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Implications of gestational age at antenatal care attendance on the successful implementation of a maternal respiratory syncytial virus (RSV) vaccine program in coastal Kenya

Authors
  • Nyiro, Joyce U.1
  • Bukusi, Elizabeth2, 3
  • Mwaengo, Dufton3
  • Walumbe, David1
  • Nyaguara, Amek1
  • Nyawanda, Bryan4
  • Otieno, Nancy4
  • Berkley, James A.1
  • Munywoki, Patrick1
  • Nokes, D. James1, 5
  • 1 Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya , Kilifi (Kenya)
  • 2 Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Nairobi, Kenya , Nairobi (Kenya)
  • 3 University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya , Nairobi (Kenya)
  • 4 Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, Kisumu, Kenya , Kisumu (Kenya)
  • 5 School of Life Sciences and Zeeman Institute (SBIDER), University of Warwick, Coventry, UK , Coventry (United Kingdom)
Type
Published Article
Journal
BMC Public Health
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Nov 16, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12889-020-09841-9
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundMaternal immunisation to boost respiratory syncytial virus (RSV) specific antibodies in pregnant women is a strategy to enhance infant protection. The timing of maternal vaccination during pregnancy may be critical for its effectiveness. However, Kenya has no documented published data on gestational age distribution of pregnant women attending antenatal care (ANC), or the proportion of women attending ANC during the proposed window period for vaccination, to inform appropriate timing for delivery or estimate potential uptake of this vaccine.MethodsA cross-sectional survey was conducted within the Kilifi Health and Demographic Surveillance System (KHDSS), coastal Kenya. A simple random sample of 1000 women who had registered pregnant in 2017 to 2018 and with a birth outcome by the time of data collection was taken. The selected women were followed at their homes, and individually written informed consent was obtained. Records of their antenatal attendance during pregnancy were abstracted from their ANC booklet. The proportion of all pregnant women from KHDSS (55%) who attended for one or more ANC in 2018 was used to estimate vaccine coverage.ResultsOf the 1000 women selected, 935 were traced with 607/935 (64.9%) available for interview, among whom 470/607 (77.4%) had antenatal care booklets. The median maternal age during pregnancy was 28.6 years. The median (interquartile range) gestational age in weeks at the first to fifth ANC attendance was 26 (21–28), 29 (26–32), 32 (28–34), 34 (32–36) and 36 (34–38), respectively. The proportion of women attending for ANC during a gestational age window for vaccination of 28–32 weeks (recommended), 26–33 weeks and 24–36 weeks was 76.6% (360/470), 84.5% (397/470) and 96.2% (452/470), respectively. Estimated vaccine coverage was 42.1, 46.5 and 52.9% within the narrow, wide and wider gestational age windows, respectively.ConclusionsIn a random sample of pregnant women from Kilifi HDSS, Coastal Kenya with card-confirmed ANC clinic attendance, 76.6% would be reached for maternal RSV vaccination within the gestational age window of 28–32 weeks. Widening the vaccination window (26–33 weeks) or (24–36 weeks) would not dramatically increase vaccine coverage and would require consideration of antibody kinetics data that could affect vaccine efficacy.

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