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De Weerdt L, Herzog SA, Van Damme P, Maertens K. Timing of pertussis vaccination during pregnancy: Evidence and implementation - A systematic review. Vaccine 2024; 42:126152. [PMID: 39088988 DOI: 10.1016/j.vaccine.2024.07.053] [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: 05/15/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Pertussis vaccination in pregnancy has been introduced in an increasing number of countries to better protect infants against the disease in their first weeks of life. The optimal timing of pertussis vaccination in pregnancy is however still under debate. METHODS We systematically reviewed published literature on safety, immunogenicity and effectiveness of pertussis vaccination in pregnancy related to timing of vaccination. The search was conducted using PubMed, MEDLINE and Web of Science and yielded 1623 articles, thereof 777 duplicates. Screening resulted in the inclusion of 45 publications reporting on safety (n = 11), immunogenicity (n = 26) and/or effectiveness (n = 9). We also mapped pertussis recommendations in pregnancy by government institutions globally according to the recommended timing of vaccination. RESULTS Overall, the selected publications did not indicate increased safety concerns associated with timing of pertussis vaccination in pregnancy. Immunogenicity studies often suggested optimal protection at birth after early third trimester vaccination. Few studies investigated qualitative antibody characteristics, and none investigated antibody titers in breastmilk or cellular-mediated immunity related to timing of vaccination. Effectiveness studies showed decreased vaccine effectiveness of late third trimester pertussis vaccination compared to vaccination earlier in pregnancy. Worldwide, a general recommendation for pertussis vaccination in pregnancy was found for 58 countries, with as many as 22 different recommended timings registered. CONCLUSION The timing of pertussis vaccination in pregnancy seems to impact immunogenicity and vaccine effectiveness, with optimal immune responses at birth suggested following early third trimester vaccination and reduced vaccine effectiveness of late third trimester pertussis vaccination suggested compared to vaccination earlier in pregnancy. However, inconsistent and lacking data are reflected in the divergent national recommendations for pertussis vaccination in pregnancy worldwide. SUMMARY Pertussis vaccination in pregnancy aims to protect infants in their first weeks of life. Our review suggests that immunogenicity and vaccine effectiveness are impacted by the timing of vaccination in pregnancy. National recommendations for pertussis vaccination in pregnancy vary widely worldwide.
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Affiliation(s)
- Louise De Weerdt
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Sereina A Herzog
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
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Jasset MOJ, Andrea Lopez Zapana P, Bahadir Z, Shook L, Dennis MM, Gilbert ME, Liu MZA, Yinger MRV, Bald MC, Bradford MCG, Silfen MAH, Klein SL, Pekosz A, Permar S, Konnikova L, Yonker LM, Lauffenburger D, Nelson A, Elovitz MA, Edlow AG. Longer interval between maternal RSV vaccination and birth increases placental transfer efficiency. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.14.24310390. [PMID: 39072025 PMCID: PMC11275666 DOI: 10.1101/2024.07.14.24310390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Background Respiratory Syncytial Virus (RSV) is associated with significant neonatal and infant morbidity and mortality. Maternal bivalent RSVpreF RSV vaccination to protect neonates and infants was approved in September 2023 for administration between 32+0 and 36+6 weeks to protect neonates and infants. This approved timeframe is narrower than the 24-36 week window evaluated in the clinical trial, due to the possible association between preterm birth and vaccine administration. Currently, data are lacking on how maternal vaccine timing within the approved window affects the transfer of antibodies from mother to fetus, critical information that could influence clinical practice. Objectives We sought to examine how gestational age at vaccination and time elapsed from maternal RSV vaccination to delivery impacted transfer of maternal antibodies measured in the umbilical cord at delivery and in peripheral blood of 2-month infants. We also examined differences in maternal and cord RSV antibody levels achieved by vaccination versus natural RSV infection. Study Design A prospective cohort study was conducted at two academic medical centers between September 20, 2023 and March 21, 2024, enrolling 124 individuals who received the RSV vaccine during pregnancy. Infant capillary blood was collected at 2 months of age from 29 of the infants. Maternal and cord IgG levels achieved by RSV vaccination were compared to those associated with maternal natural RSV infection, using banked blood from 20 maternal:cord dyads collected prior to the availability of the maternal RSV vaccine. Levels of IgG against RSV strain A2 and B fusion (F) and attachment (G) proteins and against pertussis toxin (as a comparator antigen from a vaccine routinely administered earlier in pregnancy) were measured using a Binding Antibody Multiplex Assay. Differences in titers between vaccination and natural infection were examined using Wilcoxon rank sum test. Differences in cord:maternal transfer ratios and 2-month infant antibody levels by timing of maternal vaccination were evaluated by Kruskal-Wallis testing. Results Maternal RSV vaccination resulted in significantly higher maternal and cord anti-F RSV antibody levels than natural infection (5.72 vs 4.82 log 10 MFI, p < 0.0001 maternal; 5.81 vs 5.03 log 10 MFI, p < 0.0001 cord). Maternal vaccination 2-3 weeks and 3-4 weeks prior to delivery was associated with significantly lower cord:maternal transfer ratios than were observed when vaccination occurred > 5 weeks prior to delivery (p = 0.03 for 2-3 weeks, p = 0.007 for 3-4 weeks), and significantly lower transfer ratios than observed for pertussis vaccination administered prior to 30 weeks' gestation (p = 0.008 for 2-3 weeks, p = 0.03 for 3-4 weeks, similar at > 4 weeks). Conclusions Vaccine administration earlier in the approved 32-36 week window (at least 5 weeks prior to delivery) results in the highest transplacental transfer of maternal antibodies to the neonate. These results should inform the counseling of pregnant individuals on optimal vaccination timing.
