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Licata F, Romeo M, Riillo C, Di Gennaro G, Bianco A. Acceptance of recommended vaccinations during pregnancy: a cross-sectional study in Southern Italy. Front Public Health 2023; 11:1132751. [PMID: 37250080 PMCID: PMC10213683 DOI: 10.3389/fpubh.2023.1132751] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Vaccine administration is a recommended, safe, and effective measure to protect pregnant women against vaccine-preventable diseases (VPDs). Despite available guidance, maternal immunization rates for vaccination against influenza and with the reduced antigen content tetanus-diphtheria-acellular pertussis vaccine (Tdap) in Italy remain incredibly low. The primary goal of the study was to explore what Italian pregnant women knew about VPDs and immunization during pregnancy and what factors affected their decision to be vaccinated. Methods This cross-sectional study took place between October 2021 and April 2022 in the Southern part of Italy. All consecutive pregnant women, from those attending the selected facilities on randomly selected days, were approached to request participation. The inclusion criteria for participation were age ≥18 years, the ability to understand, speak, and read Italian, and being pregnant at any gestational age. The questionnaire, using a combination of checkboxes and free text answers, consisted of 32 items divided into five parts and lasted ~10 min. Results The results showed that 61% knew that the influenza vaccine is recommended and 48.7% knew that influenza could be risky during pregnancy; 74.1% wrongly reported that the Measles-Mumps-Rubella (MMR) vaccine is recommended during pregnancy. Seven out of 10 pregnant women believed that strong evidence supported the safety of vaccinations during pregnancy, and more than half (55.6%) thought they were at increased risk of severe illness with COVID-19. Women in the sample believed that vaccines received during pregnancy pose a risk of adverse events to the unborn child with a median value of 6 (IQR 3-9), on a scale ranging from 1 to 10. Similarly, the fear of contracting pertussis and influenza during pregnancy showed a median value of 6 (IQR 3-9) and 5 (IQR 3-8), respectively. Only 21.1% and 36.5% of women received influenza and Tdap vaccines during pregnancy. Conclusion Unrealistic risk perception with a negative attitude toward vaccines in pregnancy and a low percentage of vaccinated pregnant women confirm the urgency of training women to make informed choices to increase overall vaccine uptake.
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Lubrano C, Mancon A, Anelli GM, Gagliardi G, Corneo R, Bianchi M, Coco C, Dal Molin G, Vignali M, Schirripa I, Di Simone N, Pavone G, Pellegrino A, Gismondo MR, Savasi VM, Cetin I. Immune Response and Transplacental Antibody Transfer in Pregnant Women after COVID-19 Vaccination. J Pers Med 2023; 13:jpm13040689. [PMID: 37109075 PMCID: PMC10141882 DOI: 10.3390/jpm13040689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
COVID-19 infection is associated with increased risk of pregnancy complications, making vaccination during pregnancy critical for mother-neonate dyads. Few data, often with an unrepresentative sample size, are available on SARS-CoV-2 vaccine-induced humoral and cell-mediated response. Here, we evaluated anti-S antibody and interferon-gamma (IFN-γ) production elicited by SARS-CoV-2 immunization in maternal and neonatal plasma. Pregnant women (n = 230) were prospectively enrolled and classified as unvaccinated (n = 103) and vaccinated (n = 127); after serological screening for previous infections, assays were performed on 126 dyads, 15 mothers and 17 newborns. Positive anti-S antibodies were found in most of the vaccinated subjects, regardless of timespan between immunization and delivery (range: 7-391 days). A total of 89 of 92 vaccinated women showed a broad response to COVID-19 immunization and highly effective placental transfer, as attested by anti-S positive rates (maternal = 96.7%, cord = 96.6%). Most of our subjects had indeterminate results in an IGRA assay, preventing a conclusive evaluation of IFN-γ production. Indeed, pregnancy-related hormonal changes may influence T-cell response with an impact on IFN-γ production. Positive pregnancy and perinatal outcomes reinforce the evidence that the anti-SARS-CoV-2 immunization is effective and well-tolerated in pregnant women and also protective for the fetus/neonate, even though it was not possible to define the related IFN-γ production and role.
