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NVAC Maternal Immunization Working Group Charge

Preamble

The U.S. 2010 National Vaccine Plan (NVP) indicates the need to develop new and improved vaccines (Goal 1) and specifies the need to advance the science of neonatal and maternal immunity including immunization and the development of immunological models to study maternal immunization and effects on offspring(section 1.2.3). The NVP recommends supporting communications to enhance informed vaccine decision-making (Goal 3) and states that the U.S. should ensure access to, and better use of recommended vaccines in the United States (Goal 4). The NVP highlights the need to address disparities in vaccination rates among racial and ethnic minorities (section 4.2.2) and to educate and support health care providers in vaccination counseling and vaccine delivery for their patients and themselves (section 4.6). Healthy People 2020 objectives include reducing incidence of preventable infectious diseases with the goal of a 10% improvement in (reduction of) pertusiss cases in children under the age of one.1

Pregnant women are at increased risk of complications from some vaccine preventable diseases such as influenza which could be prevented through vaccination.2,3  In addition there are other serious infectious diseases that can impact young infants before they can be actively immunized and for whom maternal vaccination may be protective. For instance, following recent outbreaks of pertusiss which have resulted in infant deaths, in 2011 the Advisory Committee on Immunization Practices recommended Tdap for pregnant women during late pregnancy to protect infants through placental transfer of antibodies.4  Despite both influenza and pertussis immunizations being recommended during late pregnancy, vaccine coverage remains unacceptably low. Alarmingly, recent outbreaks of pertussis have affected Hispanic infants disproportionately.

There is a need to further bring prenatal care into the culture of immunization and prevention in order to achieve goals outlined in the NVP and Healthy People 2020, reduce socio-economic disparities, reduce morbidity and mortality, and encourage development of new vaccines, essentially establishing a national platform for maternal immunization. Monitoring the impact of maternal immunization on prevention of morbidity and mortality in both the mother and her infant is also important. There is also a need to assure vaccine safety systems are adequate to detect any causally related adverse events either in the newborn or the pregnant women.

Charge

The Assistant Secretary for Health charges the National Vaccine Advisory Committee (NVAC) to review the current state of maternal immunizations and existing best practices. The working group should first identify programmatic barriers to implementation of current recommendations regarding maternal immunization and make recommendations for overcoming these barriers. Efforts to identify barriers to and opportunities for developing vaccines for pregnant women should then be identified as well as ways to overcome these barriers and leveraging the opportunities. The working group should complete its work and make its final report to NVAC by the June 2013 meeting. This report should provide recommendations to the Assistant Secretary of Health on how to implement the recommendations.

Votes

14 in favor of accepting the charge and formation of the Working Group; one NVAC member was absent. Charge was approved by NVAC on 5 June 2012.

 

§Immunization of pregnant and post-partum women

  1. Health People 2020 Topics and Objectives. Department of Health and Human Services. 2010.
  2. Zaman K, Roy E, Arifeen SE, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med. Oct 9 2008;359(15):1555-1564.
  3. Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. Apr 21 2010;303(15):1517-1525.
  4. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months --- Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. Oct 21 2011;60(41):1424-1426.