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Immink MM, Bekker MN, de Melker HE, den Hartog G, Rots NY, van Gageldonk PGM, Groenendaal F, Sanders EAM, van der Maas NAT. Maternal Pertussis Immunization and Immunoglobulin G Levels in Early- to Late-Term and Preterm Infants. JAMA Netw Open 2024; 7:e2424608. [PMID: 39078627 PMCID: PMC11289700 DOI: 10.1001/jamanetworkopen.2024.24608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/28/2024] [Indexed: 07/31/2024] Open
Abstract
Importance Maternal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination protects newborns against severe pertussis. Data on transplacental antibody transfer on Tdap vaccination before 24 weeks' gestation remain scarce and are particularly relevant for preterm infants to increase the time interval for maternal antibody transfer. Objective To assess noninferiority of anti-pertussis toxin (anti-PT) immunoglobulin G (IgG) antibody levels at age 2 months in early- to late-term infants following Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 30 0/7 and 33 0/7 weeks' gestation and compared with preterm infants. Design, Setting, and Participants This prospective, multicenter cohort study included pregnant women aged 18 years or older in birthing centers and hospitals in the Netherlands between August 2019 and November 2021 who received Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation. Women with imminent premature birth were recruited if they had received maternal Tdap vaccination between 20 and 24 weeks' gestation. Blood samples were collected from mothers at delivery, from the umbilical cord, and from infants at age 2 months. Data from infants' blood samples at age 2 months were compared with a reference cohort (recruited between January 2014 and February 2016) of early- to late-term infants of the same age whose mothers had received Tdap vaccination between 30 0/7 and 33 0/7 weeks' gestation. Exposure Maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation or 30 0/7 and 33 0/7 weeks' gestation. Main Outcomes and Measures The primary outcome was the geometric mean concentration (GMC) of anti-PT IgG antibodies in early- to late-term infants (≥37 0/7 weeks' gestation) at age 2 months, comparing maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' vs 30 0/7 and 33 0/7 weeks' gestation (reference cohort). Anti-PT GMC in 2-month-old infants born preterm (<35 0/7 weeks' gestation) compared with early- to late-term infants after maternal Tdap vaccination between 20 and 24 weeks' gestation was a secondary outcome. Results In total, 221 women who delivered 239 offspring were enrolled in the study; 66 early- to late-term infants (median gestational age [GA], 40.6 weeks [IQR, 39.8-41.0 weeks]; 38 [57.6%] male) and 73 preterm infants (median GA, 32.1 weeks [IQR, 29.5-33.0 weeks]; 42 [54.5%] female) had blood samples collected at 2 months of age. Anti-PT GMC was 14.7 IU/mL (95% CI, 10.6-20.4 IU/mL) in early- to late-term infants following maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 27.3 IU/mL (95% CI, 20.1-37.1 IU/mL) in 55 infants in the reference group (median GA, 40.3 [IQR, 39.1-41.0]; 33 [60.0%] female). The mean anti-PT GMC in preterm infants in the study group was 11.2 IU/mL (95% CI, 8.1-15.3 IU/mL) (P = .23 compared with early- to late-term infants). Conclusions and Relevance In this cohort study, 2-month-old preterm and early- to late-term infants showed significantly lower anti-PT antibody levels following maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 30 0/7 and 33 0/7 weeks' gestation; preterm and early- to late-term infants had similar anti-PT antibody levels, but both groups showed significantly lower antibody levels compared with the reference group. Epidemiological research should investigate whether maternal Tdap vaccination before 24 weeks' gestation provides sufficient protection against clinical pertussis, particularly in preterm infants, as long as no correlate of protection is available.
