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Maternal and Infant Immunization-Worldwide, pneumonia kills more children under 5 than AIDS, malaria and measles combined, but pneumococcal vaccine is not recommended for children under 2. The Mother’s Gift study, led by Mark Steinhoff, MD, examines the effectiveness of immunizing pregnant women against pneumococcus to not only improve the health of the mothers but also so that antibodies will be passed to their newborns. This strategy could save many infant lives and it would be relatively easy to integrate pneumococcal vaccine into Bangladesh’s current maternal vaccine schedule.
Randomized Controlled Evaluation of the Safety and Immunogenicity of Pneumococcal Polysaccharide and Conjugate Vaccines in Young Adults in Asia-A study in the elderly indicated that a second dose of pneumococcal vaccine resulted in less antibody production than initial vaccination. To determine whether this observed decreased immunogenicity may have been a function of diminished immune activity in older individuals or is inherent to the vaccine, women who received the 23V pneumococcal vaccine while pregnant will receive a second dose four to five years postpartum to determine whether there is a decrease in the immunogenicity of the vaccine with multiple doses.
Field Trial of Maternal Influenza Immunization in Asia-Influenza is an important cause of morbidity and mortality worldwide. Pregnant women experienced high mortality during past epidemics, and are more susceptible to seasonal influenza, with fourfold higher rates of hospitalization compared to woman who are not pregnant. The impact of influenza on the fetus when influenza is contracted during pregnancy is less clear, although cases of stillbirths and fetal deaths have been reported. Mark Steinhoff, MD, is investigating the effect of influenza immunization in a large randomized controlled trial of influenza vaccine in pregnant women in Nepal. The primary outcome to be examined will be the incidence of influenza-like febrile illness episodes in the mother and her infant through six months postpartum, as well as birth weights and the complications of delivery.
Chlamydia Trachomatis: A Study of the Prevalence of Disease in Pregnant Women and Rates of Transmission to the Infant in Vellore, India-Untreated chlamydia can cause pelvic inflammatory disease (PID), and there is some evidence that untreated chlamydial infections can lead to premature delivery. Untreated pregnant mothers can pass chlamydia to their children, which may cause conjunctivitis and pneumonia in their children. Fogarty NIH fellow Navjyot Vidwan, MD, measured the prevalence of chlamydia infection in pregnant women and its transmission to infants in Vellore, India. Results of this study can be used to determine the cost effectiveness of routine chlamydia screening of pregnant women in southern India.
Viral Respiratory Infections in Honduran Children-Acute respiratory infections (ARIs) are the leading cause of death among children under 5 years of age in developing countries. Elizabeth Schlaudecker, MD, a Fogarty NIH fellow, is conducting a prospective sentinel clinic surveillance study to determine the viral etiologies and seasonality of ARIs at a clinic in Intibucá, in rural Honduras. Results from this study will enable public health personnel and doctors to develop better therapeutic and preventative strategies, such as timing of flu vaccine.
Epidemiology and Estimation of Burden of Influenza in Children in China-Steve Black, MD, is leading an epidemiological study of the burden of influenza in Chinese children. Asia has often been the source of new strains of influenza with epidemic or even pandemic potential. Although it has been recognized that young children often serve as reservoirs of transmission of the disease, the large burden of morbidity and mortality in Chinese infants and young children has not been studied in detail. In China, preliminary data show that respiratory illness in young children results in substantial morbidity and hospitalization costs. The study will assess the timing and variability of strains of influenza causing hospitalization in this age group so that appropriate vaccine strategies can be developed.
High Prevalence of Rickets and Subclinical Maternal and Childhood Vitamin D Deficiency in the Middle East: A Randomized Controlled Trial of Prenatal Vitamin D Supplementation to Prevent Vitamin D Deficiency in Mothers and Their Infants-Vitamin D deficiency has become a major concern as modern life limits exposure to sunlight for many. Breast milk, which is generally the best food for newborns and infants, lacks Vitamin D in vitamin D deficient women. Dr. Adekunle Dawodu, MD, is working in UAE, where sun exposure is further limited by cultural norms for female clothing, to determine how much vitamin D must be given as a supplement to pregnant mothers and infants to achieve vitamin D sufficiency.
Vaccine Safety DataNet-Many people refuse vaccinations for infectious diseases because of a fear of perceived side effects, such as contracting Guillain-Barre syndrome from flu shots. Biostatistician Caitlin Dodd and Steven Black, MD, are part of a coalition of scientists from around the world using a novel statistical method, the self-controlled case series, to determine the relationship between H1N1 vaccines to Guillain-Barre. Countries involved include the United States, Australia, Israel, Spain, South Africa, Mexico and Brazil and the European Medicines Agency, with representatives from Norway, France, the Netherlands, Greece and the United Kingdom. Both the statistical method and the international network can lead to better research on the side effects of current and future vaccines.
Mark Steinhoff, MD, director of the Global Health Center at Cincinnati Children’s, and his international team of seven coauthors have been recognized for advancing the case for influenza immunization during pregnancy.
The group published an article, titled “Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial,” in CMAJ, a journal of the Canadian Medical Association (CMAJ 2012;184:645-53).
In recognition of their work, they recently received the Bruce Squires Award. This award is given annually to the author(s) of the research paper published in the journal that is most relevant to the practice of medicine and most likely to impact it in a positive way.
The study, conducted in Bangladesh, offers the first evidence that maternal immunization during pregnancy is associated with fewer babies born who are small for their gestational age and an increase of the average birth weight by 200 grams.
“That was a completely new finding,” says Steinhoff. “The vaccine clearly showed a difference in birth weight, indicating that maternal immunization benefited the fetus.”
All of the women in the study were in their third trimester, when fetal growth is at its peak. If the mother becomes ill and is unable to eat, it can make a big difference, says Steinhoff.
Subsequent studies conducted by other researchers in the United States and Canada have showed similar results.
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