Pneumococcal Vaccination of Pregnant Women Does Not Prevent Infant Infection

Current evidence does not support administering pneumococcal vaccination to women who are pregnant to prevent infection in their newborns, finds a systematic review.¹

Invasive pneumococcal infection, such as that caused by Streptococcus pneumoniae, can cause pneumonia, meningitis, and bacteremia in young children, and is responsible for at least 1 million deaths in children worldwide.¹ The recommended pneumococcal vaccination schedule for infants is 4 doses of 13-valent pneumococcal conjugate vaccine given at 2, 4, 6, and 12 to 15 months of age; this vaccine covers 13 strains of pneumococci that cause between 80% and 90% of all cases of invasive pneumococcal infections in the United States.² However, this schedule offers no protection for infants younger than 3 months. It has been suggested that pneumococcal vaccination during pregnancy may be a way to confer some protection against pneumococcal infection during the first months of life before the protective effects of the pneumococcal vaccine given at 2 months begin.¹

To assess whether pneumococcal vaccination during pregnancy protects against infant infection, researchers identified 7 randomized controlled trials in pregnant women comparing pneumococcal vaccine with placebo or doing nothing or with another vaccine to prevent infant infections. Five of these trials, which included a total of 579 participants, contributed usable data for meta-analysis.

All 5 trials compared 23-valent pneumococcal polysaccharide vaccine, which is indicated for adults and children older than 2 years, with a control vaccine. (The 23-valent vaccine cannot be used in children younger than 2 years because it fails to activate an immune response.) In each trial, a single injection of either the pneumococcal vaccine or the control vaccine was given at a mean gestational age of 27 to 38 weeks.¹

The researchers determined that pneumococcal vaccination during pregnancy does not reduce the risk of neonatal infection. Some evidence suggested that pneumococcal vaccination during pregnancy may be associated with a reduction in pneumococcal colonization in infants by age 16 months, but there was no evidence of this reduction at 2 to 3 months of age or at 6 to 7 months of age when data on infant nasal carriage of pneumococci was analyzed. Based on these findings, the authors’ concluded that there is insufficient evidence to evaluate whether pneumococcal vaccination during pregnancy has any affect on reducing pneumococcal infections in infants.

Pertinent Point:
- The available evidence evaluating whether maternal pneumococcal immunization during pregnancy can prevent pneumococcal infections in an infant’s first 3 months of life is insufficient to draw any conclusions about the protective effects of pneumococcal vaccination during pregnancy.
 

References:

1. Chaithongwongwatthana S, Yamasmit W, Limpongsanurak S, et al. Pneumococcal vaccination during pregnancy for preventing infant infection. Cochrane Database System Rev. 2012;7:CD004903. DOI: 10.1002/14651858.CD004903.pub3.
2. Department of Health and Human Services, Centers for Disease Control and Prevention. Prevention of Pneumococcal Disease Among Infants and Children-Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide VaccineRecommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. December 10, 2010;59(RR-11):1-18.