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Affiliation(s)
- Chiara Lubrano
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Alessandro Mancon
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Gaia Maria Anelli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Gloria Gagliardi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Roberta Corneo
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Micol Bianchi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Chiara Coco
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Giulia Dal Molin
- Department of Biomedical Science for Health, Macedonio Melloni Hospital-ASST Fatebenefratelli Sacco, University of Milan, 20133 Milan, Italy
| | - Michele Vignali
- Department of Biomedical Science for Health, Macedonio Melloni Hospital-ASST Fatebenefratelli Sacco, University of Milan, 20133 Milan, Italy
| | - Irene Schirripa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Giulia Pavone
- Department of Woman, Child and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
- Unit of Obstetrics and Gynecology, Alessandro Manzoni Hospital, ASST Lecco, 23900 Lecco, Italy
| | - Antonio Pellegrino
- Unit of Obstetrics and Gynecology, Alessandro Manzoni Hospital, ASST Lecco, 23900 Lecco, Italy
| | - Maria Rita Gismondo
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Laboratory of Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Valeria Maria Savasi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Department of Woman, Child and Neonate, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Irene Cetin
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, 20154 Milan, Italy
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Wainstock T, Sergienko R, Orenshtein S, Sheiner E. Factors associated with COVID-19 vaccination likelihood during pregnancy. Int J Gynaecol Obstet 2023; 161:478-484. [PMID: 36651802 DOI: 10.1002/ijgo.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 11/12/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify maternal background, medical and gynecological characteristics associated with COVID-19 vaccination likelihood, in the context where COVID-19 vaccination rates among pregnant women are significantly lower than the general population. METHODS In a retrospective cohort study, including all women who delivered between January and September 2021, background and medical history, including current and previous pregnancies diagnoses, were compared between vaccinated and unvaccinated women. Multivariable logistic models were used to identify factors associated with vaccination for the entire population, and for the two distinctive populations included in the study (Bedouin Arabs and Jewish women). RESULTS The study population included 7017 women, of whom 1925 (27.4%) were vaccinated during pregnancy. According to the multivariable analysis, unvaccinated mothers were younger with lower socioeconomic score. They were more likely to be Bedouin Arabs, have a poor obstetrical history or recurrent pregnancy loss, and insufficient prenatal care. Additional risk factors were inconsistent between the two ethnicities included in the study. CONCLUSIONS Ethnicity, insufficient prenatal care, and having a poor obstetric history were consistently associated with lower vaccination among pregnant women. These factors should be considered in future plans aimed at increasing vaccination among pregnant women.
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Affiliation(s)
- Tamar Wainstock
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shani Orenshtein
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Nyiro JU, Bukusi E, Mwaengo D, Nyaguara A, Nyawanda B, Otieno N, Bigogo G, Murunga N, Widdowson MA, Verani JR, Chaves SS, Mwangudza H, Odundo C, Berkley JA, Nokes DJ, Munywoki PK. Efficiency of transplacental transfer of respiratory syncytial virus (RSV) specific antibodies among pregnant women in Kenya. Wellcome Open Res 2022; 7:43. [PMID: 35402734 PMCID: PMC8976186 DOI: 10.12688/wellcomeopenres.17636.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Maternal immunisation to boost respiratory syncytial virus (RSV) antibodies in pregnant women, is a strategy being considered to enhance infant protection from severe RSV associated disease. However, little is known about the efficiency of transplacental transfer of RSV-specific antibodies in a setting with a high burden of malaria and HIV, to guide the implementation of such a vaccination program. Methods: Using a plaque reduction neutralization assay, we screened 400 pairs of cord and maternal serum specimens from pregnant women for RSV-specific antibodies. Participants were pregnant women of two surveillance cohorts: 200 participants from a hospital cohort in Kilifi, Coastal Kenya and 200 participants from a surveillance cohort in Siaya, Western Kenya. Transplacental transfer efficiency was determined by the cord to maternal titre ratio (CMTR). Logistic regression was used to determine independent predictors of impaired transplacental transfer of RSV-specific antibodies. Results: A total of 800 samples were screened from the 400 participants. At enrollment the median age was 25 years (Interquartile range (IQR): 21-31). Overall, transplacental transfer was efficient and did not differ between Kilifi and Siaya cohort (1.02 vs. 1.02; p=0.946) but was significantly reduced among HIV-infected mothers compared to HIV-uninfected mothers (mean CMTR: 0.98 vs 1.03; p=0.015). Prematurity <33 weeks gestation (Odds ratio [OR]: 0.23, 95% confidence interval [CI] 0.06-0.85; p=0.028), low birth weight <2.5 kgs (OR: 0.25, 95% CI: 0.07-0.94; p=0.041) and HIV infection (OR: 0.47, 95% CI:0.23-0.98; p=0.045) reduced efficiency of transplacental transfer among these women. Conclusions: Transplacental transfer of RSV-specific antibodies among pregnant women in Kenya is efficient. A consideration to integrate other preventive interventions with maternal RSV vaccination targeting infants born premature (<33 weeks gestation), with low birth weight <2.5 kgs, or HIV-infected mothers is likely to improve vaccine outcomes in this setting.
