Maternal Immunization as a Strategy to Decrease Susceptibility to Infection in Newborn Infants

Benjamin Lindsey; Beate Kampmann; Christine Jones

Disclosures

Curr Opin Infect Dis. 2013;26(3):248-253. 

In This Article

New Maternal Vaccines

Other vaccines are recommended by the Advisory Committee on Immunization Practices during pregnancy if risk factors are present, a number of which could be considered for routine use in pregnancy, namely hepatitis A and B, meningococcal and pneumococcal polysaccharide vaccines.[30] Several other prospects for vaccines in the pipeline include vaccines against respiratory syncytial virus (RSV), group B Streptococcus (GBS) and cytomegalovirus (CMV). Here we focus on the most developed of these vaccines.

GBS predominately causes disease in infants less than 3 months of age.[42] GBS is a significant cause of infant infection and mortality globally. Currently, prevention of early onset infant GBS is possible with intra-partum prophylactic antibiotics; however, they have no impact on late onset disease, can have serious side effects such as anaphylaxis and are susceptible to development of antibiotic resistance.[43] A vaccine given during pregnancy would overcome these problems and further reduce the burden of GBS disease.[44]

Currently, there is no licensed GBS vaccine; however, several human clinical trials have shown that a polysaccharide-conjugate vaccine is well tolerated and immunogenic. The target for these vaccines is a capsular polysaccharide (CPS), of which there are 10 serotypes. Surface proteins that are present on all bacterial serotypes have been discovered and although vaccines to these antigens have been produced they have yet to enter clinical trials in humans.[44] Until these vaccines are developed further the most likely candidate for a vaccine would be a multivalent conjugate vaccine incorporating CPS serotypes Ia, Ib, II, III and V, which represent the majority of GBS disease, thereby preventing 85% of disease globally.[45]

To date, conjugate-CPS vaccine has been administered to pregnant women in only one published study. This double-blind randomized controlled trial showed that the GBS type III CPS-tetanus toxoid vaccine was immunogenic in the mothers with efficient trans-placental transfer of IgG and that significant infant antibody levels remained after 2 months.[46] A number of other studies are currently in progress.[47]

Although many more studies are needed to adequately evaluate the safety and effectiveness of maternal GBS vaccination, current evidence suggests that this could play an important role in preventing this serious infection in the future.

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