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Previous Volume 359:1555-1564 October 9, 2008 Number 15 Next

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ABSTRACT

Background Young infants and pregnant women are at increased risk for serious consequences of influenza infection. Inactivated influenza vaccine is recommended for pregnant women but is not licensed for infants younger than 6 months of age. We assessed the clinical effectiveness of inactivated influenza vaccine administered during pregnancy in Bangladesh.

Methods In this randomized study, we assigned 340 mothers to receive either inactivated influenza vaccine (influenza-vaccine group) or the 23-valent pneumococcal polysaccharide vaccine (control group). Mothers were interviewed weekly to assess illnesses until 24 weeks after birth. Subjects with febrile respiratory illness were assessed clinically, and ill infants were tested for influenza antigens. We estimated the incidence of illness, incidence rate ratios, and vaccine effectiveness.

Results Mothers and infants were observed from August 2004 through December 2005. Among infants of mothers who received influenza vaccine, there were fewer cases of laboratory-confirmed influenza than among infants in the control group (6 cases and 16 cases, respectively), with a vaccine effectiveness of 63% (95% confidence interval [CI], 5 to 85). Respiratory illness with fever occurred in 110 infants in the influenza-vaccine group and 153 infants in the control group, with a vaccine effectiveness of 29% (95% CI, 7 to 46). Among the mothers, there was a reduction in the rate of respiratory illness with fever of 36% (95% CI, 4 to 57).

Conclusions Inactivated influenza vaccine reduced proven influenza illness by 63% in infants up to 6 months of age and averted approximately a third of all febrile respiratory illnesses in mothers and young infants. Maternal influenza immunization is a strategy with substantial benefits for both mothers and infants. (ClinicalTrials.gov number, NCT00142389 [ClinicalTrials.gov] .)

Source Information

From the International Centre for Diarrheal Disease Research, Dhaka, Bangladesh (K.Z., E.R., S.E.A., M.R., R.R., N.S.S., R.E.B.); and the Bloomberg School of Public Health (E.W., S.B.O., M.C.S.), Institute for Vaccine Safety (S.B.O.), and Department of Pediatrics, School of Medicine (M.C.S.) — all at Johns Hopkins University, Baltimore.

This article (10.1056/NEJMoa0708630) was published at www.nejm.org on September 17, 2008.

Address reprint requests to Dr. Steinhoff at the Children's Global Health Center, Cincinnati Children's Hospital, 3333 Burnet Ave., MLC 2048, Cincinnati, OH 45229, or at m.steinhoff{at}gmail.com.

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