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Affiliation(s)
- Joyce U. Nyiro
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Dufton Mwaengo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Amek Nyaguara
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bryan Nyawanda
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Nancy Otieno
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Nickson Murunga
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Jennifer R. Verani
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Sandra S. Chaves
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Hope Mwangudza
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Calleb Odundo
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A. Berkley
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - D James Nokes
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- School of Life Sciences and Zeeman Institute (SBIDER), University of Warwick, Coventry, UK
| | - Patrick K. Munywoki
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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5
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Nyiro JU, Bukusi E, Mwaengo D, Nyaguara A, Nyawanda B, Otieno N, Bigogo G, Murunga N, Widdowson MA, Verani JR, Chaves SS, Mwangudza H, Odundo C, Berkley JA, Nokes DJ, Munywoki PK. Efficiency of transplacental transfer of respiratory syncytial virus (RSV) specific antibodies among pregnant women in Kenya. Wellcome Open Res 2022; 7:43. [PMID: 35402734 PMCID: PMC8976186 DOI: 10.12688/wellcomeopenres.17636.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 02/15/2024] Open
Abstract
Background: Maternal immunisation to boost respiratory syncytial virus (RSV) antibodies in pregnant women, is a strategy being considered to enhance infant protection from severe RSV associated disease. However, little is known about the efficiency of transplacental transfer of RSV-specific antibodies in a setting with a high burden of malaria and HIV, to guide the implementation of such a vaccination program. Methods: Using a plaque reduction neutralization assay, we screened 400 pairs of cord and maternal serum specimens from pregnant women for RSV-specific antibodies. Participants were pregnant women of two surveillance cohorts: 200 participants from a hospital cohort in Kilifi, Coastal Kenya and 200 participants from a surveillance cohort in Siaya, Western Kenya. Transplacental transfer efficiency was determined by the cord to maternal transfer ratio (CMTR). Logistic regression was used to determine independent predictors of impaired transplacental transfer of RSV-specific antibodies. Results: A total of 800 samples were screened from the 400 participants. At enrollment the median age was 25 years (Interquartile range (IQR): 21-31). Overall, transplacental transfer was efficient and did not differ between Kilifi and Siaya cohort (1.02 vs. 1.02; p=0.946) but was significantly reduced among HIV-infected mothers compared to HIV-uninfected mothers (mean CMTR: 0.98 vs 1.03; p=0.015). Prematurity <33 weeks gestation (Odds ratio [OR]: 0.23, 95% confidence interval [CI] 0.06-0.85; p=0.028), low birth weight <2.5 kgs (OR: 0.25, 95% CI: 0.07-0.94; p=0.041) and HIV infection (OR: 0.47, 95% CI:0.23-0.98; p=0.045) reduced efficiency of transplacental transfer among these women. Conclusions: Transplacental transfer of RSV-specific antibodies among pregnant women in Kenya is efficient. A consideration to integrate other preventive interventions with maternal RSV vaccination targeting infants born premature (<33 weeks gestation), with low birth weight <2.5 kgs, or HIV-infected mothers is likely to improve vaccine outcomes in this setting.
