevention & control Kaplan-Meier Estimate Male Medical sciences Neonates Polymerase chain reaction Pregnancy Pregnancy Complications, Infectious - immunology Pregnancy Complications, Infectious - prevention & control Pregnancy Outcome Seroconversion South Africa Vaccination Vaccine efficacy Vaccines Vaccines, Inactivated - immunology Viral diseases Viral diseases of the respiratory system and ent viral diseases Womens health Young Adult South Africa United States > US Human Vaccination Infant Infection Prevention Pregnancy Medicine Immunoprophylaxis Viral disease Influenza Female Woman Protection
ISSN:	0028-4793, 1533-4406, 1533-4406
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Abstract	In two trials of a trivalent inactivated influenza vaccine in pregnant women in South Africa, HIV-infected and HIV-uninfected vaccine recipients had increased influenza antibody titers and decreased influenza attack rates. Pregnant women are designated as a priority group for seasonal influenza vaccination by the World Health Organization (WHO) 1 because of their heightened susceptibility to severe influenza from the second trimester to the early postpartum period. 2 , 3 Since pregnancy is associated with immunomodulation, including the attenuation of cell-mediated immune responses, 4 the efficacy of inactivated influenza vaccine (IIV) in pregnant women may differ from its efficacy in healthy nonpregnant women and in men. 5 This difference in vaccine efficacy could be further accentuated in pregnant women infected with the human immunodeficiency virus (HIV), who are at heightened risk for severe influenza illness 6 – . . .
AbstractList	BackgroundThere are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency virus (HIV) infection and protection of their infants.MethodsWe conducted two double-blind, randomized, placebo-controlled trials of trivalent inactivated influenza vaccine (IIV3) in South Africa during 2011 in pregnant women infected with HIV and during 2011 and 2012 in pregnant women who were not infected. The immunogenicity, safety, and efficacy of IIV3 in pregnant women and their infants were evaluated until 24 weeks after birth. Immune responses were measured with a hemagglutination inhibition (HAI) assay, and influenza was diagnosed by means of reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays of respiratory samples.ResultsThe study cohorts included 2116 pregnant women who were not infected with HIV and 194 pregnant women who were infected with HIV. At 1 month after vaccination, seroconversion rates and the proportion of participants with HAI titers of 1:40 or more were higher among IIV3 recipients than among placebo recipients in both cohorts. Newborns of IIV3 recipients also had higher HAI titers than newborns of placebo recipients. The attack rate for RT-PCR–confirmed influenza among both HIV-uninfected placebo recipients and their infants was 3.6%. The attack rates among HIV-uninfected IIV3 recipients and their infants were 1.8% and 1.9%, respectively, and the respective vaccine-efficacy rates were 50.4% (95% confidence interval [CI], 14.5 to 71.2) and 48.8% (95% CI, 11.6 to 70.4). Among HIV-infected women, the attack rate for placebo recipients was 17.0% and the rate for IIV3 recipients was 7.0%; the vaccine-efficacy rate for these IIV3 recipients was 57.7% (95% CI, 0.2 to 82.1).ConclusionsInfluenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov numbers, NCT01306669 and NCT01306682.) There are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency virus (HIV) infection and protection of their infants.BACKGROUNDThere are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency virus (HIV) infection and protection of their infants.We conducted two double-blind, randomized, placebo-controlled trials of trivalent inactivated influenza vaccine (IIV3) in South Africa during 2011 in pregnant women infected with HIV and during 2011 and 2012 in pregnant women who were not infected. The immunogenicity, safety, and efficacy of IIV3 in pregnant women and their infants were evaluated until 24 weeks after birth. Immune responses were measured with a hemagglutination inhibition (HAI) assay, and influenza was diagnosed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays of respiratory samples.METHODSWe conducted two double-blind, randomized, placebo-controlled trials of trivalent inactivated influenza vaccine (IIV3) in South Africa during 2011 in pregnant women infected with HIV and during 2011 and 2012 in pregnant women who were not infected. The immunogenicity, safety, and efficacy of IIV3 in pregnant women and their infants were evaluated until 24 weeks after birth. Immune responses were measured with a hemagglutination inhibition (HAI) assay, and influenza was diagnosed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays of respiratory samples.The study cohorts