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Borghesi A. Life-threatening infections in human newborns: Reconciling age-specific vulnerability and interindividual variability. Cell Immunol 2024; 397-398:104807. [PMID: 38232634 DOI: 10.1016/j.cellimm.2024.104807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
In humans, the interindividual variability of clinical outcome following exposure to a microorganism is immense, ranging from silent infection to life-threatening disease. Age-specific immune responses partially account for the high incidence of infection during the first 28 days of life and the related high mortality at population level. However, the occurrence of life-threatening disease in individual newborns remains unexplained. By contrast, inborn errors of immunity and their immune phenocopies are increasingly being discovered in children and adults with life-threatening viral, bacterial, mycobacterial and fungal infections. There is a need for convergence between the fields of neonatal immunology, with its in-depth population-wide characterization of newborn-specific immune responses, and clinical immunology, with its investigations of infections in patients at the cellular and molecular levels, to facilitate identification of the mechanisms of susceptibility to infection in individual newborns and the design of novel preventive and therapeutic strategies.
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Affiliation(s)
- Alessandro Borghesi
- Neonatal Intensive Care Unit, San Matteo Research Hospital, Pavia, EU, Italy; School of Life Sciences, Swiss Federal Institute of Technology, Lausanne, Switzerland.
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2
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Immunization of preterm infants: current evidence and future strategies to individualized approaches. Semin Immunopathol 2022; 44:767-784. [PMID: 35922638 PMCID: PMC9362650 DOI: 10.1007/s00281-022-00957-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Preterm infants are at particularly high risk for infectious diseases. As this vulnerability extends beyond the neonatal period into childhood and adolescence, preterm infants benefit greatly from infection-preventive measures such as immunizations. However, there is an ongoing discussion about vaccine safety and efficacy due to preterm infants' distinct immunological features. A significant proportion of infants remains un- or under-immunized when discharged from primary hospital stay. Educating health care professionals and parents, promoting maternal immunization and evaluating the potential of new vaccination tools are important means to reduce the overall burden from infectious diseases in preterm infants. In this narrative review, we summarize the current knowledge about vaccinations in premature infants. We discuss the specificities of early life immunity and memory function, including the role of polyreactive B cells, restricted B cell receptor diversity and heterologous immunity mediated by a cross-reactive T cell repertoire. Recently, mechanistic studies indicated that tissue-resident memory (Trm) cell populations including T cells, B cells and macrophages are already established in the fetus. Their role in human early life immunity, however, is not yet understood. Tissue-resident memory T cells, for example, are diminished in airway tissues in neonates as compared to older children or adults. Hence, the ability to make specific recall responses after secondary infectious stimulus is hampered, a phenomenon that is transcriptionally regulated by enhanced expression of T-bet. Furthermore, the microbiome establishment is a dominant factor to shape resident immunity at mucosal surfaces, but it is often disturbed in the context of preterm birth. The proposed function of Trm T cells to remember benign interactions with the microbiome might therefore be reduced which would contribute to an increased risk for sustained inflammation. An improved understanding of Trm interactions may determine novel targets of vaccination, e.g., modulation of T-bet responses and facilitate more individualized approaches to protect preterm babies in the future.
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Alonso S, Vidal M, Ruiz-Olalla G, González R, Manaca MN, Jairoce C, Vázquez-Santiago M, Balcells R, Vala A, Rupérez M, Cisteró P, Fuente-Soro L, Cova M, Angov E, Nhacolo A, Sevene E, Aponte JJ, Macete E, Aguilar R, Mayor A, Menéndez C, Dobaño C, Moncunill G. Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique. Front Immunol 2021; 12:614246. [PMID: 33746958 PMCID: PMC7965965 DOI: 10.3389/fimmu.2021.614246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/08/2021] [Indexed: 01/16/2023] Open
Abstract
Transplacental transfer of antibodies is essential for conferring protection in newborns against infectious diseases. We assessed the impact of different factors, including gestational age and maternal infections such as HIV and malaria, on the efficiency of cord blood levels and placental transfer of IgG subclasses. We measured total IgG and IgG subclasses by quantitative suspension array technology against 14 pathogens and vaccine antigens, including targets of maternal immunization, in 341 delivering HIV-uninfected and HIV-infected mother-infant pairs from southern Mozambique. We analyzed the association of maternal HIV infection, Plasmodium falciparum exposure, maternal variables and pregnancy outcomes on cord antibody levels and transplacental transfer. Our results show that maternal antibody levels were the main determinant of cord antibody levels. Univariable and multivariable analysis showed that HIV reduced the placental transfer and cord levels of IgG and IgG1 principally, but also IgG2 to half of the antigens tested. P. falciparum exposure and prematurity were negatively associated with cord antibody levels and placental transfer, but this was antigen-subclass dependent. Our findings suggest that lower maternally transferred antibodies may underlie increased susceptibility to infections of HIV-exposed infants. This could affect efficacy of maternal vaccination, especially in sub-Saharan Africa, where there is a high prevalence of HIV, malaria and unfavorable environmental factors.
