Respiratory Syncytial Virus Vaccine(Moderna)

Reports first quarter revenues of $0.1 billion, GAAP net loss of $(1.0) billion and GAAP EPS of $(2.52) Reiterates 2025 expected revenue range of $1.5 to $2.5 billion and 2025 year-end cash balance of approximately $6 billion Announces reduction of $1.4 to $1.7 billion in estimated GAAP operating costs by 2027 Advancing up to 10 products toward approval, including multiple oncology candidates CAMBRIDGE, MA / ACCESS Newswire / May 1, 2025 / Moderna, Inc. (NASDAQ:MRNA) today reported financial results and provided business updates for the first quarter of 2025. "In the first quarter, we continued to execute with financial discipline, significantly reducing our operating expenses, and further prioritized our investments in oncology," said Stéphane Bancel, Chief Executive Officer of Moderna. "Looking ahead, we are reiterating our 2025 financial framework and announcing a cost structure that is expected to reduce our annual operating expenses by approximately $1.5 billion by 2027. With several Phase 3 readouts approaching and continued momentum toward 10 product approvals, we remain confident in Moderna's long-term outlook." Recent progress includes: Commercial Updates COVID-19: The Company reported $84 million in Spikevax® sales in the first quarter of 2025, which includes $29 million of U.S. sales and $55 million of international sales. As previously reported, Moderna entered into a tender opportunity in January to compete for COVID vaccine business in the EU. RSV: The Company reported $2 million in mRESVIA® sales in the first quarter of 2025. Moderna's RSV vaccine for adults aged 60 years and older has been recently approved in Australia, Switzerland, Taiwan and the UK. First Quarter 2025 Financial Results Revenue: Total revenue for the first quarter of 2025 was $108 million, compared to $167 million in the first quarter of 2024. The decline was primarily driven by lower net product sales, which totaled $86 million in the quarter. The reduction in product sales reflects lower vaccination rates compared to the same period last year and the continued normalization of COVID into a seasonal commercial market, with demand expected to be concentrated in the second half of the year. Cost of Sales: Cost of sales for the first quarter of 2025 was $90 million, which included third-party royalties of $5 million, inventory write-downs of $42 million, unutilized manufacturing capacity and wind-down costs of $21 million, and losses on firm purchase commitments of $10 million. Compared to the same period in 2024, cost of sales decreased by $6 million, or 6%, reflecting lower sales volume and the seasonal nature of the Company's COVID vaccine business, with limited product sales in both periods. Despite the overall decrease in cost of sales, cost of sales as a percentage of net product sales increased to 104%, compared to 58% in the first quarter of 2024, reflecting the impact of lower net product sales. Research and Development Expenses: Research and development expenses for the first quarter of 2025 decreased by 19% to $856 million, compared to the first quarter in 2024. The decrease was primarily driven by lower clinical development costs across respiratory programs due to timing of trial activities and program wind-downs. This reduction was partially offset by increased investment in Moderna's individualized neoantigen therapy (mRNA-4157), which has been assigned the generic name intismeran autogene, and norovirus programs. Selling, General and Administrative Expenses: Selling, general and administrative expenses for the first quarter of 2025 decreased by 23% to $212 million, compared to the first quarter in 2024. The decline was primarily driven by broad-based reductions across digital, facility, marketing, personnel-related expenses, and external consulting and service costs, as the Company continues to streamline operations and prioritize cost management. Income Taxes: The Company recognized an income tax provision of $7 million for the first quarter of 2025, compared to $10 million in the same period last year. In both periods, the income tax provision was not material, as the Company continues to maintain a global valuation allowance against most of its deferred tax assets. Net Loss: Net loss was $(1.0) billion for the first quarter of 2025, compared to $(1.2) billion for the first quarter of 2024. Loss Per Share: Loss per share was $(2.52) for the first quarter of 2025, compared to $(3.07) for the first quarter of 2024. Cash Position: Cash, cash equivalents and investments as of March 31, 2025, were $8.4 billion, compared to $9.5 billion as of December 31, 2024. The decrease during the quarter was primarily driven by the operating loss for this quarter. 2025 Financial Framework Expectations for full year 2025 remain consistent with prior expectations. Revenue: The Company reiterates 2025 expected revenue of $1.5 to $2.5 billion. Moderna expects revenue of approximately $0.2 billion in the first half of the year, reflecting the seasonality of its respiratory business. Cost of Sales: Cost of sales for 2025 is expected to be approximately $1.2 billion. Research and Development Expenses: Full-year 2025 research and development expenses are anticipated to be approximately $4.1 billion. Selling, General and Administrative Expenses: Selling, general and administrative expenses for 2025 are projected to be approximately $1.1 billion. Income Taxes: The Company continues to expect its full-year tax expense to be negligible. Capital Expenditures: Capital expenditures for 2025 are expected to be approximately $0.4 billion. Cash and Investments: Year-end cash and investments for 2025 are projected to be approximately $6 billion. 2026 and 2027 Financial Updates Moderna is expanding its cost efficiency and prioritization programs and expects estimated GAAP operating costs of $5.4 to $5.7 billion in 2026, a reduction from the Company's previous estimate of $5.9 billion. The Company is announcing a new 2027 GAAP operating cost estimate of $4.7 to $5.0 billion, resulting in a reduction of $1.4 to $1.7 billion in estimated operating costs by 2027, compared to its 2025 estimate. Recent Progress and Upcoming Late-Stage Pipeline Milestones The Company continues to advance its research and development portfolio. Recently, Moderna updated its prioritized pipeline by adding its Phase 2 oncology candidate, checkpoint (mRNA-4359) therapy, and deprioritizing its flu/COVID combination vaccine (mRNA-1083) for adults aged 18-49. Respiratory vaccines: Next-generation COVID-19 vaccine: Moderna shared pivotal safety, immunogenicity and relative vaccine efficacy data for its next-generation COVID-19 vaccine (mRNA-1283) at the Advisory Committee on Immunization Practices meeting in April 2025. The Company filed