The importance of maternal vaccination

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Robert H. Hopkins, Jr, MD, discusses the importance of pregnant women receiving vaccines against respiratory diseases to protect themselves and their infants.

Contemporary OB/GYN:

Hi, I'm Celeste Krewson with Contemporary OB/GYN and I'm here with Dr. Hopkins to discuss how maternal vaccines can protect mothers and infants from respiratory infections. Do you want to introduce yourself?

Robert H. Hopkins, Jr, MD:

Sure. I'm Bob Hopkins, I'm the Medical Director for the National Foundation for Infectious Diseases. I'm also a practicing internist and pediatrician at the University of Arkansas for medical sciences. Glad to be here with you.

Contemporary OB/GYN:

Thank you for joining me today. So, it gets started, can you mention a bit how diseases like COVID, the flu and RSV impacts mothers and infants?

Hopkins:

Well, you know, we have to recognize that we are in a different world from the standpoint of respiratory infectious diseases now than we were 3 or 4 years ago. COVID-19 is still with us, we continue to see variants circulate. Most of the variants we're seeing now are the Omicron type of COVID lineage. We have a vaccine that has been approved this fall that we recommend for all adults receive 1 dose, in fact, everyone down to 5 years of age should receive a dose. And it's particularly important for pregnant women to get that vaccine because we know that pregnancy is a risk factor for severe COVID illness. and infants are at risk for severe COVID illness. And so vaccinating pregnant women with the COVID vaccine helps to reduce that risk for the mother and for the infant. That's in addition to the fact that we're typically in our influenza season. While we haven't seen a lot of influenza disease yet, this is the right time to vaccinate pregnant women against influenza, again, to protect that pregnant woman as well as her infant from influenza disease. Now we have the opportunity to also protect infants from RSV with either a maternal immunization with RSV vaccine between the 32nd and 36th week of pregnancy, to allow passive transfer of that antibody to the infant to protect the infant. Or if that doesn't happen, to give the infant a medication called Nirsevimab, which is a long-acting monoclonal antibody, passive immunization with an infant to protect them against RSV disease, which causes thousands and thousands of hospitalizations and severe illnesses in our small children. And we shouldn't forget our last maternal immunization T-Dap to reduce the risk for pertussis in infants. Same process, has to transfer those antibodies from mom to baby to protect them against whooping cough.

Contemporary OB/GYN:

And can you discuss a bit about how maternal vaccination protects mothers and infants?

Hopkins:

Sure. So, for COVID and influenza, we get both direct protection of the mother by stimulating the immune system to produce antibodies to protect that mother from influenza and COVID-19 infections, you also get transfer of some of those antibodies through the placenta into the infant. For RSV disease, and for pertussis protection, while the mothers can get those illnesses, they typically are not terribly severe in pregnant women, but we want the mother to produce those antibodies that can then get passed through the placenta to protect their infants from what can be severe infections in their infants.

Contemporary OB/GYN:

And you've discussed it a little bit already, but can you go into some more detail on why maternal vaccines are so crucial?

Hopkins:

Well, unfortunately, pregnancy is a time where our immune system is suppressed a bit. We have that naturally, because we don't want to have the immune system react against that infant who is in utero. And so, we know that pregnancy is a time that women are at increased risk of severe disease from COVID, from influenza. We know that the risk of those diseases not only continues through pregnancy, but at least for a couple of weeks after delivery, and so, we want to make sure that those pregnant women are protected. And our infants have a new immune system, they haven't had exposure to influenza, to COVID, to pertussis or whooping cough, to RSV, or many other pathogens. So, because their immune system is so immature, we need to do everything we can to protect those infants from the infections.

Contemporary OB/GYN:

With all of this in mind, how can clinicians talk to their pregnant patients with vaccine hesitancy about vaccines?

Hopkins:

The best place to start is from the standpoint of a discussion around what are your goals? I think for most of us, our goal for our pregnant women is for them to stay healthy and for them to have a healthy baby that starts off life on the right foot. And so, I think if you have a woman and who is hesitant about vaccines, the way that I would start the discussion is, you know, tell me what you've heard. Tell me what concerns you have about these vaccines. And I'm going to explore that, you know, to try to see what their concerns are. But then I'm going to talk about what are things that are important for them: staying healthy or keeping their family healthy. And then I'm going to recommend that they get the vaccine so that they get the same level of protection for themselves, and for that newborn baby, that I have taken for myself, that I've given to my wife, I've given to my children and my parents, I want them to get the same level of health and protection that I give my own family. So, you put a face on that recommendation.

Contemporary OB/GYN:

Those are all great points, thank you. We're just about ready to wrap up, but is there anything you want to add first?

Hopkins:

Well, just that I think all of us are in this together. You know, we're focusing on the ob-gyn provider. But I think it's also important that we think about these women in their medical home that they may follow with on a on a regular basis, the primary care community, medical staff within that home as well as in their ob-gyn offices. All of them need to be speaking with that same language and focused on protection and the health of those families.

Contemporary OB/GYN:

Thank you for joining me today.

Hopkins:

Certainly, Celeste. It's been my pleasure.

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