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Affiliation(s)
- Maarten M. Immink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Hester E. de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Gerco den Hartog
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Obstetrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nynke Y. Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Pieter G. M. van Gageldonk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Elisabeth A. M. Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Nicoline A. T. van der Maas
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Lee JY, Lee JA, Lee HK, Kim YB, Lee SM, Nam CJ. BVN008, Diphtheria-tetanus-acellular pertussis combined vaccine has no effects on fertility and prenatal and postnatal developmental toxicity in female Sprague-Dawley rats. Reprod Toxicol 2024; 126:108587. [PMID: 38663639 DOI: 10.1016/j.reprotox.2024.108587] [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: 02/07/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/30/2024]
Abstract
Tdap is an acronym for tetanus(T), diphtheria(D), and acellular pertussis(aP), and is a preventive vaccine that combines vaccines against three diseases. BVN008 is a Tdap vaccine designed to protect against three diseases: diphtheria, tetanus, and pertussis. The lower-case "d" and "p" in Td and Tdap means these vaccines use smaller amounts of diphtheria and whooping cough. The lower doses are appropriate for adolescents and adults. The purpose of this study was to identify adverse effects in pregnant or lactating female Sprague-Dawley rats including maternal fertility and toxicity, and development of the embryos, fetus, and pups following intramuscular administration of BVN008. Two groups of 50 female Sprague-Dawley rats were administered four or five intramuscular injections of the vaccine (human dose of 0.5 mL at 4 and 2 weeks before pairing, on gestation day (GD) 8 and 15, and lactation day (LD) 7. A negative control group was administered 0.9% saline at the same dose four or five times. There were no adverse effects on fertility, reproductive performance, or maternal toxicity of the F0 females. There was no effect of developmental toxicity in F1 fetuses and pups including fetal body weight and morphology, postnatal growth, development, and behavior until weaning. Antibodies against tetanus, diphtheria, and pertussis were transferred to the F1 fetuses and F1 pups via placenta and milk. These results demonstrate that BVN008 had no detectable adverse effects in either the F0 female rats, the F1 fetuses or pups.
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Affiliation(s)
- Joo-Young Lee
- Nonclinical Research Institute, CORESTEMCHEMON Inc., 240, Nampyeong-ro, Yangji-myeon, Cheoin-gu, Yongin-si, Gyeonggi-do 17162, Republic of Korea; Laboratory of Veterinary Toxicology, College of Veterinary Medicine, Chungbuk National, University, Chungdae-ro 1 (Gaesin-dong), Cheongju, Chungbuk 28644, Republic of Korea
| | - Jin-A Lee
- Boryung Biopharma Co. Ltd., Seoul, Republic of Korea
| | - Hyun-Kul Lee
- Nonclinical Research Institute, CORESTEMCHEMON Inc., 240, Nampyeong-ro, Yangji-myeon, Cheoin-gu, Yongin-si, Gyeonggi-do 17162, Republic of Korea
| | - Yun-Bae Kim
- Laboratory of Veterinary Toxicology, College of Veterinary Medicine, Chungbuk National, University, Chungdae-ro 1 (Gaesin-dong), Cheongju, Chungbuk 28644, Republic of Korea
| | - Sang-Mi Lee
- Boryung Biopharma Co. Ltd., Seoul, Republic of Korea.
| | - Chun-Ja Nam
- Nonclinical Research Institute, CORESTEMCHEMON Inc., 240, Nampyeong-ro, Yangji-myeon, Cheoin-gu, Yongin-si, Gyeonggi-do 17162, Republic of Korea.
