Kachikis Alisa, Eckert Linda O, Englund Janet
1 Department of Obstetrics and Gynecology, University of Washington , Seattle, Washington.
2 Department of Global Health, University of Washington , Seattle, Washington.
Viral Immunol. 2018 Mar;31(2):184-194. doi: 10.1089/vim.2017.0135. Epub 2018 Feb 23.
Maternal immunization for prevention of morbidity and mortality of pregnant women and their neonates due to infectious diseases is ongoing worldwide. The complexity of vaccine research and development in this population is challenging. Not only do vaccines for pregnant women require evidence of immunogenicity, potency, stability, and limited reactogenicity, they must also provide efficacy in decreasing morbidity for the pregnant woman, her fetus, and the neonate, demonstrate safety or lack of evidence of harm, and offer benefit or potential benefit of vaccination during pregnancy. Since the 19th century, evidence of protective effects of vaccination during pregnancy has been documented. Pandemic influenza and pertussis outbreaks in recent years have affected a paradigm shift in vaccine research and development as well as current policy regarding immunization in pregnancy. Studies of the immune system in pregnant women and neonates have shown that immune changes associated with pregnancy in women do not interfere with maternal vaccine responses, multiple factors are important in transplacental transfer of antibodies, and maternal antibodies are beneficial to neonates. In recent years, guidelines have been developed by expert panels to help design studies for maternal vaccinations and for harmonization of data collection, analysis, and adverse event reporting. Further research into maternal and neonatal immunology, transplacental antibody transfer, and epidemiology of diseases is needed, especially as new vaccines to respiratory syncytial virus, cytomegalovirus, and Group B streptococcus are developed. Maternal vaccinations have the potential to change the epidemiology of infectious diseases in reproductive health and pediatrics and may lead to new clinical applications to improve global maternal and neonatal health.
全球范围内正在进行孕产妇免疫接种，以预防孕妇及其新生儿因传染病而发病和死亡。该人群疫苗研发的复杂性具有挑战性。孕妇用疫苗不仅需要具备免疫原性、效力、稳定性和有限反应原性的证据，还必须在降低孕妇、其胎儿和新生儿发病率方面具有疗效，证明安全性或无危害证据，并显示孕期接种疫苗的益处或潜在益处。自19世纪以来，孕期接种疫苗的保护作用已有文献记载。近年来的大流行性流感和百日咳疫情影响了疫苗研发以及当前关于孕期免疫接种政策的范式转变。对孕妇和新生儿免疫系统的研究表明，与女性孕期相关的免疫变化不会干扰母体疫苗反应，多种因素在抗体经胎盘转移中很重要，且母体抗体对新生儿有益。近年来，专家小组制定了指南，以帮助设计孕产妇疫苗接种研究，并统一数据收集、分析和不良事件报告。需要进一步研究孕产妇和新生儿免疫学、经胎盘抗体转移以及疾病流行病学，特别是在研发针对呼吸道合胞病毒、巨细胞病毒和B族链球菌的新疫苗时。孕产妇疫苗接种有可能改变生殖健康和儿科学中传染病的流行病学，并可能带来新的临床应用，以改善全球孕产妇和新生儿健康。
