Safety of pertussis vaccination in pregnant women in UK: observational study

July 31, 2014

Source: British Medical Journal 2014; 349:g4219

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Date of publication: July 2014

Publication Type: Journal Article

In a nutshell:  Objective To examine the safety of pertussis vaccination in pregnancy. Design Observational cohort study. Setting The UK Clinical Practice Research Datalink. Participants 20 074 pregnant women with a median age of 30 who received the pertussis vaccine and a matched historical unvaccinated control group. Main outcome measure Adverse events identified from clinical diagnoses during pregnancy, with additional data from the matched child record identified through mother-child linkage. The primary event of interest was stillbirth (intrauterine death after 24 weeks’ gestation). Results There was no evidence of an increased risk of stillbirth in the 14 days immediately after vaccination (incidence rate ratio 0.69, 95% confidence interval 0.23 to 1.62) or later in pregnancy (0.85, 0.44 to 1.61) compared with historical national rates. Compared with a matched historical cohort of unvaccinated pregnant women, there was no evidence that vaccination accelerated the time to delivery (hazard ratio 1.00, 0.97 to 1.02). Furthermore, there was no evidence of an increased risk of stillbirth, maternal or neonatal death, pre-eclampsia or eclampsia, haemorrhage, fetal distress, uterine rupture, placenta or vasa praevia, caesarean delivery, low birth weight, or neonatal renal failure, all serious events that can occur naturally in pregnancy. Conclusion In women given pertussis vaccination in the third trimester, there is no evidence of an increased risk of any of an extensive predefined list of adverse events related to pregnancy. In particular, there was no evidence of an increased risk of stillbirth. Given the recent increases in the rate of pertussis infection and morbidity and mortality in neonates, these early data provide initial evidence for evaluating the safety of the vaccine in pregnancy for health professionals and the public and can help to inform vaccination policy making.

Length of publication: 6-page article

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Severe vaccine complications are rare, review finds

July 31, 2014

Source: British Medical Journal 2014; 349:g4411

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Date of publication: July 2014

Publication Type: News Item

In a nutshell:  Although some childhood vaccines are associated with severe adverse events, these complications are “extremely” rare, according to a new systematic review.1 The review, which updates and adds to the 2011 Institute of Medicine (IOM) report entitled Adverse Effects of Vaccines: Evidence and Causality, was commissioned by the US Agency for Healthcare Research and Quality to identify gaps in evidence on the safety of vaccines.2 The review focused on vaccines recommended for routine use in the US for children aged 6 years and younger: DTaP (diphtheria, tetanus, and acellular pertussis); hepatitis A; hepatitis B, haemophilus influenza type b (Hib); influenza (live attenuated and inactivated); meningococcal (conjugate or polysaccharide); measles, mumps, and rubella (MMR); pneumococcal (conjugate or polysaccharide); rotavirus; and varicella. The study excluded studies of vaccine formulations never used or no longer available in the US, such as whole cell pertussis vaccine, oral polio vaccine, and pneumococcal conjugate vaccine 7 vaccine.

Length of publication: 1-page news story


Child flu vaccine pilots announced for second year

July 30, 2014

Source: GOV.UK

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Date of publication: July 2014

Publication Type: News Item

In a nutshell: More than 700,000 healthy school-aged children across England are to be offered a free flu vaccination for the winter, as the successful child flu vaccine pilot programme launched in 2013 by Public Health England (PHE) enters the second year.

Length of publication: 1-page news story


Vaccinate boys as well as girls against HPV: it works, and it may be cost effective

July 30, 2014

Source: British Medical Journal  2014; 349:g4834

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Date of publication: July 2014

Publication Type: Comment

In a nutshell: Protecting boys as well as girls by vaccinating against human papillomavirus may cut the incidence of genital warts and several cancers among both sexes, writes Gillian Prue. Human papillomavirus (HPV) infection is common in men. Many of these infections are transient and clinically insignificant, but persistent infection with HPV types 6 and 11 can lead to genital warts, and oncogenic types 16 and 18 may lead to some head and neck, anal, or penile cancers. The incidence of each of these cancers has increased worldwide in the past two decades, and HPV causes 5% of all human cancers. Since September 2008 a free vaccination programme has been available for 12-13 year old girls in the United Kingdom, with a catch-up programme to vaccinate girls aged up to 18. Australia, the United States, two Canadian provinces, and Austria have introduced vaccination for boys as well as girls. And now the UK’s Joint Committee on Vaccination and Immunisation, an advisory committee of the Department of Health, is investigating whether to extend the HPV vaccination programme to boys (see http://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation). The cost effectiveness of the vaccine is a key consideration.