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Taton M, Willems F, Widomski C, Georges D, Martin C, Jiang Y, Renard K, Konopnicki D, Cogan A, Necsoi C, Matagne A, De Wit S, Ackerman ME, Marchant A, Dauby N. HIV-related immune activation attenuates polyfunctional IgG and memory B-cell responses to Tdap immunization during pregnancy. EBioMedicine 2024; 104:105179. [PMID: 38848615 PMCID: PMC11192781 DOI: 10.1016/j.ebiom.2024.105179] [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: 04/14/2023] [Revised: 05/17/2024] [Accepted: 05/17/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Maternal pertussis vaccination with Tdap vaccine is recommended to protect newborns from severe postnatal infection. HIV-exposed uninfected (HEU) infants have a higher incidence of pertussis infection and may particularly benefit from maternal immunization. The impact of HIV infection on the quality of IgG and memory B cell (MBC) responses to Tdap vaccination in pregnant women (PW) living with HIV (PWH) is unknown. METHODS In this observational study, humoral immune responses to Tdap vaccination, including IgG levels, Fc-dependent effector functions, and MBC frequencies, were measured before and after vaccination in 40 PWH and 42 HIV-uninfected PW. Placental transfer of IgG and avidity were assessed in cord blood (CB). Soluble and cellular immune activation markers were quantified at baseline. FINDINGS One month after vaccination, PWH had lower frequencies of MBC compared with HIV-uninfected PW. At delivery, PWH had attenuated pertussis-specific IgG levels and Fc-dependent effector functions. Reduced levels of maternal vaccine polyfunctional IgG and IgG avidity were transferred to HEU as compared to HIV-unexposed newborns. After adjustment with ethnicity, maternal antibody levels and gestational age at vaccination, HIV infection was independently associated with decreased levels of PT specific-IgG in CB. Both maternal and neonatal pertussis-specific IgG responses as well as PT-specific IgG avidity were inversely correlated with maternal sCD14 levels before vaccination among PWH. INTERPRETATION Maternal HIV infection is associated with attenuated humoral immune responses to Tdap vaccination that correlate with sCD14. Suboptimal transfer of maternal immunity may further increase the risk of severe pertussis infection in HEU infants. FUNDING This work was supported by IRIS Fund managed by the Foundation Roi Baudouin [2017J1820690206902], Association Vésale pour la Recherche Médicale and the Medical Council of CHU Saint-Pierre and has been funded in part with Federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services, under Award No. U19AI145825. N.D. is a clinical researcher and A.M. is Research Director at the Fonds de la Recherche Scientifique (F.R.S.-FNRS), Belgium. M.E.A. was partially supported by NIHNIAID1U19AI14825. This article is published with the support of the Fondation Universitaire of Belgium.
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Affiliation(s)
- Martin Taton
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabienne Willems
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Cyprien Widomski
- European Plotkin Institute for Vaccinology, Université Libre de Bruxelles (ULB), , Brussels, Belgium
| | - Daphnée Georges
- European Plotkin Institute for Vaccinology, Université Libre de Bruxelles (ULB), , Brussels, Belgium; Faculty of Sciences, Université de Liège, Liège, Belgium
| | - Charlotte Martin
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Yiwei Jiang
- European Plotkin Institute for Vaccinology, Université Libre de Bruxelles (ULB), , Brussels, Belgium
| | - Katty Renard
- Clinical Research Unit, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Deborah Konopnicki
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alexandra Cogan
- Department of Gynecology and Obstetrics, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Coca Necsoi
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - André Matagne
- Faculty of Sciences, Université de Liège, Liège, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Margaret E Ackerman
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA; Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Arnaud Marchant
- European Plotkin Institute for Vaccinology, Université Libre de Bruxelles (ULB), , Brussels, Belgium
| | - Nicolas Dauby
- Institute for Medical Immunology and ULB Center for Research in Immunology (U-CRI), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Olson-Chen C, Swamy GK, Gonik B, Forsyth K, Heininger U, Hozbor D, von König CHW, Chitkara AJ, Top KA, Muloiwa R, van der Schyff M, Tan TQ. The current state of pertussis vaccination in pregnancy around the world, with recommendations for improved care: Consensus statements from the Global Pertussis Initiative. Int J Gynaecol Obstet 2024; 165:860-869. [PMID: 38251722 DOI: 10.1002/ijgo.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024]
Abstract
Bordetella pertussis, which causes a respiratory disease known as pertussis ("whooping cough") remains an important global challenge, with the incidence in pertussis cases increasing in recent years. Newborns and infants are at increased risk for severe morbidity and mortality from this bacterium. Vaccination in pregnancy has become an important strategy to both passively transfer immunity as well as prevent infection in pregnant persons, who are a major source of newborn infection, thus attempting to decrease the impact of this serious disease. It is considered safe for the pregnant person, the developing fetus, and the infant, and during the first 3 months of life it has been shown to be highly effective in preventing pertussis. There are a variety of strategies, recommendations, and adherence rates associated with pertussis vaccination in pregnancy around the world. We summarize the 2021 Global Pertussis Initiative Annual Meeting that reviewed the current global status of pertussis vaccination in pregnancy and remaining medical and scientific questions, with a focus on vaccination challenges and strategies for obstetric and gynecologic healthcare providers.
