懷孕期間注射流感疫苗對新生兒有保護力


  【24drs.com】根據6月號美國婦產科期刊(American Journal of Obstetrics & Gynecology)上一篇人口基礎監控研究結果,懷孕期間注射流感疫苗對新生兒有保護力。
  
  Wake Forest Baptist醫學中心小兒科副教授Katherine A. Poehling醫師在新聞稿中表示,一般建議所有孕婦在懷孕期間接種流感疫苗,因為孕婦在懷孕期間、或產後立即感染流感的發病率和死亡率增加,我們也知道,孕婦可將抗體透過胎盤傳給胎兒;這篇研究顯示,懷孕期間接種流感疫苗不只可保護母親,也可保護新生兒。
  
  研究目標是評估母親懷孕期間接種疫苗和6個月以下新生兒確認因流感住院之風險間的關聯,在2002至2009年的11月至4月流感季節之間,新疫苗監測網絡在美國3個城市進行了主動式人口基礎實驗室確認流感監測,對象是因發燒和/或呼吸道症狀住院的孩童。
  
  採用邏輯回歸分析比較懷孕期間接種流感疫苗之助益、以及住院嬰兒流感檢測陽性/陰性的結果。
  
  住院的1,510名6個月以下新生兒中,有151人(10%)經實驗室確認為流感;住院嬰兒的母親中,共有294人(19%)表示在懷孕期間有接種流感疫苗,包括了流感陽性嬰兒的18名母親(12%)以及流感陰性嬰兒的276名母親(20%;未校正勝算比[OR]為0.53;95%信心區間[CI]為0.32 - 0.88;校正OR為0.52;95% CI為0.30 - 0.91);和未接種疫苗之母親的嬰兒相比,有接種疫苗之母親的嬰兒因流感住院的比率少了45%-48%。
  
  研究作者寫道,我們的結果支持目前孕婦接種流感疫苗的建議,因為6個月以下的新生兒住院率是最高的,而這個年齡層又不能施打流感疫苗,這些資料可以佐證,接種疫苗的母親所生的嬰兒因為透過母親獲得抗體而獲得幫助。
  
  研究限制包括,違反協議導致排除一些符合條件的嬰幼兒、缺乏流感疫苗狀態和母親流感等資料、缺乏母親或嬰兒的血清分析、不知道是否可推論到門診病患。
  
  Poehling醫師表示,其他研究有類似的結果,但是發表在一般期刊或小兒科與感染症期刊,發表的資料實際上和我們有所差別,除了小兒科醫師必須瞭解、更重要的是照顧孕婦的婦產科(OB/GYNs)醫師們也要知道;小兒科醫師已經為孩童施打疫苗很久的時間了,但是,婦產科施打疫苗在近十年來有所改變,所以每個人必須瞭解新建議並調整,這對於婦產科醫師而言是嶄新的任務。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6565&x_classno=0&x_chkdelpoint=Y
  

Influenza Vaccination During Pregnancy May Protect Newborns

By Laurie Barclay, MD
Medscape Medical News

July 1, 2011 — Influenza vaccination during pregnancy may protect newborns, according to the results of a population-based surveillance study published in a supplement to the June issue of the American Journal of Obstetrics & Gynecology.

"It is recommended that all pregnant women receive the influenza vaccine during pregnancy because it is known that pregnant women have increased morbidity and mortality during pregnancy and in the immediate postpartum period if they get the flu," lead author Katherine A. Poehling, MD, MPH, an associate professor of pediatrics at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, said in a news release. "We also know that mothers pass antibodies through the placenta to the baby. This study showed us that receiving the influenza vaccine during pregnancy not only protects the mother, but also protects the baby in the early months of life."

The study goal was to evaluate the association of maternal vaccination during pregnancy with risk for laboratory-confirmed influenza hospitalizations in infants younger than 6 months. During the 2002 through 2009 influenza seasons, from November through April, the New Vaccine Surveillance Network conducted active population-based, laboratory-confirmed influenza surveillance in 3 US counties among children hospitalized for fever and/or respiratory symptoms.

Logistic regression analyses allowed comparison of the exposure of interest (influenza vaccination during pregnancy) and the outcome (positive/negative influenza testing among hospitalized infants).

Laboratory-confirmed influenza was present in 151 (10%) of 1510 hospitalized infants younger than 6 months. Among mothers of the hospitalized infants, a total of 294 (19%) reported being vaccinated against influenza during pregnancy, including 18 mothers of influenza-positive infants (12%) and 276 mothers of influenza-negative infants (20%; unadjusted odds ratio [OR], 0.53; 95% confidence interval [CI], 0.32 - 0.88; and adjusted OR, 0.52; 95% CI, 0.30 - 0.91). Compared with infants of unvaccinated mothers, infants of vaccinated mothers were 45% to 48% less likely to have influenza hospitalizations.

"Our results support the current influenza vaccination recommendation for pregnant women," the study authors write. "Given that infants <6 months of age have the highest hospitalization rate among all children and that the vaccine is not licensed for that age group, these data support that infants born to vaccinated mothers benefit from the transfer of maternally derived antibodies."

Limitations of this study include protocol violations leading to the exclusion of some eligible infants, lack of confirmation of influenza vaccination status and documented influenza disease status from mothers, lack of serologic assays on infants or mothers, and unknown generalizability to outpatient settings.

"Similar findings have been published from other studies, but they've been published in general journals or journals about pediatrics and infectious diseases," Dr. Poehling said. "Where the information is published really does make a difference because pediatricians need to know about it, but it's even more important that the doctors taking care of pregnant women — obstetricians and gynecologists (OB/GYNs) — know it, too. Pediatricians have been vaccinating children for a long time, but vaccine recommendations for OB/GYNs have changed over the last decade, so everyone is having to learn new recommendations and adjust. This is a relatively new activity for OB/GYNs."

The Centers for Disease Control and Prevention supported this study. Some of the study authors report various financial relationships with the National Institute of Allergy and Infectious Diseases, Wachovia Research Fund, Medimmune, Wyeth, Novartis, Sanofi-Pasteur, CSL, and/or NexBio.

Am J Obstet Gynecol. 2011:S141-S148.

    
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