Neonatal, Parental vaccination strategies

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Project Main Description

a)    Neonatal vaccinology:     

A high incidence and severity of many VPDs, in particular pertussis and potentially group B streptococcal infection, occurs in the first months of life, but research into the use of vaccines in the neonatal period is sparse. This is due to concerns about lack of immune response or later “tolerance” to vaccine antigens following early exposure. The CI team has a track record in novel research into neonatal vaccination strategies in pertussis, which is being utilised to build research capacity in this important but understudied area.

The global burden of infectious diseases in early life is considerable, with estimates of 2.5 million annual infectious diseases related deaths in under 1 year olds. In Australia, pertussis (whooping cough) is a particular problem in infants under 4 months old, who experience the most significant pertussis-related morbidity and are incompletely protected by the current pertussis vaccine strategies.

One of the key areas of uncertainty is how well neonates respond to vaccines administered at birth, given the immaturity of the immune system in early life. In addition, there are several as yet unanswered questions regarding neonatal vaccination, including the influence of a birth dose on concomitant antigen responses, safety, influence of maternal antibodies, cellular immune responses and longevity of immunity. These questions can be addressed through a series of clinical vaccine trials involving both pertussis and hepatitis B vaccines as are being currently conducted.

 

b)   Maternal and parental vaccination strategies

The aim of maternal vaccination is to protect the mother during her pregnancy, as well as provide indirect protection to neonates through the passive transfer of maternal antibodies, as exemplified by the global success of maternal tetanus vaccination in eliminating neonatal tetanus. In Australia, influenza vaccine has been recommended during pregnancy for some years but vaccine uptake remains low. There are many reasons for this, including maternal reluctance to be vaccinated during pregnancy and provider reluctance to recommend vaccination at this time. This CRE will enhance knowledge on the parental and health professional attitudes to maternal and neonatal vaccination, explore which types of vaccine messages and programs are most effective in delivering vaccines to pregnant women to influenza vaccines and vaccine efficacy in protecting mothers and babies through a series of clinical trials and epidemiological studies. 

 

Progress/Update

Projects

  • Impact of newborn hepatitis B vaccination two decades on (PRP B. Liu)
  • Immunogenicity and safety of acellular vaccine at birth. (CI N. Wood )
  • FluMum: A prospective cohort study of mother-infant pairs assessing the effectiveness of maternal influenza vaccinationin prevention of influenza in early infancy(CI N. Wood) 
  • Persistence of immunity and response to a booster dose of dTpa or DTPa vaccine at 18 months old following acellular pertussis vaccine given at birth in healthy infants. (CI N. Wood)
  • Protecting babies from the effects of whopping cough and influenza: a study of maternal vaccination and an educational intervention to improve uptake (the MumVacc study). (CI J Leask)
  • Best practices for communicating pertussis booster recommendations to pregnant women. (CI N. Wood)
  • Optimising pertussis vaccine scheduling for the protection of young infants (PRP J. Wood, CI P. McIntyre, PRP T. Snelling, AI N. Wood, PRP A. Newall, in collaboration with Jodie McVernon, Trish Campbell and Nic Gerard from University of Melbourne)


Workshops

  Workshop on allergy and neonatal immunisation in collaboration with Food and allergy CRE

This workshop was hosted and organised by both our CRE and Centre for Food and on 28th October 2013 in Melbourne. The workshop was very well attended, with over 20 participants and included leading Australian experts in allergy from the CRE in Food Allergy and leading vaccine experts from our CRE and other invited guests. Discussion topics include the epidemiology of allergic diseases, biological plausibility of any relationship to vaccines and identify potential studies to examine further any association between food allergy and vaccines. Potential grant applications for the future were discussed.

 

 

Publications

 

Hayles H.E , Cooper SC, Wood N, Sinn J, Skinner S.R. What predicts postpartum pertussis booster vaccination? A controlled intervention trial. Vaccines. 33(1): 228–236. January 2015. [Full text]

McIntyre PB, Clark TA. Pertussis vaccine in pregnancy—first dose for every infant? [comment]. he Lancet. [Epub ahead of print]. September 2014. [Full text]

Wiley KE, Cooper SC, Wood N, Leask J. Understanding pregnant women’s attitudes and behaviour towards influenza and pertussis vaccination. Qualitative Health Research. In press. July 2014.

Macartney KK, Heywood AE, McIntyre PB. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database of Systematic Reviews. Issue 6. June 2014. [Full text]

Chow MY, Yin JK, Heron L, Morrow A, Dierig A, Booy R, Leask J. The impact of influenza-like illness in young children on their parents: a quality of life survey. Quality of Life Research. 23(5):1651-60. June 2014. [Full text

Wood N, Marshall H, White OJ, Holt PG, McIntyre P. Antibody and cell mediated immunity to pertussis 4 years after monovalent acellular pertussis vaccine at birth. Pediatric Infectious Disease Journal. 33(5):511-7. May 2014. [Full

Wiley KE, Massey PD, Cooper Robbins SC, Wood N, Quinn HE, Leask J. Pregnant women’s intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: a cross sectional survey. Vaccine. 31 (37):3972-8. August 2013. [Full text]

Penelope Abbott, Robert Menzies, Joyce Davison, Louise Moore and Han Wang. Improving immunisation timeliness in Aboriginal children through personalised calendars. BMC Public Health. 13:598. June 2013. [Full text]

Marshall, H., McIntyre, P., Richmond, P., Buttery, J., Royle, J., Gold, M., Wood, N., Elliott, E., Zurynski, Y., Toi, C., Dwyer, D., Booy, R.. Changes in patterns of hospitalized children with varicella and of associated varicella genotypes following introduction of varicella vaccine in Australia. Pediatric Infectious Disease Journal. 32(5):530-537. May 2013. [Full text]

Brynley P. Hull∗, Robert Menzies, Kristine Macartney, Peter B. McIntyre. Impact of the introduction of rotavirus vaccine on the timeliness of other scheduled vaccines: The Australian experience. Vaccine. 31 (15): 1964– 1969. April 2013. [Full text]

Wiley KE, Massey PD, Cooper SC, Wood NJ, Ho J, Quinn HE, Leask J. Uptake of influenza vaccine by pregnant women: a cross-sectional survey. The Medical Journal of Australia. 198(7):373-5. March 2013. [Full Text]

Wiley KE, Leask J. Respiratory vaccine uptake during pregnancy. The Lancet Respiratory Medicine. 1(1): 9-11. March 2013. [Full Text]

Gao Z, Wood JG, Burgess MA, Menzies R, McIntyre PB, MacIntyre CR. Models of strategies for control of rubella and congenital rubella syndrome - A 40 year experience from Australia. Vaccine. 31(4):691–697. January 2013. [Full text]

Wiley KE, Zuo Y, Macartney KK, McIntyre PB. Sources of pertussis infection in young infants: A review of key evidence informing targeting of the cocoon strategy. Vaccine. 31(4):618-25. January 2013. [Full text]

Wiley KE, Zuo Y, Macartney KK, McIntyre PB. Sources of pertussis infection in young infants: a review of key evidence informing targeting of the cocoon strategy. Vaccine. 31(4) : 618 -25. January 2013. . [Full text

Project Status
Current