Linder N, Ohel G
Department of Pediatrics, Tel-Aviv University, Tel Hashomer, Israel.
Clin Perinatol. 1994 Sep;21(3):663-74.
It is estimated that 4 million children die each year of vaccine-preventable diseases and another 4 million are permanently disabled. Although vaccination is the most cost-effective health method, there is a discrepancy between our level of knowledge and practices applied. Vaccination of pregnant women provides the mother with antibodies that could be transferred across the placenta and provide the neonate with high antibody titers until active immunization is likely to be protective. The ability to provide such passive childhood immunization is beneficial and cost-effective, especially in developing countries where routine childhood immunization is not widely practiced. Further progress depends on the development of more efficient antigens, carrier proteins, and formulations of multiple-antigen vaccines. Further studies should determine the ideal timing for in utero vaccination to provide protective antibodies to the full-term infant and the premature infant. This ideally should be achieved without compromising the protective effect during the first months of life and without causing immune tolerance when given early in pregnancy. The future of in utero vaccination depends on continuing basic research, which should provide improved vaccines and clinical studies that demonstrate the safety and effectiveness of vaccination for both mothers and infants. Liability issues should be addressed and greater awareness of obstetricians, family physicians, and the general public should be achieved.
据估计，每年有400万儿童死于疫苗可预防的疾病，另有400万儿童永久致残。尽管接种疫苗是最具成本效益的保健方法，但我们的知识水平与实际应用之间存在差距。孕妇接种疫苗可使母亲获得抗体，这些抗体可通过胎盘传递，为新生儿提供高抗体滴度，直至主动免疫可能产生保护作用。提供这种被动儿童免疫的能力是有益且具有成本效益的，特别是在常规儿童免疫未广泛实施的发展中国家。进一步的进展取决于开发更有效的抗原、载体蛋白和多抗原疫苗制剂。进一步的研究应确定宫内接种疫苗的理想时机，以便为足月儿和早产儿提供保护性抗体。理想情况下，这应该在不影响生命最初几个月的保护效果且在妊娠早期接种时不引起免疫耐受的情况下实现。宫内接种疫苗的未来取决于持续的基础研究，该研究应提供改进的疫苗以及证明对母亲和婴儿接种疫苗的安全性和有效性的临床研究。应解决责任问题，并提高产科医生、家庭医生和公众的认识。
