Vaccinating pregnant women – a global perspective
The World Health Organization (WHO) influenza vaccine policy recommendations aim to protect vulnerable high-risk groups from severe disease. In a 2012 update of its influenza vaccine position, WHO recommended that countries considering the initiation or expansion of programmes for seasonal influenza vaccination should prioritize pregnant women. This position was based on disease burden evidence available, the safety profile and effectiveness of seasonal influenza vaccine, and the operational feasibility of maternal immunization in low- and middle-income countries.
Since 2012, there have been many advances in the field of maternal influenza immunization. Still, many countries, mostly with low or middle income, have not yet introduced maternal immunization into their national immunization programs. Generally, low-resource countries have multiple competing public health priorities and limited resources. Additional data regarding the incidence of severe influenza disease in pregnant women and young children and the anticipated impact of maternal influenza immunization, may be necessary to demonstrate the value proposition of maternal influenza immunization in countries considering influenza vaccine policies.
Based on these information needs, WHO is developing technical guidance to support the introduction of maternal influenza immunization and to inform concepts of maternal immunization with other vaccines that may benefit pregnant women and their offspring.
To help assess the vaccine’s impact, WHO has called an expert group to evaluate influenza morbidity and the vaccines effectiveness in pregnant women, children <6 months of age, and the fetus.
Furthermore, WHO is developing health economics guidance to enable countries assess the economic burden of influenza disease, the cost effectiveness of influenza vaccine, and to estimate the potential costs of introducing a maternal influenza immunization programme. These tools will enable decision makers in low-resource setting to prioritize maternal influenza immunization, comparing it to other health interventions.
Tools to assess confidence and use of vaccines among pregnant women, along with the Tailoring Immunization Programmes for influenza (TIP FLU) guide are in development to help countries identify reasons for vaccine hesitancy and develop interventions addressing those specific issues.
Other implementation issues receiving WHO attention include reviewing information needs for pregnancy/lactation sections of package inserts, developing vaccine safety terminology for maternal immunization, and considering strategies to support year-round availability of influenza vaccine in tropical regions.
In order to inform widespread implementation of maternal influenza immunization as a strategy, however, more work needs to be done. As a next step to current efforts, there must be increased focus on ways to optimally deliver vaccines to pregnant women in low-resource settings. Demonstration projects are needed to evaluate different vaccine delivery approaches, including the integration of vaccine into routine care delivery. Delivery methods that are cost effective and do not adversely affect routine immunization programs or antenatal care must be identified. Post-licensure safety surveillance must be implemented. Monitoring and evaluation systems are needed, including strategies to measure the number of severe influenza illnesses reduced by any program. The goal of any implementation research agenda should be to produce sustainable, integrated programs with predictable vaccine supply and manageable delivery, storage, and stock rotations procedures.
Disclaimer: The authors of this article work for the World Health Organization. They alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.
Considerations of strategies to provide influenza vaccine year round.
Lambach P, Alvarez AM, Hirve S, Ortiz JR, Hombach J, Verweij M, Hendriks J, Palkonyay L, Pfleiderer M
Vaccine. 2015 Aug 28