Immunization, Vaccines and Biologicals

Maternal influenza immunization: Guidance to inform introduction of infuenza vaccine in low and middle-income countries


In 2012, the World Health Organization (WHO) released a position paper on influenza vaccination stating that pregnant women should have the highest priority for seasonal influenza vaccination in countries considering the initiation or expansion of influenza immunization programs. The recommendation that pregnant women be prioritized in immunization programs was based on a review of influenza burden of disease, vaccine safety, and vaccine performance by the WHO Strategic Advisory Group of Experts on Immunization (SAGE).

Despite the WHO recommendation, maternal influenza immunization has not been incorporated into routine immunization programs in many low-resource countries. A 2012 consultation of experts by the Bill & Melinda Gates Foundation (BMGF) identified operational challenges and knowledge gaps hindering implementation of maternal influenza immunization programs.

In response to this consultation, BMGF awarded a grant to WHO and PATH to execute a maternal influenza immunization project in order to address some of the remaining obstacles to implementing seasonal influenza immunization programs for pregnant women and data gaps about potential vaccine impact.

The US Center of Disease Control kindly agreed to provide financial support to the development of economic tools to support decision making on vaccine introduction and to estimate the costs of introducing influenza vaccination in countries.

The following pages will list the guidance documents resulting from these efforts, addressing uncertainties around routine maternal influenza immunization decision making and implementation, informing on how to conduct economic analysis on the burden of influenza and the introduction of the vaccine, as well as a protocol for conducting a study to assess and address vaccine hesitancy.