for regulatory approval of mRNA-1283 with the FDA using a priority review voucher in 2024. The FDA has assigned a Prescription Drug User Fee Act (PDUFA) goal date of May 31, 2025. Respiratory syncytial virus (RSV) vaccine: The Company recently shared positive Phase 3 data for its RSV vaccine (mRNA-1345) in high-risk adults aged 18-59 at the ESCMID 2025 Global Congress. Moderna filed for regulatory approval of mRNA-1345 for high-risk adults with the FDA using a priority review voucher in 2024. The FDA has assigned a PDUFA goal date of June 12, 2025. Seasonal flu + COVID vaccine: Moderna shared positive Phase 3 immunogenicity data for its flu/COVID combination vaccine (mRNA-1083) for adults aged 50 years and older at its 2024 R&D Day event. The Company submitted mRNA-1083 for regulatory approval in older adults in 2024. Based on FDA feedback confirming the need for Phase 3 flu efficacy data, Moderna expects an extended review timeline and is now targeting approval in 2026. Seasonal flu vaccine: Moderna has shared positive Phase 3 immunogenicity and safety data for its seasonal flu vaccine (mRNA-1010). The Phase 3 vaccine efficacy study (P304) exceeded its case accrual target in the first season and Moderna anticipates an interim data readout in summer 2025. Next-generation COVID-19 vaccine: Moderna shared pivotal safety, immunogenicity and relative vaccine efficacy data for its next-generation COVID-19 vaccine (mRNA-1283) at the Advisory Committee on Immunization Practices meeting in April 2025. The Company filed for regulatory approval of mRNA-1283 with the FDA using a priority review voucher in 2024. The FDA has assigned a Prescription Drug User Fee Act (PDUFA) goal date of May 31, 2025. Respiratory syncytial virus (RSV) vaccine: The Company recently shared positive Phase 3 data for its RSV vaccine (mRNA-1345) in high-risk adults aged 18-59 at the ESCMID 2025 Global Congress. Moderna filed for regulatory approval of mRNA-1345 for high-risk adults with the FDA using a priority review voucher in 2024. The FDA has assigned a PDUFA goal date of June 12, 2025. Seasonal flu + COVID vaccine: Moderna shared positive Phase 3 immunogenicity data for its flu/COVID combination vaccine (mRNA-1083) for adults aged 50 years and older at its 2024 R&D Day event. The Company submitted mRNA-1083 for regulatory approval in older adults in 2024. Based on FDA feedback confirming the need for Phase 3 flu efficacy data, Moderna expects an extended review timeline and is now targeting approval in 2026. Seasonal flu vaccine: Moderna has shared positive Phase 3 immunogenicity and safety data for its seasonal flu vaccine (mRNA-1010). The Phase 3 vaccine efficacy study (P304) exceeded its case accrual target in the first season and Moderna anticipates an interim data readout in summer 2025. Latent and other vaccines: Cytomegalovirus (CMV) vaccine: The Company recently shared 36-month durability data from a Phase 2 extension trial of its CMV vaccine candidate (mRNA-1647) at the ESCMID 2025 Global Congress. The pivotal Phase 3 study of mRNA-1647 is fully enrolled and accruing cases, evaluating its efficacy, safety and immunogenicity in the prevention of primary infection in women of childbearing age. The Data Safety Monitoring Board (DSMB) met to review the initial study data in 2024 and informed the Company that the criterion for early efficacy was not met. The DSMB recommended that the study