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Maternal Influenza Vaccine Reduces the Risk of Respiratory Syncytial Virus and Related Respiratory Hospitalizations
Charlie Holland1,2, Huong Le1,2, Avram Levy3
1Wesfarmers Centre of Vaccines and Infectious Diseases, The Kids Research Institute Australia, The University of Western Australia, Perth, Western Australia,Australia.
Insights
Maternal inactivated influenza vaccine (IIV) significantly reduced respiratory syncytial virus (RSV) hospitalizations in infants when given in the first or second trimester. This finding supports improved infant immunization strategies.
Area of Science:
- Public Health
- Immunology
- Pediatrics
Background:
- Respiratory Syncytial Virus (RSV) is a leading cause of infant hospitalizations.
- Maternal inactivated influenza vaccine (IIV) may offer protection to infants against RSV.
- Western Australia provides a unique setting to study maternal IIV impact on infant RSV hospitalizations.
Purpose of the Study:
- To evaluate the effectiveness of maternal IIV in preventing RSV hospitalizations in infants under 6 months.
- To analyze the impact of IIV administration timing during pregnancy on infant RSV outcomes.
- To assess secondary outcomes such as pneumonia, bronchiolitis, and all-cause ARI hospitalizations.
Main Methods:
- Population-based cohort study utilizing linked longitudinal data from April 2012 to December 2021.
- Cox proportional hazards models with inverse probability treatment weighting were employed.
- Infant RSV-confirmed hospitalizations were the primary outcome, with adjustments for socio-demographic and perinatal factors.
Main Results:
- The study included 288,059 infants; 30.3% of mothers received IIV.
- Maternal IIV was associated with a 10% non-significant reduction in RSV hospitalizations overall.
- Administration in the first or second trimester showed significant reductions: 35% and 25% respectively.
Conclusions:
- Maternal IIV is most effective against RSV hospitalizations when administered in the first or second trimester.
- Non-specific vaccine effects warrant consideration in public health evaluations.
- Findings support enhanced maternal IIV policies to improve infant immunization and reduce RSV burden.
Background:
We examined the impact of maternal inactivated influenza vaccine (IIV) on respiratory syncytial virus (RSV) hospitalizations in Western Australian infants aged ≤6 months.
Methods:
We conducted a population-based cohort study of births from April 2012 to December 2020 using linked, longitudinal data on births, deaths, perinatal data, hospitalizations, antenatal immunization records, and respiratory pathogen laboratory testing, with follow-up to 31 December 2021. We performed Cox proportional hazards models with inverse probability treatment weighting. Mother's receipt of IIV was the exposure against the primary outcome, RSV-confirmed hospitalization in infants, adjusting for sociodemographic and perinatal factors and stratifying by vaccination trimester. Secondary outcomes included International Classification of Diseases-coded pneumonia, bronchiolitis, and all-cause acute respiratory infection hospitalizations.
Results:
The cohort comprised 288 059 infants. Overall, 87 277 mothers (30.3%) received a maternal IIV. There were 2707 RSV-confirmed hospitalizations in 2702 infants aged ≤6 months, the majority (69.7%) occurring in maternally unvaccinated infants. Exposure to maternal IIV was associated with an overall nonsignificant 10.0% reduction in RSV hospitalizations (weighted adjusted hazard ratio [aHR], 0.90 [95% confidence interval {CI}, .80-1.01]) compared with maternally unvaccinated infants. However, by trimester, maternal IIV was most effective when administered in first (weighted aHR, 0.65 [95% CI, .50-.85]) or second (weighted aHR, 0.75 [95% CI, .62-.90]) trimesters. Maternal IIV was associated with a 35.0% and 25.0% reduced risk against RSV hospitalizations when administered in the first or second trimester, respectively. Similar findings were observed for secondary outcomes.
Conclusions:
Nonspecific effects should be included in the full public health evaluation of maternal IIV. These findings are important for policymakers and community to improve immunization.
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