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Affiliation(s)
- Selena Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Gemma Ruiz-Olalla
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - M. Nelia Manaca
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Reyes Balcells
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anifa Vala
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - María Rupérez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pau Cisteró
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Laura Fuente-Soro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Marta Cova
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Evelina Angov
- U.S. Military Malaria Vaccine Program, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
| | - Arsenio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Department of Physiologic Science, Clinical Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - John J. Aponte
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ruth Aguilar
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Savulescu DM, Groome M, Malfeld SCK, Madhi S, Koen A, Jones S, Duxbury V, Scheuermaier K, De Assis Rosa D, Suchard M. HLA antibody repertoire in infants suggests selectivity in transplacental crossing. Am J Reprod Immunol 2020; 84:e13264. [PMID: 32395838 PMCID: PMC7507134 DOI: 10.1111/aji.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
Problem Late in pregnancy, women produce and transfer high amounts of antibodies to the foetus. During gestation, women produce antibodies against human leukocyte antigens (HLA), including antibodies directed at foetal HLA. There is paucity of data on transplacental crossing, specificity and role of HLA antibodies in pregnancy and new‐borns. Method of study Using highly sensitive Luminex technology, we measured prevalence of IgG HLA antibodies in 30 mother‐infant pairs six weeks post‐partum. Additionally, in six pregnant women, we measured HLA antibodies longitudinally and HLA‐typed infant DNA to assess whether maternal HLA antibodies were directed at infant specificities. Results Overall, 68% of mothers and 44% of infants expressed HLA‐I antibodies and 56% of mothers and 52% of infants expressed HLA‐II antibodies. Infants shared up to 78% of antibodies with their mothers, suggesting that the remaining antibodies were self‐made. Less than 25% of maternal HLA antibodies were detected in infants, possibly due to selection in transplacental crossing. We detected complement‐fixing HLA antibodies in mothers and at low levels in infants. In a third of our pregnant subjects, we detected infant‐directed HLA antibodies. Conclusion Our findings raise the possibility of selection in transplacental crossing of HLA antibodies. As HLA antibodies may act as autoantibodies in the neonate, the mechanism of a selective transfer may give important insights into immune tolerance. Findings also suggest that infants start producing their own HLA antibodies in the first weeks of life, which, together with maternally derived antibodies may impact the infant's immune reaction to HLA proteins.
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Affiliation(s)
- Dana M Savulescu
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Michelle Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Susan C K Malfeld
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Shabir Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Stephanie Jones
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Vania Duxbury
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Karine Scheuermaier
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Debbie De Assis Rosa
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Zahreddine M, Mayrand MH, Therrien C, Trevisan A, Dagenais C, Monnier P, Laporte L, Niyibizi J, Deshaies C, Carceller AM, Fraser W, Brassard P, Lacroix J, Bédard MJ, Girard I, Audibert F, Coutlée F, Trottier H. Antibodies to human papillomavirus types 6, 11, 16 and 18: Vertical transmission and clearance in children up to two years of age. EClinicalMedicine 2020; 21:100334. [PMID: 32382718 PMCID: PMC7201033 DOI: 10.1016/j.eclinm.2020.100334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/04/2020] [Accepted: 03/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: There is a paucity of data on the dynamics of human papillomavirus (HPV) antibodies in children. We aimed to describe the vertical transmission and clearance of antibodies against HPV6, 11, 16 and 18 in children. Methods: We used data from pregnant women recruited into the HERITAGE cohort study between 2009 and 2012 who were positive for HPV-DNA at baseline. Dried blood spots were collected during the first trimester in pregnant participants, and at birth, 6, 12, and 24 months of age in children. The level of total immunoglobulin G (IgG) against HPV6, 11, 16 and 18 were measured using Luminex immunoassays. Spearman's coefficients were used to correlate HPV antibody levels between newborns and mothers. Panel and Kaplan-Meier graphics described antibody dynamics in the first 24 months of life. Findings: Antibodies from newborns and mothers (n = 58 pairs) were moderately to highly correlated with coefficients of 0·81 (95% confidence intervals (CI):0·70-0·88), 0·68 (95% CI:0·5-0·80), 0·90 (95% CI:0·83-0·94) and 0·85 (95% CI:0·76-0·91) against HPV6, 11, 16 and 18, respectively. In newborns seropositive at birth, anti-HPV antibodies were cleared by 80% and 100% at 12 and 24 months, respectively. Only two children presented detectable HPV antibodies at 24 months. The first child had no detectable antibodies at birth and the second presented increasing levels after two undetected measures. Interpretation: Correlation between mother and newborn IgG antibodies against HPV suggests vertical transfer. Most children cleared anti-HPV antibodies within six to 12 months. Funding: The Canadian Institutes of Health Research (CIHR).
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Affiliation(s)
- Monica Zahreddine
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - Marie-Hélène Mayrand
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Department of Obstetrics and Gynecology, Université de Montréal and CRCHUM, Montreal, Canada
| | - Christian Therrien
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Canada
| | - Andrea Trevisan
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - Carole Dagenais
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Canada
| | - Patricia Monnier
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Canada
| | - Louise Laporte
- Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - Joseph Niyibizi
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - Catherine Deshaies
- Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - Ana Maria Carceller
- Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Paul Brassard
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, Université de Montréal and CRCHUM, Montreal, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, St-Mary's Hospital Center, McGill University, Montreal, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
| | - François Coutlée
- Department of Microbiology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Canada
- Corresponding author at: Sainte-Justine Hospital Research Center, 3175 Côte-Sainte-Catherine Street, Room B.17.002, Montreal (QC), H3T 1C5, Canada.