continue as planned. The Company remains blinded and anticipates efficacy data from the study in 2025. Norovirus vaccine: The two-season Phase 3 study evaluating the efficacy, safety and immunogenicity of Moderna's trivalent vaccine against norovirus (mRNA-1403) is fully enrolled in the Northern Hemisphere and enrolling in the Southern Hemisphere. The FDA clinical hold following a single adverse event report of a case of Guillain-Barré syndrome has been lifted. The timing of the Phase 3 readout will be dependent on case accruals. Cytomegalovirus (CMV) vaccine: The Company recently shared 36-month durability data from a Phase 2 extension trial of its CMV vaccine candidate (mRNA-1647) at the ESCMID 2025 Global Congress. The pivotal Phase 3 study of mRNA-1647 is fully enrolled and accruing cases, evaluating its efficacy, safety and immunogenicity in the prevention of primary infection in women of childbearing age. The Data Safety Monitoring Board (DSMB) met to review the initial study data in 2024 and informed the Company that the criterion for early efficacy was not met. The DSMB recommended that the study continue as planned. The Company remains blinded and anticipates efficacy data from the study in 2025. Norovirus vaccine: The two-season Phase 3 study evaluating the efficacy, safety and immunogenicity of Moderna's trivalent vaccine against norovirus (mRNA-1403) is fully enrolled in the Northern Hemisphere and enrolling in the Southern Hemisphere. The FDA clinical hold following a single adverse event report of a case of Guillain-Barré syndrome has been lifted. The timing of the Phase 3 readout will be dependent on case accruals. Oncology therapeutics: Intismeran autogene: Moderna continues to demonstrate the potential clinical benefit of mRNA-4157. In collaboration with Merck, the Phase 3 clinical trial for adjuvant melanoma is fully enrolled. Two Phase 3 studies for non-small cell lung cancer (NSCLC) are enrolling. A randomized Phase 2 study for high-risk muscle invasive bladder cancer is enrolling, and a randomized Phase 2 study for adjuvant renal cell carcinoma is fully enrolled. Moderna and Merck have launched a new Phase 2 study for patients with high-risk non-muscle invasive bladder cancer. Checkpoint adaptive immune modulation therapy (AIM-T): Moderna is expanding the number of oncology development candidates in its prioritized pipeline with the addition of Checkpoint AIM-T (mRNA-4359). The Phase 1/2 study is ongoing and a Phase 2 study, which includes first-line melanoma and first-line metastatic NSCLC patients, is enrolling. Intismeran autogene: Moderna continues to demonstrate the potential clinical benefit of mRNA-4157. In collaboration with Merck, the Phase 3 clinical trial for adjuvant melanoma is fully enrolled. Two Phase 3 studies for non-small cell lung cancer (NSCLC) are enrolling. A randomized Phase 2 study for high-risk muscle invasive bladder cancer is enrolling, and a randomized Phase 2 study for adjuvant renal cell carcinoma is fully enrolled. Moderna and Merck have launched a new Phase 2 study for patients with high-risk non-muscle invasive bladder cancer. Checkpoint adaptive immune modulation therapy (AIM-T): Moderna is expanding the number of oncology development candidates in its prioritized pipeline with the addition of Checkpoint AIM-T (mRNA-4359). The Phase 1/2 study is ongoing and a Phase 2 study, which includes first-line