MRC Unit The Gambia Contributes to Creating a Roadmap for Program Development on Maternal Immunisation Safety Monitoring in Low and Middle-Income Countries

Improving maternal, newborn and child health by lowering the frequency of infections through immunisations has served as a foundation of public health. Such infections kill more than 900,000 under 5-year-old children annually. In low and middle-income countries (LMICs) where there is the greatest burden of vaccine-preventable disease and the most limited access to basic health services, maternal immunisation will reduce morbidity and mortality among pregnant women and infants.

mipvThe report summarises existing programs in pharmacovigilance and maternal, newborn, and child health (MNCH) surveillance in LMICs. It identifies gaps and needs for the safe delivery of vaccines in pregnancy and outlines a roadmap for program development and implementation for monitoring the safety of maternal immunisations in LMICs.

The presentations from the MRCG’s Vaccines and Immunity theme’s research experience during the preparatory meetings and finally writing of this document contributed significantly to the comprehensive proposal to monitoring safety of maternal immunisations in LMICs. MRCG’s research works towards a better understanding of natural or vaccine-induced immunity implicated in defence against serious infectious diseases, with a focus on pregnant women and their newborn babies in the context of maternal immunisation.

The report highlights MRCG’s previous research on Maternal immunisation with Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine in The Gambia, in section 2 of the report. The research evaluated maternal responses to Haemophilus influenzae type b (Hib) vaccine given to pregnant Gambian women, the transplacental transfer of antibody, and the effect of maternal immunisation on infant responses to the vaccine.

Mulholland K, Suara RO, Siber G, et al. Maternal immunisation with Haemophilus influenzae type b polysaccharide—tetanus protein conjugate vaccine in the Gambia. JAMA 1996; 275:1182-8.

Two new trials of maternal immunisation are currently ongoing to study the impact of conjugated pneumococcal vaccination on pneumococcal carriage (PROPEL) and prevention of neonatal pertussis (PERISCOPE).

Our research on Risk factors for group B streptococcus colonisation and disease in Gambian women and their infants was also highlighted in section 1 (page 15). The study evaluated the prevalence of colonising and invasive disease serotypes of Group B streptococcus (GBS) in Gambian women and their infants from delivery to three months of age. The results show that GBS colonisation is dominated by serotype V, and carriage and invasive disease rates are comparable to other international sites.

Le Doare K, Jarju S, Darboe S, et al. Risk factors for group B streptococcus colonisation and disease in Gambian women and their infants. J Infect 2016; 72:283-94.

Contributing authors from MRCG included Dr Ed Clarke, Head of Infant Immunology and Prof Beate Kampmann, Theme Leader, Vaccines and Immunity. The research and experience from the field they were able to contribute added value to building an approach that is practical, affordable and sustainable.

When asked to comment on the global impact of the research of the Vaccines and Immunity Theme at MRCG, Prof Beate Kampmann said “I am proud to say that results of vaccine studies conducted at MRCG are universally cited at international conferences, and even more importantly, that the vaccines found useful in our research now all form part of the EPI program in The Gambia and further afield, where they actually benefit the population. We expect the same results with our newly developed maternal immunisation research program and its associated activities, including contributing to these kinds of reports. Vaccine research remains a cornerstone of MRCG activities.”

Commenting on the report, Dr Ed Clarke said ‘Developing a framework for the safety follow-up of mother vaccinated in pregnancy and their subsequent borne infants is critical if the potential of maternal immunization is to be fully realised.  This has been a neglected area in the past.  This report highlights the current landscape and also provides future direction in this challenging area.  It pulls together expertise from across the globe with the aim of having widespread value and impact.