included 2116 pregnant women who were not infected with HIV and 194 pregnant women who were infected with HIV. At 1 month after vaccination, seroconversion rates and the proportion of participants with HAI titers of 1:40 or more were higher among IIV3 recipients than among placebo recipients in both cohorts. Newborns of IIV3 recipients also had higher HAI titers than newborns of placebo recipients. The attack rate for RT-PCR-confirmed influenza among both HIV-uninfected placebo recipients and their infants was 3.6%. The attack rates among HIV-uninfected IIV3 recipients and their infants were 1.8% and 1.9%, respectively, and the respective vaccine-efficacy rates were 50.4% (95% confidence interval [CI], 14.5 to 71.2) and 48.8% (95% CI, 11.6 to 70.4). Among HIV-infected women, the attack rate for placebo recipients was 17.0% and the rate for IIV3 recipients was 7.0%; the vaccine-efficacy rate for these IIV3 recipients was 57.7% (95% CI, 0.2 to 82.1).RESULTSThe study cohorts included 2116 pregnant women who were not infected with HIV and 194 pregnant women who were infected with HIV. At 1 month after vaccination, seroconversion rates and the proportion of participants with HAI titers of 1:40 or more were higher among IIV3 recipients than among placebo recipients in both cohorts. Newborns of IIV3 recipients also had higher HAI titers than newborns of placebo recipients. The attack rate for RT-PCR-confirmed influenza among both HIV-uninfected placebo recipients and their infants was 3.6%. The attack rates among HIV-uninfected IIV3 recipients and their infants were 1.8% and 1.9%, respectively, and the respective vaccine-efficacy rates were 50.4% (95% confidence interval [CI], 14.5 to 71.2) and 48.8% (95% CI, 11.6 to 70.4). Among HIV-infected women, the attack rate for placebo recipients was 17.0% and the rate for IIV3 recipients was 7.0%; the vaccine-efficacy rate for these IIV3 recipients was 57.7% (95% CI, 0.2 to 82.1).Influenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov numbers, NCT01306669 and NCT01306682.).CONCLUSIONSInfluenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov numbers, NCT01306669 and NCT01306682.). In two trials of a trivalent inactivated influenza vaccine in pregnant women in South Africa, HIV-infected and HIV-uninfected vaccine recipients had increased influenza antibody titers and decreased influenza attack rates. Pregnant women are designated as a priority group for seasonal influenza vaccination by the World Health Organization (WHO) 1 because of their heightened susceptibility to severe influenza from the second trimester to the early postpartum period. 2 , 3 Since pregnancy is associated with immunomodulation, including the attenuation of cell-mediated immune responses, 4 the efficacy of inactivated influenza vaccine (IIV) in pregnant women may differ from its efficacy in healthy nonpregnant women and in men. 5 This difference in vaccine efficacy could be further accentuated in pregnant women infected with the human immunodeficiency virus (HIV), who are at heightened risk for severe influenza illness 6 – . . . There are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency virus (HIV) infection and protection of their infants. We conducted two double-blind, randomized, placebo-controlled trials of trivalent inactivated influenza vaccine (IIV3) in South Africa during 2011 in pregnant women infected with HIV and during 2011 and 2012 in pregnant women who were not infected. The immunogenicity, safety, and efficacy of IIV3 in pregnant women and their infants were evaluated until 24 weeks after birth. Immune responses were measured with a hemagglutination inhibition (HAI) assay, and influenza was diagnosed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays of respiratory samples. The study cohorts included 2116 pregnant women who were not infected with HIV and 194 pregnant women who were infected with HIV. At 1 month after vaccination, seroconversion rates and the proportion of participants with HAI titers of 1:40 or more were higher among IIV3 recipients than among placebo recipients in both cohorts. Newborns of IIV3 recipients also had higher HAI titers than newborns of placebo recipients. The attack rate for RT-PCR-confirmed influenza among both HIV-uninfected placebo recipients and their infants was 3.6%. The attack rates among HIV-uninfected IIV3 recipients and their infants were 1.8% and 1.9%, respectively, and the respective vaccine-efficacy rates were 50.4% (95% confidence interval [CI], 14.5 to 71.2) and 48.8% (95% CI, 11.6 to 70.4). Among HIV-infected women, the attack rate for placebo recipients was 17.0% and the rate for IIV3 recipients was 7.0%; the vaccine-efficacy rate for these IIV3 recipients was 57.7% (95% CI, 0.2 to 82.1). Influenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov numbers, NCT01306669 and NCT01306682.).