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Affiliation(s)
- Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Geeta K Swamy
- Division of Maternal-Fetal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bernard Gonik
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kevin Forsyth
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ulrich Heininger
- Division of Pediatric Infectious Diseases and Vaccinology, Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Daniela Hozbor
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CONICET, La Plata, Argentina
| | | | - Amar J Chitkara
- Department of Pediatrics, Max Super Speciality Hospital, New Delhi, India
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rudzani Muloiwa
- Department of Paediatrics and Child health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Malikah van der Schyff
- Department of Obstetrics and Gynaecology, Constantiaberg Mediclinic, Cape Town, South Africa
| | - Tina Q Tan
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Joseph NT, Kuller JA, Louis JM, Hughes BL. Society for Maternal-Fetal Medicine Statement: Clinical considerations for the prevention of respiratory syncytial virus disease in infants. Am J Obstet Gynecol 2024; 230:B41-B49. [PMID: 37914061 DOI: 10.1016/j.ajog.2023.10.046] [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] [Indexed: 11/03/2023]
Abstract
Respiratory syncytial virus is a leading cause of lower respiratory tract illness globally in children aged <5 years. Each year, approximately 58,000 hospitalizations in the United States are attributed to respiratory syncytial virus. Infants aged ≤6 months experience the most severe morbidity and mortality. Until recently, prevention with the monoclonal antibody, palivizumab, was only offered to infants with high-risk conditions, and treatment primarily consisted of supportive care. Currently, 2 products are approved for the prevention of respiratory syncytial virus in infants. These include the Pfizer bivalent recombinant respiratory syncytial virus prefusion F protein subunit vaccine, administered seasonally to the pregnant person between 32 0/7 and 36 6/7 weeks of gestation, and the monoclonal antibody, nirsevimab, administered to infants aged up to 8 months entering their first respiratory syncytial virus season. With few exceptions, administering both the vaccine to the pregnant person and the monoclonal antibody to the infant is not recommended. All infants should be protected against respiratory syncytial virus using one of these strategies. Key considerations for pregnant individuals include examining available safety and efficacy data, weighing accessibility and availability, and patient preferences for maternal vaccination vs infant monoclonal antibody treatment. It will be critical for maternal-fetal medicine physicians to provide effective and balanced counseling to aid patients in deciding on a personalized approach to the prevention of respiratory syncytial virus in their infants.
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Abu-Raya B, Esser MJ, Nakabembe E, Reiné J, Amaral K, Diks AM, Imede E, Way SS, Harandi AM, Gorringe A, Le Doare K, Halperin SA, Berkowska MA, Sadarangani M. Antibody and B-cell Immune Responses Against Bordetella Pertussis Following Infection and Immunization. J Mol Biol 2023; 435:168344. [PMID: 37926426 DOI: 10.1016/j.jmb.2023.168344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
Neither immunization nor recovery from natural infection provides life-long protection against Bordetella pertussis. Replacement of a whole-cell pertussis (wP) vaccine with an acellular pertussis (aP) vaccine, mutations in B. pertussis strains, and better diagnostic techniques, contribute to resurgence of number of cases especially in young infants. Development of new immunization strategies relies on a comprehensive understanding of immune system responses to infection and immunization and how triggering these immune components would ensure protective immunity. In this review, we assess how B cells, and their secretory products, antibodies, respond to B. pertussis infection, current and novel vaccines and highlight similarities and differences in these responses. We first focus on antibody-mediated immunity. We discuss antibody (sub)classes, elaborate on antibody avidity, ability to neutralize pertussis toxin, and summarize different effector functions, i.e. ability to activate complement, promote phagocytosis and activate NK cells. We then discuss challenges and opportunities in studying B-cell immunity. We highlight shared and unique aspects of B-cell and plasma cell responses to infection and immunization, and discuss how responses to novel immunization strategies better resemble those triggered by a natural infection (i.e., by triggering responses in mucosa and production of IgA). With this comprehensive review, we aim to shed some new light on the role of B cells and antibodies in the pertussis immunity to guide new vaccine development.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - Mirjam J Esser
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eve Nakabembe
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Upper Mulago Hill Road, Kampala, P.O. Box 7072, Uganda
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Kyle Amaral
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Annieck M Diks
- Department of Immunology, Leiden University Medical Center, Albinusdreef 2, Leiden ZA 2333, the Netherlands
| | - Esther Imede
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Sing Sing Way
- Department of Pediatrics, Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Ali M Harandi
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Microbiology and Immunology, University of Gothenburg, Gothenburg, Sweden
| | - Andrew Gorringe
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK; Makerere University-Johns Hopkins University Research Collaboration, MU-JHU, Upper Mulago Hill, Kampala, P.O. Box 23491, Uganda
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology and Immunology, Dalhousie University, Izaak Walton Killam Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Magdalena A Berkowska
- Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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9
