Neuraminidase inhibitors during pregnancy and risk of adverse neonatal outcomes and congenital malformations: population based European register study
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j629 (Published 28 February 2017) Cite this as: BMJ 2017;356:j629
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Stavros Saripanidis (1) says in his response that -
"Since early treatment of influenza with approved-and safe-neuraminidase inhibitors has been associated with a reduced risk of severe infection and of admission to intensive care units, it is deducible that post-exposure prophylaxis in patients at high risk is preferable than preventive mass vaccinations."
Here we differ a bit:
There are two types of Influenza vaccines - 1) Inactivated Influenza vaccine (IIA) 2) Live attenuated influenza vaccine (LAIV). The former is 50 years old and has stood the test of time. Inactivated influenza vaccine is recommended by the Centers for Disease Control and Prevention (CDC) for all pregnant women and children, except for infants aged <6 months (for whom the vaccine is poorly immunogenic) . Whereas, the latter is contraindicated in pregnant women.
The present study(2) evaluates the effect of neuraminidase inhibitors among 5824 (0.8%) exposed women and their infants and 692 232 who were not exposed. Our contention is that less than 12 months old infants are also exposed and have hospital admissions and ill-health during their infancy. The vaccine is not effective in infants less than 6 months whereas, if given to pregnant women this age group is protected by antibodies passively transferred through placenta3.
Effect of neuraminidase inhibitors should also be evaluated in infants exposed to influenza and in our opinion considering the effect of influenza in vulnerable population of pregnant mother and her infant IIV can be administered to pregnant women which will protect mother as well as her infant, considering they are high risk group3.
References:
1. http://www.bmj.com/content/356/bmj.j629/rr
2. BMJ 2017;356:j629
3. Benowitz I, Esposito DB, Gracey KD, Shapiro ED, Vázquez M. Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clin Infect Dis. 2010 Dec 15;51(12):1355-61. doi: 10.1086/657309.
Competing interests: No competing interests
Dear Editors,
One of the leading investigators in this study, had also participated in a study which revealed that extensive H1N1 vaccinations did not offer protection against influenza related hospital admissions. [1]
Since early treatment of influenza with approved-and safe-neuraminidase inhibitors has been associated with a reduced risk of severe infection and of admission to intensive care units [2], it is deducible that post-exposure prophylaxis in patients at high risk is preferable than preventive mass vaccinations.
Health policy strategists might also discover that targeted treatment of exposed patients is cheaper than extensive-and inefficient-vaccinations of the whole population.
References
[1] BMJ 2012;344:d7901
http://www.bmj.com/content/344/bmj.d7901
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370819/
Competing interests: No competing interests
Re: Neuraminidase inhibitors during pregnancy and risk of adverse neonatal outcomes and congenital malformations: population based European register study
Dear colleagues
Thank you for your interest in our paper and your valuable remarks. We studied the effect on the newborn of intrauterine exposure to neuraminidase inhibitors and could not find any negative consequences. In the present study we did not have information on the vaccination status of the pregnant women and hence we do not draw any conclusions on the benefit of vaccination versus the benefit of post exposure prophylaxis as the preferable strategy to protect women and infants.
Best Regards, on behalf of the authors
Sophie Graner
Competing interests: No competing interests