BACKGROUND: Tuberculosis (TB) disease during pregnancy results in adverse maternal and infant outcomes. The development of a TB vaccine with potential for administration during pregnancy or lactation is a priority identified by the World Health Organization. We assessed the acceptability of vaccines currently administered during pregnancy [tetanus, diphtheria and COVID-19] and willingness to receive a new TB vaccine during pregnancy and/or lactation among Ethiopian women. METHODS: From January to February 2022, we conducted surveys among pregnant women receiving antenatal care at 20 hospitals in Amhara, Ethiopia. We evaluated uptake of available vaccines (diphtheria), acceptance of new and future vaccines (COVID-19 and TB) during pregnancy and lactation, and knowledge, attitudes and beliefs associated with vaccine-specific acceptance. RESULTS: Among 200 participants, we found high intention to receive a TB vaccine during pregnancy (90%) and lactation (92%) and low COVID-19 vaccine acceptance during pregnancy (40%) and lactation (47%). Most participants believed TB vaccination would protect their child from disease (82.5%) and have societal benefits (81.5%), while few women perceived the COVID-19 vaccine to offer protection (35.5%) or have societal benefits (42.5%). Intention to receive TB vaccination during pregnancy was associated with the belief that a future maternal TB vaccine would prevent TB among infants (adjusted prevalence ratio 1.37, 95% CI: 1.10-1.70). Most participants reported high acceptability of educational interventions to increase uptake of maternal immunization. CONCLUSIONS: We found high intention to receive a new TB vaccine during pregnancy and lactation among Ethiopian women. Our findings support vaccine-specific educational interventions to strengthen maternal immunization programs in Ethiopia.

Prenatal maternal immunization is an effective tool to protect mothers and infants from poor health outcomes due to infectious diseases. We provide an overview of the rationale for the use of prenatal vaccines, discuss the immunologic environment of the maternal-fetal interface including the impact of maternal vaccines prenatally and subsequently on the infant's immune response, and review vaccines currently recommended in pregnancy and landscape for the future of maternal vaccination. This review aims to provide an understanding of the recent history and progress made in the field and highlight the importance of continued research and development into new vaccines for pregnant populations.

Many countries pursuing malaria elimination implement "reactive" strategies targeting household members and neighbors of index cases to reduce transmission. These strategies include reactive case detection and treatment (RACDT; testing and treating those positive) and reactive drug administration (RDA; providing antimalarials without testing). We conducted systematic reviews of RACDT and RDA to assess their effect on reducing malaria transmission and gathered evidence about key contextual factors important to their implementation. Two reviewers screened titles/abstracts and full-text records using defined criteria (Patient = those in malaria-endemic/receptive areas; Intervention = RACDT or RDA; Comparison = standard of care; Outcome = malaria incidence/prevalence) and abstracted data for meta-analyses. The Grading of Recommendations, Assessment, Development, and Evaluations approach was used to rate certainty of evidence (CoE) for each outcome. Of 1,460 records screened, reviewers identified five RACDT studies (three cluster-randomized controlled trials [cRCTs] and two nonrandomized studies [NRS]) and seven RDA studies (six cRCTs and one NRS); three cRCTs comparing RDA to RACDT were included in both reviews. Compared with RDA, RACDT was associated with nonsignificantly higher parasite prevalence (odds ratio [OR] = 1.85; 95% CI: 0.96-3.57; one study) and malaria incidence (rate ratio [RR] = 1.30; 95% CI: 0.94-1.79; three studies), both very low CoE. Compared with control or RACDT, RDA was associated with non-significantly lower parasite incidence (RR = 0.73; 95% CI: 0.36-1.47; 2 studies, moderate CoE), prevalence (OR = 0.78; 95% CI: 0.52-1.17; 4 studies, low CoE), and malaria incidence (RR = 0.93; 95% CI: 0.82-1.05; six studies, moderate CoE). Evidence for reactive strategies' impact on malaria transmission is limited, especially for RACDT, but suggests RDA might be more effective.