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Albrecht M, Arck PC. Vertically Transferred Immunity in Neonates: Mothers, Mechanisms and Mediators. Front Immunol 2020; 11:555. [PMID: 32296443 PMCID: PMC7136470 DOI: 10.3389/fimmu.2020.00555] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/11/2020] [Indexed: 12/31/2022] Open
Abstract
Over the last years, an increasing number of outbreaks of vaccine-preventable infectious diseases has been reported. Besides elderly and immunocompromised individuals, newborns and small infants are most susceptible to infections, as their immune system is still immature. This vulnerability during infancy can be mitigated by the transplacental transfer of pathogen-specific antibodies and other mediators of immunity from mother to the fetus during pregnancy, followed postnatally by breast milk-derived immunity. Since this largely antibody-mediated passive immunity can prevent the newborn from infections, neonatal immunity depends strongly on the maternal concentration of respective specific antibodies during pregnancy. If titers are low or wane rapidly after birth, the protection transferred to the child may not be sufficient to prevent disease. Moreover, emerging concepts propose that mothers may transfer active immunity to the newborns via vertical transfer of pathogen-specific T cells. Overall, a promising strategy to augment and prolong neonatal immunity is to vaccinate the mother before or during pregnancy in order to boost maternal antibody concentrations or availability of specific T cells. Hence, a large number of pre-and postconceptional vaccine trials have been carried out to test and confirm this concept. We here highlight novel insights arising from recent research endeavors on the influence of prenatal maternal vaccination against pathogens that can pose a threat for newborns, such as measles, pertussis, rubella and influenza A. We delineate pathways involved in the transfer of specific maternal antibodies. We also discuss the consequences for children's health and long-term immunity resulting from an adjustment of prenatal vaccination regimes.
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Affiliation(s)
- Marie Albrecht
- Laboratory for Experimental Feto-Maternal Medicine, Department of Gynecology and Obstetrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Clara Arck
- Laboratory for Experimental Feto-Maternal Medicine, Department of Gynecology and Obstetrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sathiyanarayanan S, Kumar P, Rao CR, Kumar A, Kamath A, Kamath V. Prevalence of Maternal Measles Antibody and Its Associated Factors among Infants in Coastal Karnataka, India. Indian J Community Med 2020; 45:83-88. [PMID: 32029990 PMCID: PMC6985954 DOI: 10.4103/ijcm.ijcm_259_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/13/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The current recommendation in India to commence first dose of measles immunization is at 9 months of age. The effectiveness of measles vaccination is greatly impacted by the level of maternal measles antibody (MMA) during infancy. OBJECTIVES To find the prevalence of MMA and to study the maternal and infant factors associated with persistence of MMA among the infants in a Indian rural community. METHODOLOGY Dried blood spot sample was collected before vaccination among infants aged 9 months and above when they came for first dose of measles vaccine to assess measles-specific maternal IgG antibody titers by enzyme immunoassay. Maternal and child factors influencing persistence of MMA were collected by interviewing the mothers. Association between various factors affecting seropositivity was tested using univariate logistic regression analysis and strength of association is reported as risk ratio with 95% confidence interval. RESULTS Based on the qualitative estimation among all the recruited children (250) in the study, 4 (1.6%) infants showed the presence of MMA whereas 25 (10%) of children had MMA on quantitative estimation. The effect of maternal factors, child nutrition, and sociodemographic factors on the presence of MMA was not found to be statistically significant. CONCLUSION The prevalence of persistent MMA (IgG titer ≥200 mIU/ml) among the infants aged 9-12 months was 10%. The choice of vaccinating infants at the end of 9 months for the first dose of measles vaccine is justified as the remaining (90%) of infants were susceptible for measles infection at this age.
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Affiliation(s)
- S. Sathiyanarayanan
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Pawan Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chythra R. Rao
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arun Kumar
- Department for Virus Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Veena Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Javed N, Saqib MAN, Hassan Bullo MM, Asghar RJ. Seroprevalence of Transplacentally acquired Measles antibodies in unvaccinated infants at nine months of age and its relation to the feeding practices. BMC Infect Dis 2019; 19:587. [PMID: 31277599 PMCID: PMC6612169 DOI: 10.1186/s12879-019-4167-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 06/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In recent years Pakistan has faced frequent measles outbreaks killing hundreds of children despite the availability of vaccine for decades. This study was undertaken to determine the persistence of maternal transferred measles antibody levels in infants before measles vaccination with relation to their feeding practices. METHODS A cross sectional study was conducted at district Islamabad over 1 year between 1st October 2013 to 30th Sept. 2016. Any infant less than 9 months of age, not suffering from an acute or debilitating illness and not vaccinated was enrolled in the study. After taking written informed consent from parents / guardians, information was collected on a pretested questionnaire. About 3 cc venous blood was taken to quantify any measles IgG antibodies. Data was analyzed by using Epi Info 7.2 version. RESULTS Three hundred eighty-four infants were enrolled and were divided into three age groups, 1-90, 91-180 and 181-270 days age groups. Mean age of infants was 4.4 months ±3.2 SD. Male to female ratio was 1.2:1. A level of maternal measles IgG antibodies ≥12 U/ml was taken as protective. Of total 384 infants, 91(24%) had protective measles antibody titters (> 12 U/ml). and 65 (73%) of them were on breast milk. Highest antibody levels were found in 1-90 days age group. Analysis showed that 181-270 days aged infants had 3.1875 more odds of having unprotected/ low levels of antibodies against measles than children aged less than 180 days. Age group < 180 days found to be statistically significant with protective IgG levels (OR: 3.1875, P value: < 0.000063). CONCLUSION Measles protective antibodies were found in infants < 180 days age group. Breast feeding provides early protection against measles. Levels drop down to low levels immediately after birth and then after 06 months. It is, therefore, recommended that measles vaccination should be considered for administration at 6 months or even earlier if measles immunity is desired.
