Asynchronous influenza vaccination and adverse maternal-child health outcomes in the Brazilian semiarid, 2013 to 2018: the INFLUEN-SA Study
Filho, J. Q.; Junior, F. S.; Lima, T. B.; Viana, V. A.; Burgoa, J. S.; Soares, A. M.; Leite, A. M.; Hanson, G. F.; Papin, J. A.; Moore, S. R.; Lima, A. A.
Show abstract
Recent models indicate seasonal influenza transmission in Brazil begins annually in the semiarid state of Ceara (pop. 8.8M)--before vaccine campaigns begin. To assess the extent and maternal-child health consequences of this misalignment, we tracked severe acute respiratory infections (SARI), influenza, and influenza immunizations from 2013-2018. Of 3,297 SARI cases, 145 (4%) occurred in pregnancy. Vaccine coverage was >80%; however, campaigns often occurred during or after peak influenza. Birth weights nadired and prematurity increased 30-40 weeks following peak influenza, by a magnitude of 40g and 10.7% to 15.5%, respectively. We identified 61 babies of mothers with gestational SARI; they weighed 10% less at birth (P = 0{middle dot}019) and were more often premature (OR: 2.944; 95% CI: 1.100 - 7.879) relative to controls (n=122). Mistiming of influenza vaccination adversely impacts pregnancy and birth outcomes in Ceara, with critical implications for influenza transmission dynamics nationally.
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