Effect of maternal immunization on respiratory viral infections and health outcomes in pregnant women and newborns in India

Maternal immunization (MI) demonstrated to be an effective way to reduce the number of maternal and newborn deaths from infections as evidenced from tetanus, influenza and acellular pertussis vaccination during pregnancy. Each year about 0.12–0.15 million children in India die at their birth or during neonatal period from respiratory illnesses or other infections which accounts nearly 22% of global mortality. These children are too young to be vaccinated and MI is an option to prevent deaths and adverse outcomes. In a resource limited country like India there are challenges in introducing new vaccines for pregnant women and the major obstacles are: a) lack of sufficient study-based evidences; b) high cost of vaccine production; c) concerns over vaccine safety in pregnancy; d) vaccine hesitancy. In recent past, very limited articles analysed and reviewed the burden of respiratory viral diseases among newborn children in India and few of these articles demonstrated the need for MI. Challenges in introduction of MI that include vaccine availability, programmatic issues, implementation strategies, were also not addressed thoroughly. In this narrative review, we have highlighted the current evidences of the burden of vaccine preventable respiratory viral diseases of public health importance in India, with a focus on influenza, COVID-19 and respiratory syncytial virus (RSV) and estimated the benefits of MI. Our analysis, based on available secondary data, showed that MI against influenza and RSV could save lives of more than 10,000 newborn children each year in India and may help in averting other adverse newborn outcomes that are associated with maternal infections. Policy and decision-making process for introduction of MI is complex and there are many challenges. In this article, we have discussed about the challenges and a possible roadmap for successful implementation of MI against theses viral diseases in India. This article may help in better understanding the need for maternal vaccination to prevent adverse health outcomes of newborn children.