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Affiliation(s)
- Najma Javed
- Central Research Centre, PHRC, National Institute of Health, Islamabad, Pakistan
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Waning of measles maternal antibody in infants in measles elimination settings - A systematic literature review. Vaccine 2018; 36:1248-1255. [PMID: 29398276 DOI: 10.1016/j.vaccine.2018.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 12/13/2017] [Accepted: 01/04/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Most infants are born with immunity to measles through maternal antibodies transferred in pregnancy, which decay over time. However, in measles elimination settings, where measles does not circulate endemically and most immunity is from immunization rather than infection, maternal antibody levels are lower. This results in infant immunity that wanes earlier, and a wider susceptibility gap between maternal antibody decay and infant immunization than in non-eliminated settings. We aimed to systematically quantify the extent and duration of protection from measles in infants in settings that have sustained measles elimination. METHODS We conducted a systematic review of studies of measles maternal antibody waning in infants in measles elimination settings. We searched MEDLINE, Embase, CINAHL, Scopus, BIOSIS Previews, and Global Health databases for relevant studies. Studies were included if they were set in countries that had eliminated measles for ≥3 years, and if the study cohort included healthy, full-term, unvaccinated infants ≤12 months, born to healthy mothers, and reported a relevant measure of measles maternal antibody in infants. We assessed study quality using the MetaQAT tool. RESULTS We identified 4692 unique citations, eight of which met inclusion criteria. One study reported anti-measles antibody in cord blood, six reported antibody in infant sera, and one reported both. Two studies reported that 80 and 100% of infants were protected from measles at birth. One study reported no protection amongst 3-7 month old infants, and another reported limited protection in infants >4 months. The remaining studies reported the proportion of infants with detected antibody, but not the proportion immune. CONCLUSION Although limited, these data suggest that in settings that have sustained measles elimination, some infants are susceptible to measles well before the age of routine measles immunization. Setting-specific seroprevalence and vaccine effectiveness studies are required to evaluate this in different jurisdictions.
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Fu C, Lu L, Wu H, Shaman J, Cao Y, Fang F, Yang Q, He Q, Yang Z, Wang M. Placental antibody transfer efficiency and maternal levels: specific for measles, coxsackievirus A16, enterovirus 71, poliomyelitis I-III and HIV-1 antibodies. Sci Rep 2016; 6:38874. [PMID: 27934956 PMCID: PMC5146964 DOI: 10.1038/srep38874] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/16/2016] [Indexed: 11/30/2022] Open
Abstract
Maternal antibodies transported across the placenta can provide vital immunity against infectious pathogens for infants. We here examine maternal antibody (MA) levels and their association with neonatal antibody levels. Pregnant women of gestational age ≥35 weeks were enrolled at a Guangzhou China hospital and mother-infant paired sera were collected. Measles IgG antibody was detected using ELISA assay, neutralizing antibodies titers against coxsackievirus A16 (CA16), enterovirus 71 (EV71), PV I-III and HIV-1 were performed. 711 mother-infant pairs were enrolled and positive relationships for paired serums were found (r: 0.683-0.918). 81.6%, 87.0%, and 82.3% of mothers, and 87.3%, 72.7%, and 72.2% of newborns were positive for measles, CA16 and EV71 antibodies respectively. The highest Neonatal: maternal ratio (NMR) was found in measles (1.042) and the ratios for the other pathogens ranged from 0.84 to 1.00. Linear regressions showed that log(NMR) decreased by a factor of 0.04-15.43 as log(MA) levels increased. A second analysis restricted to maternal positive measles sera revealed that MA measles of was still inversely associated with NMR. Low NMR was found in high MA HIV + serums among 22 paired sera. MA levels appear to play a role determining transplacental antibody transfer; further study is needed to reveal the mechanism.
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Affiliation(s)
- Chuanxi Fu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Long Lu
- Liwan District Maternal and Child Health Hospital, Guangzhou, China
| | - Hao Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yimin Cao
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Fang Fang
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, USA
| | - Qiongying Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Qing He
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Ming Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
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Abstract
Vaccinations of premature infants are often delayed despite being at an increased risk of contracting vaccine preventable diseases. This article reviews the current knowledge on the immune response to widely used vaccines, on the protection derived from routine immunization and on vaccine safety and tolerability in a population of preterm infants. Available data evaluating the immune response of preterm infants support early immunization without correction for gestational age. For a number of antigens, the antibody response to initial doses of vaccines may be lower than that of term infants, but protective concentrations are often achieved and memory successfully induced. Vaccines are immunogenic, safe and well tolerated in preterm infants. Preterm infants should be vaccinated using the same schedules as those usually recommended for full-term infants, with the exception of the hepatitis B vaccine, where additional doses should be administered in infants receiving the first dose during the first days of life if they weighed less than 2000 g because of a documented reduced immune response.
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Affiliation(s)
- Arnaud Gagneur
- a Department of Pediatrics ; Faculty of Medicine and Health Sciences, University of Sherbrooke ; Sherbrooke , Québec , Canada
| | - Didier Pinquier
- b Rouen University Hospital ; Neonatal Pediatric and Intensive Care Department ; IHU, EA4309, Charles Nicolle Hospital, Rouen , France
| | - Caroline Quach
- c Departments of Pediatrics and Epidemiology ; Biostatistics & Occupational Health, McGill University ; Montreal , Quebec , Canada
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Hoang HTT, Leuridan E, Maertens K, Nguyen TD, Hens N, Vu NH, Caboré RN, Duong HT, Huygen K, Van Damme P, Dang AD. Pertussis vaccination during pregnancy in Vietnam: Results of a randomized controlled trial Pertussis vaccination during pregnancy. Vaccine 2015; 34:151-9. [PMID: 26529073 DOI: 10.1016/j.vaccine.2015.10.098] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
A pertussis vaccination during pregnancy has recently been adopted in several countries to indirectly protect young infants. This study assessed the effect of adding a pertussis component to the tetanus vaccination, in the pregnancy immunization program in Vietnam. A randomized controlled trial was performed. Pregnant women received either a Tdap (tetanus, diphtheria acellular pertussis) vaccine or a tetanus only vaccine between 19 and 35 weeks' gestational age. Immunoglobulin G (IgG) against tetanus (TT), diphtheria (DT), pertussis toxin (PT), filamentous hemaglutinin (FHA) and pertactin (Prn) were measured using commercial ELISA tests, at baseline, 1 month after maternal vaccination, at delivery, and in infants from cord blood and before and after the primary series (EPI: month 2-3-4) of a pertussis containing vaccine. Significantly higher geometric mean concentrations (GMC) were observed for all 3 measured pertussis antigens in the offspring of the Tdap group, up to 2 months of age. One month after completion of the primary infant vaccination schedule, anti-Prn GMC, but not anti-PT and anti-FHA GMCs, was significantly (p=0.006) higher in the control group. Maternal antibodies induced by vaccination during pregnancy close the susceptibility gap for pertussis in young infants. Limited interference with the infant vaccine responses was observed. Whether this interference effect disappears with the administration of a fourth vaccine dose is further studied.