Length of publication: 2-page article


HPV vaccination

July 30, 2014

Source: British Medical Journal   2014; 349:g4783

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Date of publication: July 2014

Publication Type: Editorial

In a nutshell: A year ago an editorial in The BMJ highlighted the limitations of HPV vaccination in the UK1 and called for decisive action to maximise the public health benefits by thinking about vaccinating boys and some men. Similarly, a recent review by Stanley concluded, after consideration of cost effectiveness, that “failure to implement male vaccination looks like a missed public health opportunity.”2 We therefore share the disappointment expressed by the Royal College of Surgeons’ cancer services committee about the lack of response to its concerns about the inequity of vaccinating only girls against HPV in the UK.3

Length of publication: 2-page article


Preventing pertussis

July 30, 2014

Source: British Medical Journal

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Date of publication: July 2014

Publication Type: Editorial

In a nutshell: Pertussis (whooping cough) continues to be a major cause of morbidity and mortality throughout the world and is one of the leading causes of deaths from vaccine preventable diseases. In recent years, large outbreaks of pertussis have been reported in many developed countries, despite widespread use of vaccines.1 2 The United Kingdom is no exception.3 Two linked papers examine issues surrounding pertussis vaccination in the UK.4 5 Wang and colleagues (doi:10.1136/bmj.g3668) looked at children aged 5-15 with persistent cough identified in 22 general practices in the Thames Valley from November 2010 to December 2012. At least 20% had evidence of recent infection with Bordetella pertussis, based on raised concentrations of specific IgG antibodies in saliva.4Moreover, among these children with persistent cough (which in many cases was severe), the risk of pertussis was more than four times higher in children who had received the preschool pertussis vaccine booster dose seven years or more earlier compared with those who had received the booster more recently. Donegan and colleagues (doi:10.1136/bmj.g4219) report results from 20 074 pregnant women who had received the combined low dose diphtheria, acellular pertussis, and inactivated poliovirus vaccine during the first six months after the campaign to immunize pregnant women against pertussis was introduced in October 2012.5 They found no discernible increase in the risk of serious adverse events such as stillbirth, eclampsia, low birth weight, or death of the mother or the baby.

Length of publication: 2-page article


Determinants of uptake of influenza vaccination among pregnant women – A systematic review

July 30, 2014

Source: Vaccine DOI: 10.1016/j.vaccine.2014.06.067

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Date of publication: July 2014

Publication Type: Journal Article

In a nutshell:  Background Pregnant women have the highest priority for seasonal influenza vaccine. However, suboptimal coverage has been repeatedly noted in this population. To improve vaccine uptake, reviewing the determinants of vaccination is of increasing importance. Methods A detailed literature search was performed up to November 30, 2013 to retrieve articles related to uptake of influenza vaccination during pregnancy. Results Forty-five research papers were included in the review. Twenty-one studies assessed the coverage of seasonal influenza vaccination, 13 studies assessed coverage of A/H1N1 pandemic vaccination and 11 studies assessed both. Vaccination uptake ranged from 1.7% to 88.4% for seasonal influenza, and from 6.2% to 85.7% for A/H1N1 pandemic influenza. Many pregnant women were unaware that they were at high risk for influenza and its complications during pregnancy. They were also more likely to underestimate the threat of influenza to themselves and their fetus. Moreover, they had substantial concerns about the safety and efficacy of the influenza vaccine during pregnancy. Negative media reports contributed to the perception that influenza vaccination during pregnancy was risky and could result in adverse pregnancy outcomes. Although health care providers’ (HCPs) recommendations were consistently associated with vaccine uptake, most did not recommend the vaccine to their pregnant clients. Conclusions Influenza vaccination uptake among pregnant women is suboptimal and HCPs rarely recommend it. Positive vaccination recommendations from HCPs as well as direct access to the vaccine would likely substantially improve vaccination acceptance.

Length of publication: 12 page article