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Affiliation(s)
- Joyce U. Nyiro
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Dufton Mwaengo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Amek Nyaguara
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bryan Nyawanda
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Nancy Otieno
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Nickson Murunga
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Jennifer R. Verani
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Sandra S. Chaves
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Hope Mwangudza
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Calleb Odundo
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A. Berkley
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - D James Nokes
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- School of Life Sciences and Zeeman Institute (SBIDER), University of Warwick, Coventry, UK
| | - Patrick K. Munywoki
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Shen CJ, Fu YC, Lin YP, Shen CF, Sun DJ, Chen HY, Cheng CM. Evaluation of Transplacental Antibody Transfer in SARS-CoV-2-Immunized Pregnant Women. Vaccines (Basel) 2022; 10:101. [PMID: 35062762 PMCID: PMC8778956 DOI: 10.3390/vaccines10010101] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy could result in adverse perinatal outcome. Clinical data on the assessment of the immune response in vaccinated pregnant women and subsequent transplacental antibody transfer are quite limited. OBJECTIVE To assess maternal and neonatal neutralizing antibody levels against both wildtype and Delta (B.1.617.2) variants after maternal mRNA vaccination. STUDY DESIGN This cohort study was conducted 29 pregnant women who were vaccinated at least one dose of Moderna (mRNA-1273) vaccine. Both neutralizing antibody (wildtype and Delta variant) and S1 receptor binding domain IgG antibody levels were evaluated in maternal and cord blood on the day of delivery. RESULTS Superiority of antibody level was significant in fully vaccinated women compared with the one-dose group (maternal sera, median, 97.46%; cord sera, median, 97.37% versus maternal sera, median, 4.01%; cord sera, median, 1.44%). No difference in antibody level was noted in relation to interval of second immunization to delivery in the two-dose group (95.99% in 0-2 weeks, 97.45% in 2-4 weeks, 97.48% in 4-8 weeks, 97.72% in 8-10 weeks). The most pronounced reduction was observed for the Delta variant. The wildtype neutralizing antibody level of full-vaccinated women was not influenced by the pertussis vaccination. CONCLUSION The data underscore the importance of full vaccination in pregnancy and support the recommendation of COVID-19 immunization for pregnant women. The lower level of vaccine-induced neutralizing antibodies for the Delta variant indicates insufficient protection for mother and newborn and highlights the need for development of effective vaccine strategies.
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Affiliation(s)
- Ching-Ju Shen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Chen Fu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Yen-Pin Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Der-Ji Sun
- Department of Obstetrics and Gynecology, Pojen Hospital, Kaohsiung 804, Taiwan;
| | - Huan-Yun Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
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Post AL, Li SH, Berry M, Itell H, Martinez DR, Xie G, Permar SR, Swamy GK, Fouda GG. Efficiency of placental transfer of vaccine-elicited antibodies relative to prenatal Tdap vaccination status. Vaccine 2020; 38:4869-4876. [PMID: 32482459 DOI: 10.1016/j.vaccine.2020.05.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/19/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022]
Abstract
Administration of vaccines during pregnancy provides maternal protection against infectious diseases. This protection is extended to their infants during the first months of life, as pathogen-specific antibodies formed in response to maternal vaccination are transferred across the placenta to the fetus. Notably, Tdap (tetanus-diphtheria-acellular pertussis) vaccination booster is routinely administered to pregnant women both to prevent neonatal tetanus and to ensure that infants have protective levels of pertussis antibodies until they are able to establish their own vaccine-induced levels. Whether infant protection through maternal immunization is merely due to an increase in maternal antibody levels or whether maternal immunization enhances the transfer of vaccine-specific antibodies is unclear. Moreover, the potential impact of prenatal vaccinations on the transplacental transfer of other antibodies, such as antibodies raised as a result of infections or other vaccines administered prior to pregnancy, has not been studied. The goal of this study was to define the impact of maternal vaccination on IgG transplacental transfer efficiency. We analyzed antigen-specific antibody populations and IgG subclass distribution in maternal and cord blood samples from 58 mother-infant pairs. All women received the seasonal inactivated influenza vaccine during pregnancy and 25 women received the Tdap vaccine during the second or third trimester of gestation. Prenatal Tdap vaccination did not impact the efficiency of IgG transplacental transfer; however, it was associated with higher maternal and infant vaccine-elicited Tdap-specific antibody levels, and with a higher proportion of infants with protective levels of antibodies, especially against diphtheria. There was also no difference in the IgG transplacental transfer rate of antibodies against non-Tdap vaccines between the two groups of women. Our results confirm previous reports demonstrating the benefits of prenatal Tdap immunization and indicate that this strategy does not impede the transplacental transfer of other antibodies that are also important for infant protection.