melanoma and first-line metastatic NSCLC patients, is enrolling. Rare disease therapeutics: Propionic acidemia (PA) therapeutic: In an ongoing Phase 1/2 study designed to evaluate safety and pharmacology in trial participants with PA, Moderna's investigational therapeutic (mRNA-3927) has been generally well-tolerated to date with no events meeting protocol-defined dose-limiting toxicity criteria. Early results suggest potential decreases in annualized metabolic decompensation event (MDE) frequency compared to pre-treatment, and the majority of patients have elected to continue on the open label extension study. The Company's PA program is in a registrational study. Methylmalonic acidemia (MMA) therapeutic: Moderna's investigational therapeutic for MMA (mRNA-3705) has been selected by the FDA for the Support for Clinical Trials Advancing Rare Disease Therapeutics (START) pilot program. The FDA and Moderna have agreed on the pivotal study design. The Company expects to start a registrational study in 2025. Propionic acidemia (PA) therapeutic: In an ongoing Phase 1/2 study designed to evaluate safety and pharmacology in trial participants with PA, Moderna's investigational therapeutic (mRNA-3927) has been generally well-tolerated to date with no events meeting protocol-defined dose-limiting toxicity criteria. Early results suggest potential decreases in annualized metabolic decompensation event (MDE) frequency compared to pre-treatment, and the majority of patients have elected to continue on the open label extension study. The Company's PA program is in a registrational study. Methylmalonic acidemia (MMA) therapeutic: Moderna's investigational therapeutic for MMA (mRNA-3705) has been selected by the FDA for the Support for Clinical Trials Advancing Rare Disease Therapeutics (START) pilot program. The FDA and Moderna have agreed on the pivotal study design. The Company expects to start a registrational study in 2025. Company Updates & Accolades Moderna has been named to LinkedIn's list of Top Companies in the U.S. for the second consecutive year. Moderna debuted on Fortune's annual list of America's Most Innovative Companies. Moderna has been named to LinkedIn's list of Top Companies in the U.S. for the second consecutive year. Moderna debuted on Fortune's annual list of America's Most Innovative Companies. Key 2025 Investor and Analyst Event Dates Analyst Day: November 20 Analyst Day: November 20 Investor Call and Webcast Information Moderna will host a live conference call and webcast at 8:00 a.m. ET on May 1, 2025. To access the live conference call via telephone, please register at the link below. Once registered, dial-in numbers and a unique pin number will be provided. A live webcast of the call will also be available under "Events and Presentations" in the Investors section of the Moderna website. Telephone: https://register-conf.media-server.com/register/BI8c3608f9fdff4e00a5cb0cca952a4c3f Webcast: https://investors.modernatx.com Telephone: https://register-conf.media-server.com/register/BI8c3608f9fdff4e00a5cb0cca952a4c3f Webcast: https://investors.modernatx.com The archived webcast will be available on Moderna's website approximately two hours after the conference call and will be available for one year following the call. About Moderna Moderna is a leader in the creation of the field of mRNA medicine. Through the advancement of mRNA technology, Moderna is