This study states that Seasonal and pandemic influenza virus infections are associated with severe disease outcomes in pregnant women and young infants.1-6 Maternal antenatal influenza vaccination reduces the incidence of influenza among pregnant women and their young infants during the first 4-6 months of life.7-11 In 2012, the World Health Organization Strategic Advisory Group of Experts on Immunization recommended prioritization of pregnant women for influenza vaccination.12 Since that time, several countries have introduced influenza vaccination programs including programs that target pregnant women13; however, this recommendation has not been widely implemented in sub-Saharan Africa. There have also been conflicting data concerning the potential impact of antenatal influenza vaccination on birth outcomes including stillbirth, preterm birth, and low birth weight. Influenza pandemics have been associated with fetal loss,15-17 preterm birth,16, 18 and infants born small for gestational age18 particularly following maternal influenza-associated or acute respiratory hospitalization; however, there appears to be limited association between seasonal influenza epidemics and birth outcomes.19-22 A small randomized, controlled trial (RCT) of maternal influenza immunization in Bangladesh23 found that maternal influenza immunization increased mean birth weight following the influenza season and a larger RCT in Nepal.

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