Journal of Infectious Diseases
Volume 204 Issue 8 October 15, 2011
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Broadening Indications for Maternal Influenza Vaccination
W. Paul Glezen

[Extract: full text here: http://jid.oxfordjournals.org/content/204/8/1151.full ]
The primary indication for influenza vaccination of pregnant women is to decrease the risk of serious complications during pregnancy [ 1]. The case fatality rates for pregnant women during the influenza pandemics of 1918 and 1957 ranged from 20% to 50% in various reports [ 2]. As a consequence, pregnancy—with or without comorbidities—was considered a high-risk condition by the Surgeon General’s Advisory Committee. A large collaborative perinatal project sponsored by the National Institute for Neurological and Communicative Disorders and Stroke from 1959 to 1965 enrolled over 50 000 pregnant women and their offspring who were intensively followed for all events prior to and after delivery found that influenza vaccine administered to 2291 women during pregnancy had no untoward effects [ 3, 4]. From this study, it can be estimated that about 2 million women received influenza vaccine during pregnancy between 1959 and 1965. Despite the evidence of safety, influenza vaccine was no longer recommended for pregnant women without chronic underlying conditions after 1966 because “influenza-associated excess mortality among pregnant women has not been documented except in the pandemics…” [ 5]. Reports of influenza-related deaths continued to occur, and the sensitivity of the data derived from death certificates was questioned [ 6, 7]. In the early 1990s, investigators looked at risk of influenza-associated hospitalizations during pregnancy and found significant excess occurrence of pneumonia that increased as the pregnancy progressed. This led to reconsideration of the indication for …