reimagining how medicines are made and transforming how we treat and prevent disease for everyone. By working at the intersection of science, technology and health for more than a decade, the company has developed medicines at unprecedented speed and efficiency, including one of the earliest and most effective COVID vaccines. Moderna's mRNA platform has enabled the development of therapeutics and vaccines for infectious diseases, immuno-oncology, rare diseases and autoimmune diseases. With a unique culture and a global team driven by the Moderna values and mindsets to responsibly change the future of human health, Moderna strives to deliver the greatest possible impact to people through mRNA medicines. For more information about Moderna, please visit modernatx.com and connect with us on X (formerly Twitter), Facebook, Instagram, YouTube and LinkedIn. MODERNA, INC. CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited, in millions, except per share data) Three Months Ended March 31, 2025 2024 $ 86 $ 167 22 - 108 167 90 96 856 1,063 212 274 1,158 1,433 (1,050 ) (1,266 ) 90 120 (4 ) (19 ) (964 ) (1,165 ) 7 10 $ (971 ) $ (1,175 ) $ (2.52 ) $ (3.07 ) 386 382 1Includes grant, collaboration, licensing and royalty, and other miscellaneous revenue. MODERNA, INC. CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited, in millions) March 31, December 31, 2025 2024 $ 1,623 $ 1,927 4,352 5,098 78 358 128 117 585 599 6,766 8,099 2,418 2,494 2,212 2,196 752 759 556 594 $ 12,704 $ 14,142 $ 226 $ 405 1,001 1,427 125 153 252 221 1,604 2,206 58 58 667 671 35 39 274 267 2,638 3,241 982 866 10 (10 ) 9,074 10,045 10,066 10,901 $ 12,704 $ 14,142 MODERNA, INC. CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited, in millions) Three Months Ended March 31, 2025 2024 $ (971 ) $ (1,175 ) 115 101 39 36 (19 ) (27 ) 8 13 2 3 280 755 46 3 (8 ) (93 ) 9 16 (156 ) (303 ) (381 ) (398 ) (29 ) (33 ) (5 ) (6 ) 33 119 (1,037 ) (989 ) (1,764 ) (2,544 ) 1,933 1,573 688 1,285 (117 ) (196 ) (10 ) - 730 118 3 15 (1 ) - 2 (1 ) 4 14 (303 ) (857 ) 1,929 2,928 $ 1,626 $ 2,071 Spikevax® and mRESVIA® are registered trademarks of Moderna. Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, as amended, including statements regarding: Moderna's 2025 financial framework, including its expected revenue range and ending cash balance; Moderna's advancement of up to 10 product approvals; Moderna's anticipated cost reductions by 2027; and anticipated milestones for Moderna's pipeline programs. In some cases, forward-looking statements can be identified by terminology such as "will," "may," "should," "could," "expects," "intends," "plans," "aims," "anticipates," "believes," "estimates," "predicts," "potential," "continue," or the negative of these terms or other comparable terminology, although not all forward-looking statements contain these words. The forward-looking statements in this press release are neither promises nor guarantees, and you should not place undue reliance on these forward-looking statements because they involve known and unknown risks, uncertainties, and other factors, many of which are beyond Moderna's control and which could cause actual results to differ materially from those expressed or implied by these forward-looking statements. These risks, uncertainties, and other factors include, among others, those risks and uncertainties described under the heading "Risk Factors" in Moderna's