Author	Simões, Eric A.F Madhi, Shabir A Kuwanda, Locadiah Nunes, Marta C Adrian, Peter V Neuzil, Kathleen M Jones, Stephanie Weinberg, Adriana Klugman, Keith P Cutland, Clare L Hugo, Andrea Ortiz, Justin R Venter, Marietjie Treurnicht, Florette Violari, Avy van Niekerk, Nadia
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the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 3 givenname: Locadiah surname: Kuwanda fullname: Kuwanda, Locadiah organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; 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the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 7 givenname: Peter V surname: Adrian fullname: Adrian, Peter V organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; 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the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 9 givenname: Florette surname: Treurnicht fullname: Treurnicht, Florette organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; 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the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 11 givenname: Marietjie surname: Venter fullname: Venter, Marietjie organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 12 givenname: Avy surname: Violari fullname: Violari, Avy organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 13 givenname: Kathleen M surname: Neuzil fullname: Neuzil, Kathleen M organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 14 givenname: Eric A.F surname: Simões fullname: Simões, Eric A.F organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 15 givenname: Keith P surname: Klugman fullname: Klugman, Keith P organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.) – sequence: 16 givenname: Marta C surname: Nunes fullname: Nunes, Marta C organization: From the Medical Research Council, Respiratory and Meningeal Pathogens Research Unit (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., K.P.K., M.C.N.), the Department of Science and Technology–National Research Foundation, Vaccine-Preventable Diseases (S.A.M., C.L.C., L.K., A.H., S.J., P.V.A., N.N., M.C.N.), and the Perinatal HIV Research Unit (A.V.), University of the Witwatersrand, the National Institute for Communicable Diseases, the National Health Laboratory Service, Centre for Vaccines and Immunology (S.A.M., F.T., M.V.), Johannesburg, and the Department of Medical Virology, University of Pretoria, Pretoria (M.V.) — all in South Africa; the School of Medicine and Children’s Hospital, University of Colorado (A.W.), the Department of Pediatrics, Medicine and Pathology, University of Colorado School of Medicine (E.A.F.S.), and the Center for Global Health, Department of Epidemiology, Colorado School of Public Health (E.A.F.S.) — all in Aurora, Colorado; the Department of Medicine and Department of Global Health, University of Washington (J.R.O.), and the Vaccine Access and Delivery Global Program, PATH (J.R.O., K.M.N.) — both in Seattle; and the Hubert Department of Global Health, Rollins School of Public Health, and the Division of Infectious Diseases, School of Medicine, Emory University, Atlanta (K.P.K.)
BackLink	http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=29054069$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/25184864$$D View this record in MEDLINE/PubMed
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CODEN	NEJMAG
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Copyright	Copyright © 2014 Massachusetts Medical Society. All rights reserved. 2015 INIST-CNRS
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Snippet	In two trials of a trivalent inactivated influenza vaccine in pregnant women in South Africa, HIV-infected and HIV-uninfected vaccine recipients had increased... There are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency virus (HIV)... BackgroundThere are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency...
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SubjectTerms	Adult Babies Biological and medical sciences Double-Blind Method Female General aspects Hemagglutination inhibition HIV HIV Infections - complications HIV Infections - immunology Human immunodeficiency virus Human viral diseases Humans Immune response Immunization Immunogenicity Infant Infant, Newborn Infant, Premature Infants Infectious diseases Influenza Influenza Vaccines - immunology Influenza, Human - prevention & control Kaplan-Meier Estimate Male Medical sciences Neonates Polymerase chain reaction Pregnancy Pregnancy Complications, Infectious - immunology Pregnancy Complications, Infectious - prevention & control Pregnancy Outcome Seroconversion South Africa Vaccination Vaccine efficacy Vaccines Vaccines, Inactivated - immunology Viral diseases Viral diseases of the respiratory system and ent viral diseases Womens health Young Adult
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Title	Influenza Vaccination of Pregnant Women and Protection of Their Infants
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