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Lunken GR, Golding L, Schick A, Majdoubi A, Lavoie PM, Vallance BA. Gut microbiome and dietary fibre intake strongly associate with IgG function and maturation following SARS-CoV-2 mRNA vaccination. Gut 2023; 73:208-210. [PMID: 36549875 PMCID: PMC10715502 DOI: 10.1136/gutjnl-2022-328556] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Genelle Rose Lunken
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Liam Golding
- Department of Pediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alana Schick
- BC Children's Hospital Research Insitute, Gut4Health Microbiome Sequencing CORE, Vancouver, British Columbia, Canada
| | - Abdelilah Majdoubi
- Department of Pediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Bruce Andrew Vallance
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Insitute, Gut4Health Microbiome Sequencing CORE, Vancouver, British Columbia, Canada
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Knuutila A, Dalby T, Ahvenainen N, Barkoff AM, Jørgensen CS, Fuursted K, Mertsola J, He Q. Antibody avidity to pertussis toxin after acellular pertussis vaccination and infection. Emerg Microbes Infect 2023; 12:e2174782. [PMID: 36715361 PMCID: PMC9936998 DOI: 10.1080/22221751.2023.2174782] [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] [Indexed: 01/31/2023]
Abstract
Pertussis toxin (PT) is a unique virulence factor of Bordetella pertussis, and therefore a key component of acellular pertussis vaccines. Although immunity after infection seems to persist longer than after vaccination, the exact mechanisms are not fully known. In this study the overall binding strength (avidity) of anti-PT IgG antibodies was compared after acellular booster vaccination and infection, as a parameter to evaluate long-lasting protection.Danish and Finnish serum samples from a total of 134 serologically confirmed patients and 112 children who received acellular booster vaccines were included in this study. The concentration of anti-PT IgG was first determined by ELISA, followed by two separate ELISAs to evaluate antibody avidity: either with a dilution series of urea as a bond-breaking agent of antibody and antigen binding and a constant anti-PT IgG concentration between the samples or with a constant dilution ratio of sera and detergent. In addition to urea, the use of diethylamine and ammonium thiocyanate as disruptive agents were first compared between each other.A strong Spearman correlation (R > 0.801) was noted between avidity and concentration of anti-PT IgG antibodies if a constant serum dilution method was used, and avidity was noted to be higher in patients in comparison to vaccinees in Denmark, but not in Finland. However, no correlation between antibody concentration and avidity was found if a constant anti-PT IgG concentration was used (R = -0.157). With this method, avidity after vaccination was significantly higher in comparison to that after infection in both Danish and Finnish subjects (p < 0.01). A shorter time since the latest booster vaccination was found to affect avidity positively on the next PT-antigen exposure with either vaccination or infection.
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Affiliation(s)
- Aapo Knuutila
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Tine Dalby
- Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | | | - Jussi Mertsola
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Qiushui He
- Institute of Biomedicine, University of Turku, Turku, Finland,InFLAMES Research Flagship Center, University of Turku, Turku, Finland, Qiushui He
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11
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Pehlivan T, Dinleyici EC, Kara A, Kurugöl Z, Tezer H, Aksakal NB, Biri A, Azap A. The Present and Future Aspects of Life-Long Pertussis Prevention: Narrative Review with Regional Perspectives for Türkiye. Infect Dis Ther 2023; 12:2495-2512. [PMID: 37815753 PMCID: PMC10651609 DOI: 10.1007/s40121-023-00876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023] Open
Abstract
Pertussis, caused by Bordetella pertussis, remains one of the most widespread, contagious, and vaccine-preventable diseases. It results in notable morbidity and mortality as well as severe medical, social, and economic burden. Despite high global vaccine coverage, pertussis continues to be a significant epidemiologic problem, with outbreak episodes every few years just as in the pre-vaccination era. In Türkiye, there is a lack of comprehensive data on the current burden of pertussis in different age and risk groups, leading to underdiagnosis and underreporting of the disease, especially in adults who are often not considered at risk. Available data from Türkiye also reveal inadequate levels of protective antibodies in preterm newborns, emphasizing the need for additional preventive measures. Authors stated that improving physician awareness of pertussis symptoms in patients with prolonged cough, increasing access to routine pertussis tests, and conducting surveillance studies would aid in accurate diagnosis and reporting in Türkiye. As the Turkish Ministry of Health Antenatal Care Management Guide suggests routine second and third pregnancy check-up visits at weeks 18-24 and 28-32 correspondingly, this period can be considered the ideal vaccination time for Türkiye. Introducing a booster dose of Tdap at around 10 years of age or during national military service would reduce transmission and protect susceptible individuals. Identifying individuals at high risk of severe pertussis and prioritizing them for a booster dose is also crucial in Türkiye. Enhancing surveillance systems, increasing healthcare professionals' awareness through training, and organizing catch-up visits for missed vaccinations during the COVID-19 pandemic are mentioned as additional strategies to improve pertussis prevention in Türkiye. This review focuses on the global and regional burden of pertussis and obstacles to effective prevention and evaluates existing strategies to achieve lifelong pertussis prevention. Literature and current strategies were also discussed from a Turkish national standpoint.