Annual Report on Form 10-K for the fiscal year ended December 31, 2024, filed with the U.S. Securities and Exchange Commission (SEC), and in subsequent filings made by Moderna with the SEC, which are available on the SEC's website at www.sec.gov. Except as required by law, Moderna disclaims any intention or responsibility for updating or revising any forward-looking statements contained in this press release in the event of new information, future developments or otherwise. These forward-looking statements are based on Moderna's current expectations and speak only as of the date of this press release. ### Moderna Contacts Media: Chris Ridley Head of Global Media Relations +1 617-800-3651 Chris.Ridley@modernatx.com Investors: Lavina Talukdar Senior Vice President & Head of Investor Relations +1 617-209-5834 Lavina.Talukdar@modernatx.com SOURCE: Moderna, Inc.

摘要：新生儿由于免疫系统发育不完善，对传染病的抵抗力较弱，全球都急需保护这一脆弱群体。由于针对新生儿开发有效疫苗存在诸多挑战，目前只有乙肝和卡介苗在新生儿出生后的前 28 天接种，且主要针对高危群体。通过孕妇接种疫苗，借助母体抗体来保护新生儿是一种可行策略。本文将探讨目前孕期及新生儿接种疫苗的情况、正在研发的疫苗，以及疫苗推广过程中面临的挑战 。总体而言，尽管在疫苗研发和应用方面取得了一些进展，但仍需克服诸多困难，以更好地保护新生儿免受传染病的侵害。一、新生儿为何易受传染病威胁新生儿的免疫系统还在发育中，免疫记忆有限，这使得他们极易受到传染病的威胁 。2015 年，全球约有 61 万新生儿死于传染病，在低收入和中等收入国家，这一问题更为严重 。在高收入国家，虽然传染病导致新生儿死亡的情况相对较少，但仍会造成新生儿住院，给家庭和医疗系统带来沉重负担，还可能对婴儿的长期健康产生影响 。因此，保护新生儿免受传染病侵害是全球公共卫生领域的重要任务 。二、孕期接种疫苗的免疫学原理新生儿免疫特点与疫苗接种挑战：新生儿的免疫系统功能尚未完全成熟，这使得他们对一些疫苗的免疫反应不如年长儿童和成年人有效 。不过，这种 “不成熟” 也可看作是一种保护机制，能避免新生儿对无害的环境抗原和共生生物产生过度免疫反应 。但这也给新生儿疫苗接种带来了困难，例如一些疫苗在新生儿体内无法产生足够的保护效果 。母体抗体的作用：母体抗体可以通过胎盘传递给胎儿，并分泌到母乳中，为新生儿提供一定的保护 。因此，孕期接种疫苗，让母体产生抗体并传递给新生儿，是一种保护新生儿的策略 。不过，活疫苗由于存在减毒病原体感染胎盘和胎儿的风险，在孕期通常是禁忌使用的 。比如卡介苗这种活疫苗，就不适合在孕期接种，而更适合给新生儿接种 。孕期接种疫苗的免疫反应：孕期虽然不是免疫抑制状态，但全身免疫反应会发生一些微妙变化 。以破伤风、白喉、无细胞百日咳（Tdap）疫苗为例，不同研究对孕妇接种后的抗体反应存在不同结论，有的研究发现孕妇和非孕妇接种后的抗体滴度无差异，而有的研究则表明孕妇接种后的反应低于非孕期 。对于流感和新冠疫苗，孕妇接种后的抗体滴度与非孕期相似，但系统血清学研究也发现了一些细微差异 。总体来说，孕期接种疫苗产生的抗体反应足以提供保护，且由于抗体滴度会随时间下降，为了最大程度保护新生儿，孕期接种疫苗仍是较好的选择 。抗体的胎盘转运：在五类抗体中，只有 IgG 能够通过胎盘，这一过程主要由新生儿 Fc 受体（FcRn）介导（原文 Fig. 1，展示 IgG 经胎盘转运的过程，包括从母体血液循环，经滋养层细胞、绒毛结缔组织，最终进入胎儿血液循环的具体步骤）。IgG1 的转运效率最高，其次是 IgG4、IgG2 和 IgG3 。胎盘对 IgG 的转运在孕早期较少，孕中期逐渐增加，孕晚期转运速率显著提高，足月时胎儿的 IgG 浓度通常会超过母体 。因此，在孕 26 - 34 周接种疫苗，能使足月出生婴儿脐带血中的抗原特异性 IgG 达到最大化 。不过，如果首要目标是保护孕妇和胎儿免受孕期疾病的侵害，可能需要更早接种疫苗，这就需要权衡对婴儿保护的影响 。另外，母体抗体在婴儿体内的半衰期有限，会逐渐减少，这也影响了婴儿的疫苗接种计划 。母乳中的抗体：孕期接种疫苗产生的母体 IgA 会转移到母乳中，进而进入婴儿肠道 。有证据表明，孕期接种流感疫苗可能通过这种方式为新生儿提供额外保护 。此外，接种疫苗的父母和其他照顾者感染传染病的可能性降低，也能减少婴儿被感染的风险（原文 Fig. 2，展示孕期接种疫苗保护新生儿的多种机制，包括对孕妇疾病的预防、母体 IgG 经胎盘的保护、母乳中 IgA 的作用以及照顾者接种疫苗的间接保护）。三、现有的疫苗接种计划破伤风疫苗：破伤风是由破伤风杆菌的孢子进入开放性伤口引起的，在资源匮乏地区，新生儿因接生时使用非无菌器械切断脐带，感染破伤风的风险很高 。新生儿破伤风通常在出生后 3 - 28 天发病，患病婴儿会出现吸吮困难和肌肉痉挛等症状，若不进行治疗，几乎必死无疑，即便在医院接受治疗，仍有 10% - 60% 的感染新生儿会死亡 。自 20 世纪 50 年代起，破伤风疫苗开始广泛应用 。研究表明，孕妇接种 2 - 3 剂破伤风疫苗，可使新生儿破伤风死亡率降低 98% 。在全球努力下，2018 年新生儿破伤风死亡人数相较于 1988 年大幅减少了 97%，这主要归功于免疫接种的推广 。百日咳疫苗：百日咳是由百日咳杆菌引起的高度传染性呼吸道疾病，其特征为阵发性咳嗽并伴有吸气性鸡鸣声 。在 20 世纪 40 年代，百日咳导致的婴儿死亡人数比麻疹、腮腺炎、风疹、猩红热、白喉、脊髓灰质炎和脑膜炎的总和还多 。如今，全球每年仍有 85,900 名婴儿死于百日咳 。20 世纪 10 年代和 20 年代，全细胞百日咳疫苗和无细胞百日咳疫苗相继问世 。美国和英国分别在 2010 年和 2012 年开始推荐孕妇接种百日咳疫苗 。在英国，孕妇接种百日咳疫苗后，3 个月以下婴儿的百日咳病例减少了 78% 。关于孕期接种疫苗的时间和类型的建议也在不断调整，例如英国最初在孕 28 - 38 周提供百日咳疫苗接种，2016 年后将接种时间延长至 16 - 32 周，以更好地保护早产婴儿 。流感和新冠疫苗：怀孕会增加孕妇患病毒性肺炎的风险，因此接种流感和新冠疫苗可保护孕妇和胎儿 。同时，这两种疫苗对新生儿也有保护作用 。研究显示，孕期接种流感疫苗可使 2 个月以下婴儿实验室确诊流感病毒感染的风险降低 56%，6 个月以下婴儿降低 35% ；孕期接种新冠疫苗，对预防婴儿感染 SARS-CoV-2 的有效率在 21% - 84% 之间，预防婴儿因 COVID-19 住院的有效率在 32% - 95% 之间 。目前，流感疫苗通常作为季节性疫苗在孕期接种，新冠疫苗在英国也曾作为季节性疫苗接种，而美国则在有针对新变种的疫苗时进行接种 。为了更好地保护新生儿，一些国家开始考虑调整接种时间，如美国建议在孕晚期的夏季接种流感疫苗，澳大利亚也批准了专门用于保护新生儿的孕期流感疫苗 （原文 Fig. 3，展示英国、美国和印度孕期接种疫苗的时间表，直观呈现不同国家不同疫苗的接种时间安排）。