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Affiliation(s)
- Annalisa L Post
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Shuk Hang Li
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA
| | - Madison Berry
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA
| | - Hannah Itell
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA
| | - David R Martinez
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA
| | - Guanhua Xie
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA
| | - Sallie R Permar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Genevieve G Fouda
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
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8
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Choosing Pre-conception Planning for Women/Families: Counselling and Informed Consent (Part 2) – Pre-conception Reproductive Planning, Lifestyle, Immunization, and Psychosocial Issues. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:666-678. [DOI: 10.1016/j.jogc.2017.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
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9
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Ramos-Fernández JM, Hernández-Yuste A, Gutiérrez-Bedmar M, Cordón Martínez AM, Moreno-Pérez D. Does exposure of pregnant women to epidemic respiratory syncytial virus affect the severity of bronchiolitis? Enferm Infecc Microbiol Clin 2019; 37:251-255. [PMID: 30100097 DOI: 10.1016/j.eimc.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Passive transplacental immunity against respiratory syncytial virus (RSV) appears to mediate in the protection of the infant for the first 6 months of life. Lower environmental exposure in pregnant women to RSV epidemic may influence the susceptibility of these infants to infection by lowering the levels of antibodies that are transferred to the fetus. OBJECTIVES To contrast the risk of severe disease progression in infants with acute bronchiolitis by RSV, according to the mother's level of exposure to epidemic. METHOD Retrospective cohort study of previously healthy infants with RSV-acute bronchiolitis during 5 epidemics was made. We compared the severity of the infection in those born during the period of risk (when is less likely the mother's exposure to epidemic and the transfer of antibodies to the fetus: October 15th-December 15th in our latitude) with the rest of acute bronchiolitis. Bivariate analysis was performed regarding birth in period of risk and the rest of variables, using the Chi-square test. Multivariate logistic regression analysis was performed to study possible classical confounding factors. RESULTS 695 infants were included in the study. 356 infants were born during the period of risk. Of the 56 patients requiring admission to PICU, 40 of them (71.4%) were born in this period (p=0.002). In the multivariate analysis, the birth in the period of risk showed a 6.5 OR (95% CI: 2.13-19.7) independently of the rest of variables. CONCLUSIONS The worst clinical disease progression of the acute bronchiolitis by the RSV in less than 6 months age is related to lower exposure of the pregnant woman to the RSV epidemic.
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Affiliation(s)
| | | | - Mario Gutiérrez-Bedmar
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Málaga, Spain
| | | | - David Moreno-Pérez
- Servicio de Pediatría, Unidad de enfermedades infecciosas, Hospital Materno-Infantil, IBIMA, Málaga, Spain; Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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Rodríguez-Blanco N, Tuells J, Vila-Candel R, Nolasco A. Adherence and Concordance of Influenza and Pertussis Vaccination Coverage in Pregnant Women in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040543. [PMID: 30769767 PMCID: PMC6406959 DOI: 10.3390/ijerph16040543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/31/2019] [Accepted: 02/10/2019] [Indexed: 01/11/2023]
Abstract
Background: Pregnant women should receive two vaccines during pregnancy due to maternal-foetal complications and risks as well as the influenza and pertussis vaccinations. The goal was to evaluate vaccination coverage against influenza and pertussis in pregnant women, following midwife professional advice during the pregnancy follow-up; Methods: Prospective cohort study of 1017 pregnancies during the vaccination campaign in 2015⁻2016. To estimate the degree of consistency between the coverage declared by mothers and that registered in the Nominal Vaccination Registry (NVR), we used the Cohen's kappa index (k); Results: 95.4% were registered in the NVR. Vaccination coverage recorded against influenza was 64.2% (95% CI: 61.2⁻67.2), and 89.8% (95% CI: 87.9⁻91.7) against pertussis. The coverage of the pregnant women interviewed was 61.7% (95% CI: 58.1⁻67.3)) for influenza and 92.3% (95% CI: 91.4⁻95.3) for pertussis. Subsequent interviews of 67.2% of the women produced a kappa agreement index between the data obtained from interviews and those recorded in the NVR of 0.974 (IC95%: 98.0⁻99.6) for influenza, and 0.921 (IC95%: 98.1⁻99.7) for pertussis. The women identified midwives as the main source of vaccination information and advice 88.4% (IC95%: 85.8⁻90.9); Conclusions: The NVR is an effective platform for estimating immunisation coverage in pregnant women. The degree of agreement between declared vaccinations and registered vaccinations was high for both vaccines.