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Affiliation(s)
- Ha Thi Thu Hoang
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam.
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Trung Dac Nguyen
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belguim; Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium
| | - Ngoc Ha Vu
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Raissa Nadège Caboré
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), 1180 Brussels, Belgium
| | - Hong Thi Duong
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam
| | - Kris Huygen
- National Reference Centre Bordetella, Service Immunology, Scientific Institute of Public Health (WIV-ISP), 1180 Brussels, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610 Antwerpen, Belgium
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Yersin Street 1, Hanoi 10000, Vietnam.
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14
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Plans P, de Ory F, Campins M, Álvarez E, Payà T, Guisasola E, Compte C, Vellbé K, Sánchez C, Lozano MJ, Aran I, Bonmatí A, Carreras R, Jané M, Cabero L. Prevalence of anti-rubella, anti-measles and anti-mumps IgG antibodies in neonates and pregnant women in Catalonia (Spain) in 2013: susceptibility to measles increased from 2003 to 2013. Eur J Clin Microbiol Infect Dis 2015; 34:1161-71. [PMID: 25666082 DOI: 10.1007/s10096-015-2339-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
Non-immune neonates and non-immune pregnant women are at risk of developing rubella, measles and mumps infections, including congenital rubella syndrome. We describe the seroepidemiology of measles, mumps and rubella (MMR) in neonates and pregnant women in Catalonia (Spain). Anti-rubella, anti-measles and anti-mumps serum IgG titres were assessed using enzyme-linked immunosorbent assay (ELISA) tests in 353 cord blood samples from neonates of a representative sample of pregnant women obtained in 2013. The prevalence of protective antibody titres in neonates was 96 % for rubella IgG (≥8 IU/ml), 90 % for measles IgG (>300 IU/ml) and 84 % for mumps IgG (>460 EU/ml). Slightly lower prevalences of protective IgG titres, as estimated from the cord blood titres, were found in pregnant women: 95 % for rubella IgG, 89 % for measles IgG and 81 % for mumps IgG. The anti-measles and anti-mumps IgG titres and the prevalences of protective IgG titres against measles and mumps increased significantly (p < 0.001) with maternal age. The prevalence of protective anti-measles IgG titres decreased by 7 % [odds ratio (OR) = 0.15, p < 0.001), the prevalence of protective anti-rubella IgG titres increased by 3 % (OR = 1.80, p < 0.05) and the MMR vaccination coverage (during childhood) in pregnant women increased by 54 % (OR = 2.09, p < 0.001) from 2003 to 2013. We recommend to develop an MMR prevention programme in women of childbearing age based on mass MMR vaccination or MMR screening and vaccination of susceptible women to increase immunity levels against MMR.
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Affiliation(s)
- P Plans
- Public Health Agency of Catalonia, Department of Health of Catalonia, Roc Boronat 83-95, 008005, Barcelona, Spain,
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15
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van den Berg JP, Westerbeek EAM, Smits GP, van der Klis FRM, Berbers GAM, van Elburg RM. Lower transplacental antibody transport for measles, mumps, rubella and varicella zoster in very preterm infants. PLoS One 2014; 9:e94714. [PMID: 24728480 PMCID: PMC3984210 DOI: 10.1371/journal.pone.0094714] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/19/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal antibodies, transported over the placenta during pregnancy, contribute to the protection of infants from infectious diseases during the first months of life. In term infants, this protection does not last until the first recommended measles-mumps-rubella vaccination at 14 months in the Netherlands, while these viruses still circulate. The aim of the study was to investigate the antibody concentration against measles, mumps, rubella and varicella (MMRV) in mothers and preterm infants or healthy term infants at birth. METHODS Antibody concentrations specific for MMRV were measured in cord blood samples from preterm (gestational age <32 weeks and/or birth weight <1500 g) and term infants, and matched maternal serum samples, using a fluorescent bead-based multiplex immune-assay. RESULTS Due to lower placental transfer ratios of antibodies against MMRV in 96 preterm infants (range 0.75-0.87) compared to 42 term infants (range 1.39-1.65), the preterm infants showed 1.7-2.5 times lower geometric mean concentrations at birth compared to term infants. Maternal antibody concentration is the most important determinant of infant antibody concentration against MMRV. CONCLUSIONS Preterm infants benefit to a lesser extent from maternal antibodies against measles, mumps, rubella and varicella than term infants, posing them even earlier at risk for infectious diseases caused by these still circulating viruses.
