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Pneumococcal vaccination during pregnancy for preventing infant infection

  • Review
  • Intervention




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.


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 (31 December 2011) and reference lists of retrieved studies.

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 review authors independently assessed trials for inclusion, methodological quality and extracted data using a data collection form. Data were checked for accuracy. We contacted study authors for additional information.

Main results

Seven trials were included, but only five trials (579 participants) contributed data. There was no evidence that pneumococcal vaccination during pregnancy reduces the risk of neonatal infection (risk ratio (RR) 0.66; 95% confidence interval (CI) 0.30 to 1.46; two trials, 241 pregnancies). Although the data suggest an effect in reducing pneumococcal colonization in infants by 16 months of age (RR 0.33; 95% CI 0.11 to 0.98; one trial, 56 pregnancies), there was no evidence of this effect in infants at two to three months of age (RR 1.13; 95% CI 0.46 to 2.78; two trials, 146 pregnancies) or by six to seven months of age (RR 0.66; 95% CI 0.20 to 2.17; two trials, 144 pregnancies). No significant difference for tenderness at the injection site between women who received pneumococcal vaccine and those who received control vaccine (RR 3.20; 95% CI 0.32 to 31.54; two trials, 130 women).

Authors' conclusions

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








Cochrane Pregnancy and Childbirth Group's Trials Register(2011年12月31日)および回収した研究の文献リストを検索した。






7件の試験を選択したが、データに寄与したのは5件のみ(参加者579名)であった。妊娠中肺炎球菌ワクチン接種が新生児感染リスクを低下するというエビデンスはなかった[リスク比(RR)0.66、95%信頼区間(CI)0.30~1.46、2試験、妊婦241名]。データによると16ヵ月齢までの乳児での肺炎球菌定着を減少させる効果が示唆された(RR 0.33、95%CI 0.11~0.98、1試験、妊婦56名)。しかし、2~3ヵ月齢の乳児(RR 1.13、95%CI 0.46~2.78、2試験、妊婦146名)および6~7ヵ月齢の乳児(RR 0.66、95%CI 0.20~2.17、2試験、妊婦144名)ではこの効果のエビデンスはなかった。肺炎球菌ワクチン接種女性とコントロールのワクチン接種女性とに注射部位圧痛について有意差はなかった(RR 3.20、95%CI 0.32~31.54、2試験、女性130名)。



Plain language summary

Pneumococcal vaccination during pregnancy for preventing infant infection

There is not enough evidence to assess whether using pneumococcal vaccination during pregnancy can prevent infant infections.

Although the incidence of invasive pneumococcal disease is variable across the world, the rate of serious illness or death is high in children who get this infection. The Streptococcus pneumoniae (pneumococcus) organism colonizes the upper respiratory tract and can cause bacteremia, meningitis, pneumonia and other lower respiratory tract infections, and upper respiratory tract infections, including otitis media and sinusitis. Newborn vaccination schedules of three doses at two, four and six months of age with a booster dose recommended at 12 to 15 months of age could reduce the impact of pneumococcal disease in immunized children, but have no protective effect in infants less than three months of age. Maternal pneumococcal immunization during pregnancy may be a way of preventing pneumococcal disease during the infant's first months of life. We included seven randomized controlled trials. A total of 579 pregnant women participated in the five randomized controlled trials that contributed data to this review. They compared 23-valent pneumococcal polysaccharide vaccine with control vaccine. All women received a single injection of pneumococcal or control vaccine (where used). The women’s mean gestational age at the time of immunization was between 27 and 38 weeks, where stated. Only two trials with 241 pregnancies reported on neonatal infections. This was not enough information to say whether pneumococcal vaccination during pregnancy led to fewer infant infections. Two trials with 146 pregnancies reported on infant nasal carriage of pneumococci (pneumococcal colonization), which was not enough evidence to show an effect in reducing colonization at two to three months of age or six to seven months of age. The included trials were of reasonable quality. Women tended to have increased tenderness after being injected with pneumococcal vaccine, lasting only a few days after injection and no serious adverse events were reported in the trials.



妊娠中肺炎球菌ワクチン接種により新生児感染を予防できるか評価するエビデンスは不十分である。 侵襲的肺炎球菌疾患の罹患率は世界で異なっているが、この感染にかかった小児での重症率や死亡率は高い。肺炎球菌は上気道に定着し菌血症、髄膜炎、肺炎や他の下気道感染、及び中耳炎や副鼻腔炎などの上気道感染を起こしうる。2、4、6ヵ月時の3回の接種と12~15ヵ月時推奨の1回の追加接種による出生児ワクチン接種スケジュールにより、接種小児での肺炎球菌疾患の影響を低下させたが、3ヵ月未満の乳児での予防効果はない。妊娠中の母親への肺炎球菌ワクチン接種は、生後すぐの数ヵ月中の肺炎球菌疾患を予防する方法となる可能性がある。7件のRCTを選択した。本レビューのデータに寄与したのは5件のRCTでの計579名の妊婦であった。23価肺炎球菌多糖ワクチンをコントロールのワクチンと比較していた。全女性は肺炎球菌ワクチンまたはコントロールのワクチンの(使用した場合は)単回接種を受けていた。記述があった場合、接種の平均時期は妊娠27~38週であった。新生児感染について報告していたのは、妊娠241件の2件の試験のみであった。これは、妊娠中の肺炎球菌ワクチン接種が新生児感染を減少させると言うには不十分な情報であった。妊娠146件の2つの試験では、乳児の鼻腔内肺炎球菌保有(肺炎球菌定着)について報告していたが、2~3ヵ月齢または6~7ヵ月齢での定着を減少させる効果を示すエビデンスは不十分であった。選択した試験の質は妥当であった。肺炎球菌ワクチン接種後の方が圧痛を感じる傾向があったが注射後数日間続くのみであり、当該試験で重篤な有害事象の報告はなかった。


監  訳: 江藤 宏美,2012.11.14

実施組織: 厚生労働省委託事業によりMindsが実施した。

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