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Affiliation(s)
- Tamer Pehlivan
- Public Health, Remedium Consulting Group, Izmir, Türkiye.
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University School of Medicine, Eskisehir, Türkiye
| | - Ateş Kara
- Department of Pediatric Infectious Diseases, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Zafer Kurugöl
- Department of Pediatric Infectious Diseases, Ege University School of Medicine, Izmir, Türkiye
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Gazi University School of Medicine, Ankara, Türkiye
| | - Nur Baran Aksakal
- Department of Public Health, Gazi University School of Medicine, Ankara, Türkiye
| | - Aydan Biri
- Department of Obstetrics and Gynaecology, Koru Ankara Hospital, Ankara, Türkiye
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Türkiye
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Kayatani AKK, Bobbili N, Megnekou R, Matsunaga M, Leke RFG, Taylor DW. Are high avidity antibodies to Plasmodium falciparum antigens preferentially transferred across the placenta of premature and term babies? Placenta 2023; 140:11-19. [PMID: 37515848 PMCID: PMC10528449 DOI: 10.1016/j.placenta.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Transplacental transport of maternal IgG via the neonatal Fc receptor (FcRn) provides babies with passive immunity. Several factors are reported to influence transport, including the avidity of antibodies (Abs) for their cognate antigens. Unfortunately, information on the role of antibody (Ab) avidity is limited. This study investigated if i) antibodies (Abs) with high avidity for 6 Plasmodium falciparum antigens and tetanus toxoid (TTx) were preferentially transferred to premature and term Cameroonian babies and ii) if Ab avidity was increased in babies whose mothers had placental malaria (PM), implicating the involvement of immune complexes. METHODS Total IgG (mg/ml) and Abs to malarial antigens (AMA1, EBA-175, MSP1-42, MSP2, MSP3, DBL5 of VAR2CSA) and TTx were measured in paired mother-cord samples obtained from premature and term deliveries in Cameroon. Half the women had PM at delivery. Avidity Indices (AIs) were determined by treating antigen-bound-Abs with different molar concentrations of NH4SCN and calculating 50% endpoints. RESULTS Total IgG and antigen-specific Abs increased in cord blood with gestational age; however, AIs did not. AIs in paired maternal-cord blood samples were strongly associated for all antigens (r = 0.77-0.96). However, no significant different in AIs was found between paired mother-cord blood samples for any of the antigens (p values > 0.05). Similarly, Ab avidity was not increased in cord blood of babies whose mothers had PM or hypergammaglobulinemia. DISCUSSION Overall, there was no evidence that higher avidity Abs to any of the malarial antigens or TTx were preferentially transferred to Cameroonian babies.
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Affiliation(s)
- Alexander K K Kayatani
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Bioscience Building, Room 320, Honolulu, HI, 96813, USA.
| | - Naveen Bobbili
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Bioscience Building, Room 320, Honolulu, HI, 96813, USA.
| | - Rosette Megnekou
- The Biotechnology Center, University of Yaoundé 1, BP 3851, Messa, Yaoundé, Cameroon.
| | - Masako Matsunaga
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Medical Education Building, Room 411, Honolulu, HI, 96813, USA.
| | - Rose F G Leke
- The Biotechnology Center, University of Yaoundé 1, BP 3851, Messa, Yaoundé, Cameroon.
| | - Diane Wallace Taylor
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Bioscience Building, Room 320, Honolulu, HI, 96813, USA.