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Affiliation(s)
- Noelia Rodríguez-Blanco
- Department of Obstetrics and Gynaecology, Hospital Universitario del Vinalopó, Spain C/Tonico Sansano Mora, 14, 03293 Elche, Spain.
- Department of Nursing Universidad CEU Cardenal Herrera, Plaza Reyes Católicos, 19, 03204 Elche, Spain.
| | - José Tuells
- Cátedra Balmis Vacunología, University of Alicante, Campus de San Vicente Raspeig, Ap.99, E-03080 Alicante, Spain.
| | - Rafael Vila-Candel
- Department of Obstetrics and Gynaecology, Hospital Universitario de la Ribera, FISABIO, Spain, Crta. Corbera km 1, 46600 Valencia, Spain.
| | - Andreu Nolasco
- Unidad Mixta de Investigación para el Análisis de las Desigualdades en Salud y la Mortalidad FISABIO-UA, Departament of Community Health, Preventive Medicine and Public Health, and Science's History, University of Alicante, Carretera de San Vicente del Raspeig s/n, 03690 Alicante, Spain.
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11
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Fischinger S, Boudreau CM, Butler AL, Streeck H, Alter G. Sex differences in vaccine-induced humoral immunity. Semin Immunopathol 2018; 41:239-249. [PMID: 30547182 PMCID: PMC6373179 DOI: 10.1007/s00281-018-0726-5] [Citation(s) in RCA: 251] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
Vaccines are among the most impactful public health interventions, preventing millions of new infections and deaths annually worldwide. However, emerging data suggest that vaccines may not protect all populations equally. Specifically, studies analyzing variation in vaccine-induced immunity have pointed to the critical impact of genetics, the environment, nutrition, the microbiome, and sex in influencing vaccine responsiveness. The significant contribution of sex to modulating vaccine-induced immunity has gained attention over the last years. Specifically, females typically develop higher antibody responses and experience more adverse events following vaccination than males. This enhanced immune reactogenicity among females is thought to render females more resistant to infectious diseases, but conversely also contribute to higher incidence of autoimmunity among women. Dissection of mechanisms which underlie sex differences in vaccine-induced immunity has implicated hormonal, genetic, and microbiota differences across males and females. This review will highlight the importance of sex-dependent differences in vaccine-induced immunity and specifically will address the role of sex as a modulator of humoral immunity, key to long-term pathogen-specific protection.
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Affiliation(s)
- Stephanie Fischinger
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA.,Institut für HIV Forschung, Universität Duisburg-Essen, Duisburg, Germany
| | - Carolyn M Boudreau
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA
| | - Audrey L Butler
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA
| | - Hendrik Streeck
- Institut für HIV Forschung, Universität Duisburg-Essen, Duisburg, Germany
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, 400 Technology Square, Cambridge, MA, 02139, USA.
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12
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Fouda GG, Martinez DR, Swamy GK, Permar SR. The Impact of IgG transplacental transfer on early life immunity. Immunohorizons 2018; 2:14-25. [PMID: 29457151 PMCID: PMC5812294 DOI: 10.4049/immunohorizons.1700057] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pediatric vaccines have significantly reduced infectious disease-related infant mortality, but as protective immunity often require several infant vaccine doses; maternally-acquired antibodies are critical to protect infants during the first months of life. Consequently, immunization of pregnant women is an important strategy not only to protect mothers from infection, but also to provide immunity to young infants. Nevertheless, maternal immunization can also negatively impact early life immunity. In fact, maternal antibodies can interfere with the development of infant immune responses, though it is unclear if such interference is clinically significant. Moreover, the transplacental transfer of maternal immunoglobulin therapeutics can be harmful to the fetus. Thus, the risk/benefit of maternal immunization for both the mother and the fetus should be carefully weighed. In addition, it is critical to fully understand the mechanisms by which IgG is transferred across the placenta in order to develop optimal maternal and infant immunization strategies.
