Department of Psychiatry, The Ohio State University Medical Center, Columbus, OH 43210, United States.
Vaccine. 2011 Nov 8;29(48):8982-7. doi: 10.1016/j.vaccine.2011.09.039. Epub 2011 Sep 22.
In the U.S., seasonal trivalent influenza virus vaccine (TIV) is currently universally recommended for all pregnant women. However, data on the maternal inflammatory response to vaccination is lacking and would better delineate the safety and clinical utility of immunization. In addition, for research purposes, vaccination has been used as a mild immune trigger to examine in vivo inflammatory responses in nonpregnant adults. The utility of such a model in pregnancy is unknown. Given the clinical and empirical justifications, the current study examined the magnitude, time course, and variance in inflammatory responses following seasonal influenza virus vaccination among pregnant women.
Women were assessed prior to and at one day (n=15), two days (n=10), or approximately one week (n=21) following TIV. Serum interleukin (IL)-6, tumor necrosis factor (TNF)-α, C-reactive protein (CRP), and macrophage migration inhibitory factor (MIF) were determined by high sensitivity immunoassay.
Significant increases in CRP were seen at one and two days post-vaccination (ps<05). A similar effect was seen for TNF-α, for which an increase at two days post-vaccination approached statistical significance (p=.06). There was considerable variability in magnitude of response; coefficients of variation for change at two days post-vaccination ranged from 122% to 728%, with the greatest variability in IL-6 responses at this timepoint.
Trivalent influenza virus vaccination elicits a measurable inflammatory response among pregnant women. There is sufficient variability in response for testing associations with clinical outcomes. As adverse perinatal health outcomes including preeclampsia and preterm birth have an inflammatory component, a tendency toward greater inflammatory responding to immune triggers may predict risk of adverse outcomes, providing insight into biological mechanisms underlying risk. The inflammatory response elicited by vaccination is substantially milder and more transient than seen in infectious illness, arguing for the clinical value of vaccination. However, further research is needed to confirm that the mild inflammatory response elicited by vaccination is benign in pregnancy.
在美国，季节性三价流感病毒疫苗（TIV）目前普遍建议所有孕妇接种。然而，关于母体对疫苗接种的炎症反应的数据尚缺乏，这将更好地描绘免疫接种的安全性和临床实用性。此外，出于研究目的，疫苗接种已被用作轻度免疫触发，以研究非孕妇成年人的体内炎症反应。这种模型在怀孕期间的应用尚不清楚。鉴于临床和经验依据，本研究检测了孕妇接种季节性流感病毒疫苗后炎症反应的幅度、时程和变异性。
在接种 TIV 前一天（n=15）和接种后一天（n=10）或大约一周（n=21）评估了女性。通过高灵敏度免疫测定法测定血清白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α、C 反应蛋白（CRP）和巨噬细胞移动抑制因子（MIF）。
接种后一天和两天，CRP 显著增加（ps<0.05）。TNF-α也出现了类似的影响，接种后两天的增加接近统计学意义（p=.06）。反应幅度的变化存在相当大的差异；接种后两天的变化系数从 122%到 728%不等，在此时间点 IL-6 反应的变异性最大。
三价流感病毒疫苗接种会在孕妇中引起可测量的炎症反应。反应的变异性足以检测与临床结果的关联。由于不良围产期健康结局（包括子痫前期和早产）具有炎症成分，对免疫触发的炎症反应倾向更大可能预示着不良结局的风险，为风险的生物学机制提供了见解。疫苗接种引起的炎症反应比感染性疾病引起的炎症反应要轻得多，且更短暂，这证明了疫苗接种的临床价值。然而，需要进一步的研究来确认疫苗接种引起的轻度炎症反应在怀孕期间是良性的。
