Elsevier

Vaccine

Volume 21, Issue 24, 28 July 2003, Pages 3436-3441
Vaccine

Review
Maternal immunisation in developing countries

https://doi.org/10.1016/S0264-410X(03)00346-3Get rights and content

Abstract

Maternal immunisation could help to prevent the 2–3 million neonatal and early infant deaths that occur in the developing world each year. Determining the causes of neonatal and early infant deaths in developing countries is difficult as most occur at home. However, it is likely that at least half are due to infections, several of which might be prevented by maternal immunisation. Even in poor countries with few health facilities, a high percentage of pregnant women attend an antenatal clinic at least once during pregnancy. Thus, an effective delivery system for maternal immunisation already exists and, because of the success of maternal tetanus immunisation, this approach to the prevention of serious illness or death in young infants is widely accepted by the general population. However, the high prevalence of HIV and malaria found in pregnant women in some parts of the developing world, especially sub-Saharan Africa, could have an effect on the efficacy of maternal immunisation as both of these infections adversely affect placental function. Nevertheless, the potential of maternal immunisation to prevent early infant deaths in developing countries needs to be fully explored. The incidence of pneumococcal infections is high in many developing countries and about 25% of these infections occur at an age before protection could be anticipated following vaccination with a pneumococcal conjugate vaccine in infancy. Thus, a strong case can be made for a trial of the effectiveness of maternal immunisation with a pneumococcal vaccine in preventing serious illness or death in young infants in developing countries.

Introduction

Maternal immunisation provides a potential means of protecting infants against infection with a number of important pathogens during the first few months of life that has universal application. However, maternal immunisation may be of particular value in poor countries where child mortality, especially during the first few months of life, remains unacceptably high. This review highlights some of the reasons why this is the case.

Section snippets

Characteristics of poor countries that favour a role for maternal immunisation

Reasons why maternal immunisation may have a particularly important role to play in poor countries, summarised in Table 1, include the following.

Constraints on maternal immunisation in developing countries

Although there are many features that suggest that maternal immunisation might be especially useful in developing countries, there are a number of constraints that need to be taken into account.

Conclusions

Despite the potential complications of malaria and of HIV, maternal immunisation offers an attractive approach to the prevention of early infant deaths in developing countries. The problem of malaria can probably be largely overcome by ensuring that women receive intermittent presumptive treatment with antimalarials during pregnancy, now recommended practice, and that vaccination is carried out at this time or shortly afterwards. The issue of HIV is more difficult; initially studies could be

Acknowledgements

The author thanks the many colleagues with whom he has worked on the subject of maternal immunisation in The Gambia over a period of many years, in particular, Steve Obaro, Tim O’Dempsey, Amanda Leach, Rahman Suara and Kim Mulholland.

References (18)

There are more references available in the full text version of this article.

Cited by (32)

  • Knowledge and attitudes towards maternal immunization: perspectives from pregnant and non-pregnant mothers, their partners, mothers, healthcare providers, community and leaders in a selected urban setting in South Africa

    2021, Heliyon
    Citation Excerpt :

    However, some countries continue to experience challenges regarding the implementation of maternal influenza vaccination programmes. Poor availability of resources and a reluctance of pregnant women to accept vaccination due to fears about adverse impact on foetal development and health have been mentioned as major barriers to the achievement of national and international targets on maternal and child health (Ortiz et al., 2012; Greenwood 2003; Munoz and Patricia 2013). Moreover, research has shown that maternal knowledge, attitudes and beliefs play a substantial role in vaccine hesitancy (Larson Williams et al., 2018).

  • Vaccinating in Pregnancy: Opportunities and Challenges

    2020, Primary Care - Clinics in Office Practice
    Citation Excerpt :

    Maternal immunization may be particularly helpful in developing countries where infant death rates are high often due to infection, attendance at prenatal clinics is high, and breastfeeding is nearly universal. Neonatal tetanus, although still a significant cause of neonatal death, has decreased recently due to immunization with tetanus toxoid during pregnancy.26 There is some evidence that pneumococcal disease contributes to a significant portion of neonatal deaths before the age at which infants can be vaccinated.

View all citing articles on Scopus
View full text