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Influenza Other Respir Viruses. 2019 Sep;13(5):438-452. doi: 10.1111/irv.12649. Epub 2019 Jun 5.

Optimal timing of influenza vaccine during pregnancy: A systematic review and meta-analysis.

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Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.
Victorian Infectious Diseases Reference Laboratory, Epidemiology Unit, Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Computing and Information Systems, Melbourne School of Engineering, The University of Melbourne, Melbourne, Victoria, Australia.
Melbourne Clinical and Translational Sciences (MCATS) Platform, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
The Department of Psychiatry & Behavioral Health and The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of OBS & GYN, National Taiwan University Hospital, Taipei, Taiwan.
Division of Immunology and Microbiology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Obstetrics & Gynecology, Chang Gung Memorial Hospital & Chang Gung University, Taipei, Taiwan.
Department of Pediatrics, Children's Hospital of Geneva, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Division of Infectious Diseases, Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.



Pregnant women have an elevated risk of illness and hospitalisation from influenza. Pregnant women are recommended to be prioritised for influenza vaccination during any stage of pregnancy. The risk of seasonal influenza varies substantially throughout the year in temperate climates; however, there is limited knowledge of how vaccination timing during pregnancy impacts the benefits received by the mother and foetus.


To compare antenatal vaccination timing with regard to influenza vaccine immunogenicity during pregnancy and transplacental transfer to their newborns.


Studies were eligible for inclusion if immunogenicity to influenza vaccine was evaluated in women stratified by trimester of pregnancy. Haemagglutination inhibition (HI) titres, stratified by trimester of vaccination, had to be measured at either pre-vaccination and within one month post-vaccination, post-vaccination and at delivery in the mother, or in cord/newborn blood. Authors searched PubMed, Scopus, Web of Science and EMBASE databases from inception until June 2016 and authors of identified studies were contacted for additional data. Extracted data were tabulated and summarised via random-effect meta-analyses and qualitative methods.


Sixteen studies met the inclusion criteria. Meta-analyses found that compared with women vaccinated in an earlier trimester, those vaccinated in a later trimester had a greater fold increase in HI titres (1.33- to 1.96-fold) and higher HI titres in cord/newborn blood (1.21- to 1.64-fold).


This review provides comparative analysis of the effect of vaccination timing on maternal immunogenicity and protection of the infant that is informative and relevant to current vaccine scheduling for pregnant women.


immunogenicity; influenza; pregnancy; timing; trimester; vaccination

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