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Affiliation(s)
- Genevieve G. Fouda
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Pediatrics, Duke University Medical Center, Durham, NC, 27710
| | - David R. Martinez
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, 27710
| | - Geeta K. Swamy
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 27710
| | - Sallie R. Permar
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Pediatrics, Duke University Medical Center, Durham, NC, 27710
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13
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Patil AS, Sheng J, Dotters-Katz SK, Schmoll MS, Onslow M, Pierson RC. Fundamentals of Clinical Pharmacology With Application for Pregnant Women. J Midwifery Womens Health 2017; 62:298-307. [PMID: 28498553 DOI: 10.1111/jmwh.12621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/05/2017] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
Medication use is common in pregnancy, yet for most medications the optimal formulation and dosage have not been described specifically for pregnant women. Often, adverse effects are only discovered anecdotally or after extensive off-label use occurs. Since pharmacologic research that includes pregnant women is sparse and animal studies are often not applicable to the human fetus, providers must use knowledge of drug behavior and normal physiologic changes of pregnancy to personalize treatment for pregnant women. In this review, we present an overview of the basic concepts of clinical pharmacology: pharmacokinetics, pharmacodynamics, and pharmacogenomics. The normal physiologic changes of pregnancy are presented as a framework to understand alterations in drug behavior. A clinical vignette that addresses 4 pregnancy scenarios involving medications-preterm birth, vaccination, herpes simplex virus infection, and codeine toxicity-is provided to illustrate application of core clinical pharmacologic concepts. Discussion of relevant literature illustrates the challenges of offering individualized pharmacologic therapy in pregnancy.
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14
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Patil AS, Sheng JS, Dotters-Katz SK, Schmoll MS, Onslow ML. Principles of Anti-infective Dosing in Pregnancy. Clin Ther 2016; 38:2006-15. [DOI: 10.1016/j.clinthera.2016.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 01/25/2023]
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15
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Chen RT, Shimabukuro TT, Martin DB, Zuber PLF, Weibel DM, Sturkenboom M. Enhancing Vaccine Safety Capacity Globally: A Lifecycle Perspective. Am J Prev Med 2015; 49:S364-76. [PMID: 26590436 DOI: 10.1016/j.amepre.2015.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Major vaccine safety controversies have arisen in several countries beginning in the last decades of 20th century. Such periodic vaccine safety controversies are unlikely to go away in the near future as more national immunization programs mature with near elimination of target vaccine-preventable diseases that result in relative greater prominence of adverse events following immunizations, both true reactions and temporally coincidental events. There are several ways in which vaccine safety capacity can be improved to potentially mitigate the impact of future vaccine safety controversies. This paper aims to take a "lifecycle" approach, examining some potential pre- and post-licensure opportunities to improve vaccine safety, in both developed (specifically U.S. and Europe) and low- and middle-income countries.
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Affiliation(s)
- Robert T Chen
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Tom T Shimabukuro
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David B Martin
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
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16
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Chen RT, Shimabukuro TT, Martin DB, Zuber PLF, Weibel DM, Sturkenboom M. Enhancing vaccine safety capacity globally: A lifecycle perspective. Vaccine 2015; 33 Suppl 4:D46-54. [PMID: 26433922 PMCID: PMC4663114 DOI: 10.1016/j.vaccine.2015.06.073] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 12/22/2022]
Abstract
Major vaccine safety controversies have arisen in several countries beginning in the last decades of 20th century. Such periodic vaccine safety controversies are unlikely to go away in the near future as more national immunization programs mature with near elimination of target vaccine-preventable diseases that result in relative greater prominence of adverse events following immunizations, both true reactions and temporally coincidental events. There are several ways in which vaccine safety capacity can be improved to potentially mitigate the impact of future vaccine safety controversies. This paper aims to take a "lifecycle" approach, examining some potential pre- and post-licensure opportunities to improve vaccine safety, in both developed (specifically U.S. and Europe) and low- and middle-income countries.
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Affiliation(s)
- Robert T Chen
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Tom T Shimabukuro
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - David B Martin
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
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17
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Pellegrini C, McCabe ERB. Maternal immunization at the crossroads. Vaccine 2015; 33:6501-2. [PMID: 26256524 DOI: 10.1016/j.vaccine.2015.06.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Cynthia Pellegrini
- March of Dimes Foundation, 1275 Mamaroneck Avenue, White Plains, NY 10605, USA.
| | - Edward R B McCabe
- March of Dimes Foundation, 1275 Mamaroneck Avenue, White Plains, NY 10605, USA
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