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Affiliation(s)
- Jolice P. van den Berg
- Department of Paediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth A. M. Westerbeek
- Department of Paediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Gaby P. Smits
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona R. M. van der Klis
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Guy A. M. Berbers
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Ruurd M. van Elburg
- Department of Paediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
- Centre for Specialised Nutrition, Nutricia Research, Utrecht, The Netherlands
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16
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Maertens K, De Schutter S, Braeckman T, Baerts L, Van Damme P, De Meester I, Leuridan E. Breastfeeding after maternal immunisation during pregnancy: providing immunological protection to the newborn: a review. Vaccine 2014; 32:1786-92. [PMID: 24530929 DOI: 10.1016/j.vaccine.2014.01.083] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/24/2014] [Accepted: 01/30/2014] [Indexed: 11/18/2022]
Abstract
Vaccination during pregnancy results in an augmentation of disease specific maternal antibodies. Immunoglobulin G (IgG) is mainly transferred through the placenta during the third trimester of pregnancy, while secretory Immunoglobulin A (sIgA) is passed through breast milk. At birth, newborns are partially protected against infectious diseases by these antibodies. This review aims to provide an overview of the effect of vaccination during pregnancy on the immunological protection of the newborn by the presence of disease specific sIgA antibodies in breast milk and their possible protective function against disease. Our search produced 11 relevant papers; 1 on pertussis, 7 on pneumococcus, 2 on influenza and 1 on meningococcus. All of the studies in this review that measured disease specific antibodies in breast milk (n=8 papers), stressed the beneficial effect of maternal vaccination during pregnancy on the amount of disease specific sIgA in breast milk. Only a few studies demonstrated a potential protective effect, particularly with influenza vaccines. In an era where maternal vaccination is increasingly considered as a valuable strategy to protect both the mother and infant, further research is needed to assess the effect on breast milk sIgA and to understand the potentially beneficial effects to the infant.
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Affiliation(s)
- Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - Sara De Schutter
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Tessa Braeckman
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Lesley Baerts
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ingrid De Meester
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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17
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Matysiak-Klose D. [Hot spot: epidemiology of measles and rubella in Germany and the WHO European region]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:1231-7. [PMID: 23990084 DOI: 10.1007/s00103-013-1799-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The elimination of measles and rubella by 2015 is an important goal set by the World Health Organization European Region (WHO/Europa). Since 1991, the incidence of measles in WHO/Europa declined owing to routine childhood vaccination and supplementary immunization activities in the region. However, in many countries of Western Europe elimination of measles and rubella remains a challenge, and every year there are outbreaks with partly long-lasting transmission chains and dissemination of the virus internationally. In Germany, outbreaks occur because of the high proportion of susceptible individuals in specific population groups. In 2011, over 1,600 cases were reported (19.7 per 1,000,000 inhabitants, data from the Robert Koch Institute) whereas in 2012 only 167 cases were reported to the Robert Koch Institute (2 per 1,000,000 inhabitants). It is unclear whether the declining trend will continue in the following years due to improved vaccination coverage or whether number of cases will rise again because of the accumulation of susceptible groups. In Germany, there are currently no representative, country-wide data on rubella; however, data from the eastern federal states provide important epidemiological insights. Outbreaks are seldom reported, but statutory notification of rubella and congenital rubella syndrome was implemented in March 2013. As a result, it will be possible to better assess the epidemiology of rubella in Germany, although a considerable underreporting of rubella cases is anticipated.
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Affiliation(s)
- D Matysiak-Klose
- Fachgebiet Impfprävention, Robert Koch-Institut, DGZ-Ring 1, 13086, Berlin, Deutschland.
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18
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Gunes T, Koklu E, Ozturk MA, Akcakus M, Kurtoglu S, Cetin N, Koklu S. Antimeasles antibodies in preterm infants during early infancy in Turkey. ACTA ACUST UNITED AC 2013; 27:31-7. [PMID: 17469730 DOI: 10.1179/146532807x170484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM To measure maternally derived measles antibodies in sera of premature infants at birth and seropositivity rates in early infancy in a rural area of central Turkey. METHODS 65 premature and 24 full-term infants born in Erciyes University Hospital and their mothers were recruited to a longitudinal, prospective study. The infants were divided into three groups by gestational age: group A, <33 weeks; group B, 33-37 weeks; group C, >37 weeks. For specific analyses, the groups were subdivided into groups Al, B1 and C1 (infants of naturally immunised mothers) and A2, B2 and C2 (infants of vaccinated mothers). Blood samples were obtained from mothers and infants after delivery. The infants were re-evaluated at 2, 4 and 6 months of age. RESULTS Of 25 mothers, 20.3% were seronegative for measles antibodies. Twenty of the mothers had not been vaccinated. The percentages of seronegative infants at birth were 24.2% (n=8), 12.5% (n=4) and 0% (n=0) in groups A, B and C, respectively. No infants were seronegative at birth in Al, B1 or C1. Mean levels of antimeasles antibodies in all naturally immunised mothers were significantly higher than in vaccinated mothers. Antibody levels in all infants decreased rapidly with increasing age. Gestational age at birth [beta=0.179, t=3.359, 95% confidence interval (CI) 0.0001-0.0001, p<0.05], birthweight (beta=0.637, t=9.691, 95% CI 0.057-0.086, p<0.05) and maternal naturally immunised status (beta=0.168, t=2.825, 95% CI 0.002-0.014, p<0.05) were significantly associated with antibody levels after birth. In all groups of naturally immunised mothers, the percentages of seronegative infants were significantly lower than in vaccinated mothers at birth and at 2, 4 and 6 months of age. CONCLUSION The current recommendation to immunise all infants at 9 months of age might require revision for premature infants, especially those whose mothers have vaccination-induced immunity.
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Affiliation(s)
- Tamer Gunes
- Division of Neonatology, Department of Paediatrics, School of Medicine, Erciyes University, Kayseri, Turkey.