乙肝疫苗：乙肝病毒（HBV）可导致急性或慢性感染，乙肝病毒抗原呈阳性的母亲所生的婴儿，有 85% - 90% 会发展为慢性感染，这会增加他们患肝硬化、肝衰竭或肝癌的风险 。由于围产期传播是乙肝病毒在全球传播的主要途径之一，预防这种传播对于实现世界卫生组织到 2030 年消除乙肝的目标至关重要 。目前的证据表明，母体抗乙肝病毒抗体经胎盘转移对新生儿的保护作用有限 。而给新生儿接种乙肝疫苗，可使婴儿感染风险降低 73% ；若同时接种乙肝疫苗和乙肝免疫球蛋白，感染风险可降低 92% 。世界卫生组织建议所有婴儿在出生时接种乙肝疫苗，但许多欧洲国家，如英国，仅对高危婴儿在出生时接种，大多数婴儿则在后续的婴儿接种计划中接种含乙肝成分的多价疫苗 。结核病和口服脊髓灰质炎疫苗（在流行地区）：结核病和脊髓灰质炎在流行地区是导致婴儿和儿童死亡的主要原因 。世界卫生组织建议在阿富汗和巴基斯坦等国家，婴儿出生后尽快接种口服脊髓灰质炎疫苗；在撒哈拉以南非洲、南亚和东南亚的大部分地区，婴儿需接种卡介苗预防结核病 。卡介苗是目前唯一可用的结核病疫苗，但由于它是活减毒疫苗，孕期接种存在风险，因此无法通过孕期接种来预防新生儿感染结核病 。不过，婴儿接种卡介苗对预防 5 岁以下儿童因结核病死亡的有效率为 80% 。此外，在脊髓灰质炎流行地区，除了常规的婴儿接种计划外，还建议在婴儿出生时额外接种一剂口服脊髓灰质炎疫苗，以增强后续完成三剂婴儿接种计划后的血清转化效果，因为仅靠三剂接种计划在病毒流行地区不足以有效预防脊髓灰质炎 。但由于卡介苗和口服脊髓灰质炎疫苗都是活减毒疫苗，对免疫缺陷婴儿存在潜在致病风险。在英国，卡介苗仅推荐给高危婴儿接种，并且在开展严重联合免疫缺陷筛查的地区，会延迟接种卡介苗直至筛查结果出来 。随着全球消灭脊髓灰质炎工作的推进，口服脊髓灰质炎疫苗将逐步被淘汰 。四、预防呼吸道合胞病毒的新举措呼吸道合胞病毒（RSV）的危害：RSV 是导致儿童急性下呼吸道感染（LRTI）的主要原因之一。2019 年，全球估计有 3300 万例 RSV 相关的 LRTI 病例，其中 95% 的病例和 97% 的 10 万例死亡发生在低收入和中等收入国家 。在高收入国家，RSV 也是导致婴儿住院的主要原因，给医疗资源带来了巨大压力 。RSV 疫苗在孕期的应用：一种 RSV 预融合 F 蛋白疫苗（Abrysvo）已在多个国家获批用于孕期接种，以预防新生儿感染 RSV 。在 III 期试验中，该疫苗对 90 天以下婴儿的严重 RSV - LRTI 的预防效力为 81.8%，对 180 天以下婴儿的预防效力为 69.4% 。美国和阿根廷从 2023 年开始将其作为季节性疫苗接种，英国从 2024 年开始全年提供接种 。不过，在该疫苗的 III 期试验中，南非和巴西出现了早产率的非统计学显著失衡，但高收入国家未出现此情况 。为降低潜在的早产风险，美国和阿根廷选择在孕 32 周后提供接种，英国则在孕 28 周后提供接种 。这意味着极早产婴儿可能无法从母体获得通过胎盘转移的 RSV 特异性 IgG，但仍可能从母乳中的抗体以及阻断 RSV 传播中获益 。此外，Moderna 的 mRNA - 1345 疫苗目前正在进行全球 III 期临床试验 。新生儿被动免疫预防 RSV：自 20 世纪 90 年代起，高收入国家就建议在 RSV 流行季节，每月给高危婴儿注射帕利珠单抗（一种人源化抗 RSV F 蛋白单克隆抗体） 。近年来，长效抗 RSV F 蛋白单克隆抗体尼塞韦单抗（nirsevimab，商品名 Beyfortus）的出现具有突破性意义，它只需单次肌肉注射，半衰期长达 79 天 。在 III 期研究中，尼塞韦单抗对健康足月儿和晚期早产儿（大于 35 周 gestation）预防 RSV - LRTI 的效力为 74.5%，对早产儿（29 至小于 35 周 gestation）的效力为 70.1% 。在多个国家实施普遍接种计划后，尼塞韦单抗显示出了良好的覆盖率和有效性 。例如，西班牙在 2023 年 9 月实施普遍接种计划后，三个地区的覆盖率在 78.7% - 98.6% 之间，预防 RSV - LRTI 住院的效力为 70.2% 。不过，该策略的成本限制了其在全球的可及性 。目前，另一种结合 RSV F 蛋白不同位点的单克隆抗体 clesrovimab 正在进行 III 期研究，有望改善全球供应情况并降低成本 （原文 Table 2，对比 RSV 孕期接种疫苗和婴儿单克隆抗体在有效性、安全性、接种时间等方面的差异，帮助读者更清晰地了解两种预防策略）。五、预防 B 族链球菌感染的未来计划B 族链球菌（GBS）的威胁：GBS 是全球新生儿和婴儿败血症及脑膜炎的主要病因 。全球范围内，估计 GBS 每年导致 46,200 例死产、518,100 例早产和 91,900 例婴儿死亡 。目前，分娩时使用抗生素预防是减少早发型 GBS 疾病（出生后 7 天内发病）的唯一策略，但对晚发型疾病（7 - 90 天发病）、死产和早产没有效果 。GBS 疫苗的研发进展：疫苗研发最初聚焦于荚膜多糖疫苗，一种覆盖主要致病血清型的六价多糖 CRM197 结合疫苗在 I/II 期研究中显示出可接受的安全性和良好的免疫反应，并且能通过胎盘传递抗体，降低婴儿侵袭性 GBS 疾病的风险 ，目前正在计划开展 III 期关键全球研究 。另一种研发方向是基于 GBS 表面蛋白的融合蛋白疫苗，Minervax 开发的基于 Alpha-like 蛋白的疫苗已完成 II 期全球研究，并且在南非和乌干达针对 HIV 阳性和阴性孕妇的研究也已完成，后续也计划开展 III 期研究 。不过，将这些疫苗推进到 III 期临床试验并最终获批面临诸多困难，其中最大的障碍是临床疗效研究需要纳入大量的母亲和婴儿，这使得此类研究在商业上难以实现 。此外，基于血清学保护相关性的免疫终点需要针对每种 GBS 血清型进行定义，并且标准化检测方法和参考血清至关重要 。在低收入国家，虽然 GBS 疫苗的潜在益处最大，但当地产前护理水平参差不齐，也给开展可靠的临床试验带来了挑战 。尽管如此，近年来在 GBS 疫苗研发方面已经取得了显著进展和投资，为全球对抗 GBS 感染带来了希望 。六、未来展望面临的挑战：开发用于孕期和新生儿的新疫苗面临诸多复杂挑战，包括额外的后勤保障难题、伦理问题，以及这些群体在历史上常被忽视的情况 。即使是已经成熟的疫苗接种计划，在实施过程中也面临障碍 。在低收入地区，获取疫苗的渠道和物流是主要挑战，需要财政、基础设施和组织方面的支持来确保公平的疫苗可及性 。在高收入地区，疫苗供应也并非毫无问题，例如法国和美国都曾出现过尼塞韦单抗供应不足的情况 。此外，疫苗的接受度也是一个重要问题，孕期推荐疫苗的接种率较低，如在 COVID - 19 大流行期间，产前百日咳和流感疫苗的接种率均有所下降，且至今尚未恢复 。应对措施与建议：为了提高疫苗的接受度，卫生部门、科学团体和医疗专业人员需要共同协作，确保产前医疗指导中充分涵盖疫苗接种的相关信息，并充分解决特定群体的担忧 。随着更多疫苗被纳入接种计划，考虑疫苗的联合接种变得越来越重要，需要研究不同疫苗同时接种的安全性和有效性 。同时，即使某种传染病的疫苗已经获批，继续开展其他疫苗的试验对于确保全球疫苗供应的稳定性和弹性也至关重要 。未来研究方向：未来的研究还应关注其他可能通过孕期接种疫苗预防的感染性疾病，如巨细胞病毒、寨卡病毒、拉沙病毒和戊型肝炎病毒等 。此外，开发针对新生儿的更安全、更有效的结核病疫苗也是当务之急 。针对这些疾病的疫苗研发虽然面临诸多挑战，但一旦成功，将对全球公共卫生产生重大影响 。识别微信二维码，添加生物制品圈小编，符合条件者即可加入生物制品微信群！请注明：姓名+研究方向！版权声明本公众号所有转载文章系出于传递更多信息之目的，且明确注明来源和作者，不希望被转载的媒体或个人可与我们联系(cbplib@163.com)，我们将立即进行删除处理。所有文章仅代表作者观不本站。