Intervention Review

Pneumococcal vaccination during pregnancy for preventing infant infection

  1. Surasith Chaithongwongwatthana1,*,
  2. Waralak Yamasmit2,
  3. Sompop Limpongsanurak1,
  4. Pisake Lumbiganon3,
  5. Joseph A DeSimone4,
  6. Jason K Baxter5,
  7. Jorge E Tolosa6

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 31 OCT 2005

DOI: 10.1002/14651858.CD004903.pub2

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Additional Information

How to Cite

Chaithongwongwatthana S, Yamasmit W, Limpongsanurak S, Lumbiganon P, DeSimone JA, Baxter JK, Tolosa JE. Pneumococcal vaccination during pregnancy for preventing infant infection. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004903. DOI: 10.1002/14651858.CD004903.pub2.

Author Information

  1. 1

    Chulalongkorn University, Department of Obstetrics and Gynecology, Bangkok, Thailand

  2. 2

    Bangkok Metropolitan Administration Medical College and Vajira Hospital, Department of Obstetrics and Gynaecology, Bangkok, Thailand

  3. 3

    Khon Kaen University, Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen, Thailand

  4. 4

    Thomas Jefferson University, Department of Medicine, Philadelphia, PA, USA

  5. 5

    Thomas Jefferson University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Philadelphia, Pennsylvania, USA

  6. 6

    Oregon Health and Sciences University, Department of Obstetrics and Gynecology, Portland, Oregon, USA

*Surasith Chaithongwongwatthana, Department of Obstetrics and Gynecology, Chulalongkorn University, Faculty of Medicine, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand. iamsurasith@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Each year at least one million children worldwide die of pneumococcal infections. The development of bacterial resistance to antimicrobials adds to the difficulty of treatment of diseases and emphasizes the need for a preventive approach. Newborn vaccination schedules could substantially reduce the impact of pneumococcal disease in immunized children, but does not have an effect on the morbidity and mortality of infants less than three months of age. Pneumococcal vaccination during pregnancy may be a way of preventing pneumococcal disease during the first months of life before the pneumococcal vaccine administered to the infant starts to produce protection.

Objectives

To assess the effect of pneumococcal vaccination during pregnancy for preventing infant infection.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to June 2004), EMBASE (January 1985 to June 2004), and reference lists of articles. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 6 July 2011 and added the results to the awaiting classification section.

Selection criteria

Randomized controlled trials in pregnant women comparing pneumococcal vaccine with placebo or doing nothing or with another vaccine to prevent infant infections.

Data collection and analysis

Two authors independently assessed methodological quality and extracted data using a data collection form. Study authors were contacted for additional information.

Main results

Three trials (280 participants) were included. There was no evidence that pneumococcal vaccination during pregnancy reduces the risk of neonatal infection (one trial, 149 pregnancies, relative risk (RR) 0.51; 95% confidence interval (CI) 0.18 to 1.41). Although the data suggest an effect in reducing pneumococcal colonisation in infants by 16 months of age (one trial, 56 pregnancies, RR 0.33; 95% CI 0.11 to 0.98), there was no evidence of this effect in infants at two months of age (RR 0.28; 95% CI 0.02 to 5.11) or by seven months of age (RR 0.32; 95% CI 0.08 to 1.29).

Authors' conclusions

There is insufficient evidence to support whether pneumococcal vaccination during pregnancy could reduce infant infections.

[Note: The eight citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pneumococcal vaccination during pregnancy for preventing infant infection

Not enough evidence to support the use of pneumococcal vaccination during pregnancy for preventing infant infections.

Although the incidence of invasive pneumococcal disease is variable across the world, mortality rate is high in children who get this infection. Newborn vaccination schedules could reduce the impact of pneumococcal disease in immunized children, but have no effect on the morbidity and mortality of infants less than three months of age. Maternal pneumococcal immunization during pregnancy may be a method of preventing pneumococcal disease during the infant's first months of life. The review of trials found there was not enough information to say whether pneumococcal vaccination during pregnancy led to fewer infant infections.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在懷孕期間針對預防嬰兒感染所施打的肺炎雙球菌疫苗

每一年，全球都有一百萬以上的孩童死於肺炎雙球菌感染。細菌對於抗微生物藥(antimicrobials)發展出抗藥性之後，增加了這些疾病在治療上的困難，並且強調了對於預防方式之需求的重要性。對新生兒安排注射疫苗，可以大大地降低肺炎雙球菌造成的疾病在已免疫的孩童身上之衝擊，但是對於小於3個月大的嬰兒來說，卻不能對死亡率與罹病率帶來什麼影響。在施打在嬰兒身上的肺炎雙球菌疫苗而開始產生保護作用之前，在生命的一開始幾個月，藉由在懷孕期間施打肺炎雙球菌疫苗，或許是一種預防肺炎雙球菌造成的疾病之方法。

目標

在懷孕期間針對預防嬰兒感染，要評估所施打的肺炎雙球菌疫苗之效力。

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group Trials Register(2004年六月)、CENTRAL(The Cochrane Library，Issu ，2004年)、MEDLINE(1966年一月到2004年六月)、EMBASE(J1985年一月到2004年六月)，以及這些文章的參考書目清單。

選擇標準

針對用來預防嬰兒感染，隨機的對照試驗在懷孕婦女身上，將肺炎雙球菌疫苗與安慰劑或是不採取任何行動，或是與其他種的疫苗進行比較。

資料收集與分析

有2位審回顧者獨立評估了方法的品質，並使用了1種資料收集的格式來擷取出資料。針對額外的資訊，我們還聯繫了研究的作者

主要結論

其中共包含了3組試驗(280位參與者)。並沒有證據顯示懷孕期間所使用的肺炎雙球菌疫苗能夠降低新生兒感染的風險(one trial, 149 pregnancies, relative risk (RR) 0.51; 95% confidence interval (CI) 0.18 to 1.41)。雖然這些資料顯示，在16個月大之前的嬰兒身上，具有降低肺炎雙球菌的效果(1個試驗, 56懷孕, RR 0.33; 95% I 0.11 to 0.98)，但是對於2個月大(RR 0.28; 95% CI 0.02 to 5.11)或是在7個月大之前(RR 0.32; 95% CI 0.08 to 1.29)的嬰兒身上，並沒有足夠的證據可以證實這項效果。

作者結論

關於在懷孕期間所使用的肺炎雙球菌疫苗是否可以降低嬰兒感染的狀況，並沒有充分的證據可以證實。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據可以支持在懷孕期間使用肺炎雙球菌疫苗來預防嬰兒感染。雖然在這個世界上，發生侵犯性之肺炎雙球菌疾病的發生率都不相同，但是在感染到此種疾病的孩童身上，死亡率卻是很高的。新生兒接受安排注射疫苗，可以在免疫的孩童身上降低肺炎型疾病的影響，但是對於年紀小於3個月大的嬰兒來說，在罹病率與死亡率方面並沒有影響。在懷孕期間，讓母體對於肺炎產生免疫，對於嬰兒最初幾個月的生命來說，或許是一種預防肺炎型疾病的方法。本篇試驗的回顧發現，並沒有足夠的證據可以宣稱，在懷孕期間所施打的肺炎疫苗，是否可以造就較少的嬰兒感染情況。

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