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20
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Zhang X, Shirayama Y, Zhang Y, Ba W, Ikeda N, Mori R, Shibuya K. Duration of maternally derived antibody against measles: a seroepidemiological study of infants aged under 8 months in Qinghai, China. Vaccine 2011; 30:752-7. [PMID: 22133513 DOI: 10.1016/j.vaccine.2011.11.078] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/11/2011] [Accepted: 11/18/2011] [Indexed: 11/24/2022]
Abstract
To estimate the sero-prevalence of protective maternal measles antibodies among young infants and examine patterns of waning immunity in one of the poorest provinces in China, infants aged under 8 months and their mothers were randomly selected by multi-stage probabilistic sampling and blood samples were collected. Measles-specific IgG antibodies were measured in all serum samples by enzyme-linked immunosorbent assay. We determined measles-specific antibody titres for 477 pairs of infants and their mothers. After excluding 44 sub-clinical measles infection in infants, the measles antibody titres were ≧1:200, ≧1:800, and ≧1:3200 in 79.2%, 46.9%, and 17.8% of the 433 infants, respectively. The proportion of infants with titre ≧1:800 declined with age from 90.2% in newborns to 45.5% and 14.9% in the fourth and eighth month, respectively. Among the 433 mothers, measles antibody titres were ≧1:800 in 94.0%. Multivariate regression analysis showed that residence, mother's antibody levels and infant's age were significantly associated with infants' having a measles antibody titre ≧1:800. The relatively rapid decay of protective antibody in infants suggests that an earlier administration of the first dose of measles vaccination should be considered in China and a high quality interventional study is needed to decide the optimal schedule of measles immunization.
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Affiliation(s)
- Xinwei Zhang
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan.
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21
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van den Berg JP, Westerbeek EAM, van der Klis FRM, Berbers GAM, van Elburg RM. Transplacental transport of IgG antibodies to preterm infants: a review of the literature. Early Hum Dev 2011; 87:67-72. [PMID: 21123010 DOI: 10.1016/j.earlhumdev.2010.11.003] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
Newborn infants, especially preterm infants, have an immature immune system, which is not capable to actively protect against vaccine-preventable infections. Therefore, the newborn is dependent on transplacental transport of Immunoglobulin G (IgG), an active, FcRn receptor mediated process. Fetal IgG rises from approximately 10% of the maternal concentration at 17-22weeks of gestation to 50% at 28-32weeks of gestation. If transplacental acquired IgG is lower in preterm than in term infants, preterm infants are especially at risk for these vaccine-preventable diseases. The aim of this study was to review the transplacental transfer of IgG against vaccine-preventable diseases (measles, rubella, varicella-zoster, mumps, Haemophilus influenza type B, diphtheria, tetanus, pertussis and polio) to (pre)term infants and to identify factors that influence the transplacental transfer of these antigens. After selection, 18 studies on transplacental transport to preterm infants were included. In general, these studies showed for all antibodies that preterm infants have lower antibody concentrations compared with term infants. Maternal and infants antibody concentrations showed a strong correlation in 7 of the included studies. Infant antibody concentration was not associated with parity, maternal age, height or weight. Infants of vaccinated mothers had lower anti-measles antibody titers than infants of natural immunized mothers. IgG titers of preterm infants decrease earlier in life below protective antibody titers than term infants. Combined with their immature immune system, this puts preterm infants at increased risk for vaccine-preventable diseases.
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Affiliation(s)
- J P van den Berg
- Department of Paediatrics, Division of Neonatology, VU University Medical Center Amsterdam, The Netherlands
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22
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Transplacental transport of IgG antibodies specific for pertussis, diphtheria, tetanus, haemophilus influenzae type b, and Neisseria meningitidis serogroup C is lower in preterm compared with term infants. Pediatr Infect Dis J 2010; 29:801-5. [PMID: 20803841 DOI: 10.1097/inf.0b013e3181dc4f77] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Maternal antibodies, transported through the placenta during pregnancy, contribute to the protection of infants from infectious diseases during the first months of life. The aim of this study was to measure the concentration of antibodies against several vaccine-preventable diseases in paired maternal and cord blood serum samples in preterm and term infants and to assess placental transfer ratios and infant antibody concentrations against vaccine-preventable diseases. METHODS Antibody concentrations specific against pertussis proteins (pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae), diphtheria and tetanus toxins, and antibody concentrations specific against polysaccharides from Haemophilus influenzae type b and Neisseria meningitidis serogroup C were measured in cord blood samples from preterm (<32 weeks and 1500 g) and term infants and maternal serum samples, using a fluorescent bead-based multiplex immunoassay. RESULTS A total of 96 preterm and 42 term infants and their mothers were included in the study. Placental transfer ratios of antibodies against all vaccine antigens were significantly lower in preterm infants (medians varied from 0.26 to 0.86) compared with term infants (medians, 0.74-1.89; all antibodies P < 0.05). Furthermore, polysaccharide-vaccine-specific antibodies showed lower transplacental transport ratios than protein-vaccine-specific antibodies. Maternal concentrations are the most important determinants of infant antibody concentrations against vaccine-preventable diseases. CONCLUSIONS Preterm infants benefit to a lesser extent from maternal antibodies against vaccine-preventable diseases than term infants, posing them at higher risk for infectious diseases in the first months of life.
