Vaccine
Volume 33, Issue 47, Pages 6371-6502 (25 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/46

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Advancing Maternal Immunization Programs through Research in Low and Medium Income Countries
Edited by M. Nesin, J. Read, M. Koso-Thomas, M. Brewinski Isaacs and A. Sobanjo-ter Meulen
[23 articles focused to the maternal immunization issue theme]

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Maternal Immunization: Current status and future prospects
Editorial
Page 6371
Mirjana Nesin, Jennifer Read, Marion Koso-Thomas, Maggie Brewinski Isaacs, Ajoke Sobanjo-ter Meulen
Overwhelming evidence demonstrates the benefits of vaccines to individuals (both children and adults) and to the public, primarily via herd immunity. The Global Vaccine Action Plan (GVAP), approved by the World Health Assembly in 2012, strives to ‘provide full benefits of vaccination to all people’, while Millennium Development Goals 4 and 5 work toward reduced child mortality and improved maternal health. Immunizing mothers during pregnancy (MI) against vaccine-preventable diseases has the potential to improve health outcomes in both mothers and their infants and to meet GVAP and Millennium Goals. MI may emerge as a key strategy to address neonatal mortality in particular, which accounts for almost half of all under five deaths globally.

Aside from the success of the Maternal and Neonatal Tetanus Elimination (MNTE) program, population data are now available for other successful MI programs, for example, in Argentina (described in this issue), and in the United Kingdom [1]. These programs have demonstrated the feasibility and effectiveness of MI programs in high, medium and low income counties. No safety signals related to the vaccines administered as part of these programs were observed.

An increasing amount of data regarding the efficacy and immunogenicity of MI in both mothers and their infants are becoming available. For example, studies have demonstrated the efficacy of influenza vaccines in protecting pregnant women and their infants, and the safety and effectiveness of maternal Tdap vaccination has been demonstrated in a large population of pregnant women [1], [2] and [3]. There is the potential for the results of ongoing trials of new RSV and GBS vaccines to contribute to the basis of licensure for a MI indication. An enabling regulatory and policy environment would facilitate introduction of new, and expanding indications of licensed, vaccines to include pregnant women.

However, major knowledge gaps and implementation challenges remain. They are related to the lack of descriptive epidemiologic data, especially in low and medium income countries (LMICs); the lack of harmonized definitions across studies, allowing meta-analyses and improved pharmacovigilance across studies and reporting systems; better understanding of infrastructure and experience with conducting clinical trials in LMICs settings; lack of integrated approaches to antenatal care, etc. The manuscripts included in this issue attempt to address some of these challenges: several studies describe the epidemiology of vaccine-preventable diseases (Polack et al., Halasa et al., Searle et al.); address harmonization of terms and definitions (Munoz et al.; Fulton et al.); provide perspective by researchers in LICs (Laufer et al., Cutland et al.); and describe regulatory (Gruber) and ethical (White and Madhi) aspects of MI.

Strong partnerships among a diverse set of institutions and geographies are needed to overcome knowledge gaps, implement studies, develop polices, and evaluate the efficacy and effectiveness of MI. A conference organized by NIH and BMGF in 2014 was a collaborative effort that brought together key global experts and stakeholders. Some authors of the manuscripts in this issue were presenters at the conference. The objectives of the conference and this special issue of Vaccine are to address knowledge gaps and identify approaches to move this important field forward worldwide.

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Maternal immunization – Promises and concerns
Pages 6372-6373
Janet A. Englund
Abstract
In this issue of Vaccine, the maternal immunization platform as an approach to protect mothers and infants against diverse pathogens is presented. Potential vaccine targets and the safety, science, trial designs, ethical considerations, and international perspectives focusing on low and middle income countries (LMIC) are discussed. This information provides a timely update because maternal immunization is increasingly being considered as an intervention to prevent maternal and/or neonatal disease. Prioritization of vaccine targets for maternal immunization by researchers, public health officials and health care workers needs to begin now.