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Kruczek A, Cutland C, Madhi SA. Effect of maternal HIV infection on measles susceptibility during early infancy: implications for optimizing protection of the infant. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The measles virus was first isolated as the causative pathogen of measles approximately 50 years ago by John Enders and Thomas Peebles. Despite a safe and effective vaccine extant for nearly the same amount of time, control of measles nevertheless remains a challenge in developing countries. This article investigates the possible contribution of maternal HIV infection on measles susceptibility in infants. The current WHO position on measles vaccination in HIV-infected children recommends vaccinating asymptomatic HIV-infected infants as early as 6 months of age, followed with two additional doses at 9 and 18 months. This is rarely implemented due to logistical constraints related to early HIV diagnosis in infants and access to vaccines in low-resource settings. In addition, measles vaccine safety and immunogenicity in HIV-infected children are based on very low levels of scientific evidence. There are no specific recommendations for measles immunization of HIV-uninfected children born to HIV-infected mothers. We reviewed the available data on transplacental transfer of measles antibody and the influence of HIV, the findings of which suggest that consideration should be given to extending early measles immunization to all infants born to HIV-infected women.
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Affiliation(s)
| | - Clare Cutland
- Department of Science & Technology/National Research Foundation: Vaccine Preventable Diseases & Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - Shabir A Madhi
- Department of Science & Technology/National Research Foundation: Vaccine Preventable Diseases & Medical Research Council: Respiratory & Meningeal Pathogens Research Unit, University of the Witwatersrand, Soweto, South Africa
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24
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Go H, Hashimoto K, Imamura T, Sato M, Kawasaki Y, Momoi N, Hosoya M. An extremely low body weight infant born to a mother with measles. J Perinatol 2010; 30:146-8. [PMID: 20118942 DOI: 10.1038/jp.2009.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The incidence of measles epidemics has decreased recently owing to the development and widespread use of measles vaccine in the United States of America and Europe. However, repeated measles epidemics have been reported in Japan. Here, the authors report a case of an extremely low body weight infant (ELBWI) whose mother had a measles virus infection. Real-time PCR was performed on the infant's blood and urine samples and skin, nasal secretion, and anal swabs, as well as on the mother's breast milk, blood samples and throat swabs. The infant was found to be positive for measles virus by PCR, but not immunoglobulin M positive. An earlier report showed that there were no such cases in which the patient was found to be positive for measles virus by real-time PCR but was not infected by the measles virus.
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Affiliation(s)
- H Go
- Department of Pediatrics, Fukushima Medical University of School of Medicine 1 Hikarigaoka, Fukushima, Japan.
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Kinetics of decline of maternal measles virus-neutralizing antibodies in sera of infants in France in 2006. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 15:1845-50. [PMID: 18815232 DOI: 10.1128/cvi.00229-08] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The optimal age for measles vaccination is an important health issue, since maternal antibodies may neutralize the vaccine antigen before a specific immune response develops, while delaying vaccination may increase the risk of complicated diseases in infants. However, measles vaccination impacts the duration of protection afforded by transplacental transfer of maternal antibodies: vaccination-induced maternal antibodies disappear faster than disease-induced antibodies. In order to maintain protection against measles in infants, it is important to monitor the dynamics of this phenomenon in vaccinated populations. To assess the current situation in France, a multicenter, prospective seroepidemiological study was conducted in seven French hospitals between October 2005 and January 2007. Maternal measles antibody concentrations from 348 infants 0 to 15 months old were measured using the plaque reduction neutralization assay. Geometric mean concentrations and the percentage of infants with maternal measles antibody concentrations above the protection threshold (>or=120 mIU/ml) were assessed according to age. Results show that after more than 20 years of routine measles vaccination in France, maternal measles-neutralizing antibodies decrease dramatically in French infants by 6 months of age, from 1,740 mIU/ml for infants 0 to 1 month old to 223 mIU/ml for infants 5 to 6 months old, and that 90% of infants are not protected against measles after 6 months of age. Infant protection against measles could be optimized both by increasing herd immunity through an increased vaccine coverage and by lowering the age of routine vaccination from 12 to 9 months.
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Measles vaccine. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Leuridan E, Van Damme P. Passive transmission and persistence of naturally acquired or vaccine-induced maternal antibodies against measles in newborns. Vaccine 2007; 25:6296-304. [PMID: 17629601 DOI: 10.1016/j.vaccine.2007.06.020] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 06/08/2007] [Accepted: 06/11/2007] [Indexed: 12/01/2022]
Abstract
This paper reviews literature on passively transferred maternal antibodies against measles in infants. The amount and decay of these antibodies can be a result of changing patterns in society: increasing cohorts of women are vaccinated against measles instead of having naturally acquired immunity, the age of first childbirth is increasing and young adults are less exposed to natural boosters. The concentration and persistence of maternal antibodies differ in infants of women vaccinated against measles versus infants of naturally immune women. The date for commencing universal measles vaccination should take into account the presence of these antibodies since they can hamper the immunological response to vaccination. Each country should therefore consider adapting the timing of vaccination in relation to its measles sero-epidemiological situation. The possibility of priming the immune system with an early vaccine dose and boosting later on offers opportunities for vaccination at very young age.
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Affiliation(s)
- E Leuridan
- Centre for the Evaluation of Vaccination, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium.
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28
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Abstract
Premature infants are at increased risk of vaccine preventable infections, but audits have shown that their vaccinations are often delayed. Early protection is desirable. While the evidence base for immunisation of preterm infants is limited, the available data support early immunisation without correction for gestational age. For a number of antigens the antibody response to initial doses may be lower than that of term infants, but protective concentrations are often achieved and memory successfully induced. A 2-3-4 month schedule may be preferable for immunisation of preterm infants in order to achieve protection as early as possible, but an additional dose may be required to achieve persistence of protection. This update focuses on the use of routine childhood vaccines in premature infants.
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Arya SC, Agarwal N. Measles during pregnancy including neonates. J Infect 2005; 51:340-1. [PMID: 16291291 DOI: 10.1016/j.jinf.2005.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Accepted: 01/10/2005] [Indexed: 11/20/2022]
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