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Sartoretti J, Fontannaz P, Martinez de Tejada B, Othenin-Girard V, Chilin A, Lemaître B, Blanchard-Rohner G, Siegrist CA, Eberhardt CS. Influence of Timing of Maternal Pertussis Immunization on the Avidity of Transferred Antibodies in Term and Preterm Neonates. Clin Infect Dis 2023; 77:645-648. [PMID: 37073575 PMCID: PMC10444006 DOI: 10.1093/cid/ciad227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
The timing of maternal pertussis vaccination influences the titers of cord-blood anti-pertussis antibodies. Whether it affects their avidity is unknown. We demonstrate in 298 term and 72 preterm neonates that antibody avidity is independent of the timing of maternal vaccination, whether comparing second with third trimester or intervals before birth.
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Affiliation(s)
- Julie Sartoretti
- Center for Vaccinology and Neonatal Immunology, Department of Pathology-Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
- Department for Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Paola Fontannaz
- Center for Vaccinology and Neonatal Immunology, Department of Pathology-Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Department for Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Obstetrics, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Véronique Othenin-Girard
- Department for Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Antonina Chilin
- Division of Obstetrics, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Barbara Lemaître
- Division of Laboratory Medicine, Department of Diagnostics and of Medical Specialties, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Géraldine Blanchard-Rohner
- Center for Vaccinology and Neonatal Immunology, Department of Pathology-Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
- Department for Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claire-Anne Siegrist
- Center for Vaccinology and Neonatal Immunology, Department of Pathology-Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
- Department for Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Vaccinology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christiane Sigrid Eberhardt
- Center for Vaccinology and Neonatal Immunology, Department of Pathology-Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department for Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Vaccinology, University Hospitals of Geneva, Geneva, Switzerland
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Vaccination in Pregnancy against Pertussis: A Consensus Statement on Behalf of the Global Pertussis Initiative. Vaccines (Basel) 2022; 10:vaccines10121990. [PMID: 36560400 PMCID: PMC9786323 DOI: 10.3390/vaccines10121990] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
Infants are at high risk for severe morbidity and mortality from pertussis disease during early infancy. Vaccination against pertussis in pregnancy has emerged as the ideal strategy to protect infants during these early, vulnerable, first months of life. On 30 November and 1 December 2021, the Global Pertussis Initiative held a meeting that aimed to discuss and review the most up-to-date scientific literature supporting vaccination against pertussis in pregnancy and outstanding scientific questions. Herein, we review the current and historically published literature and summarize the findings as consensus statements on vaccination against pertussis in pregnancy on behalf of the Global Pertussis Initiative.
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15
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Protecting the Offspring, the Gift of Maternal Immunization: Current Status and Future Perspectives. Vaccines (Basel) 2022; 10:vaccines10111953. [DOI: 10.3390/vaccines10111953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Pregnancy is characterized by immunological alterations in pregnant women that permit the growth of a semi-allogenic fetus, resulting in greater susceptibility of childbearing women to infections. Furthermore, due to the immaturity of the immune system of neonates, a protection gap is present in early life, leaving neonates and infants vulnerable to infectious diseases with increased morbidity and mortality. Maternal immunization against influenza, pertussis, and, in the context of the COVID-19 pandemic, SARS-CoV-2 has been implemented in several countries, with beneficial effects on both the mother and the offspring. The main protective mechanism of vaccination during pregnancy is transplacental transfer of maternal antibodies. However, recent evidence has implied that the fetal immune system may be influenced beyond passive immunity. This review sheds light on the current status of the routinely administered vaccinations during pregnancy, focusing on the impact of maternal immunization on the priming of the fetal immune system and suggesting future perspectives for the optimization of vaccination strategies.
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Timing of SARS-CoV-2 vaccination during the third trimester of pregnancy and transplacental antibody transfer: a prospective cohort study. Clin Microbiol Infect 2022; 28:419-425. [PMID: 34740773 PMCID: PMC8563509 DOI: 10.1016/j.cmi.2021.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/01/2021] [Accepted: 10/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to assess the impact of early versus late third-trimester maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination on transplacental transfer and neonatal levels of SARS-CoV-2 antibodies. METHODS Maternal and cord blood sera were collected following term delivery after antenatal SARS-CoV-2 BNT162b2 mRNA vaccination, with the first vaccine dose administered between 27 and 36 weeks of gestation. SARS-CoV-2 spike protein (S) and receptor-binding domain (RBD) -specific, IgG levels and neutralizing potency were evaluated in maternal and cord blood samples. RESULTS The study cohort consisted of 171 parturients-median age 31 years (interquartile range (IQR) 27-35 years); median gestational age 39+5 weeks (IQR 38+5-40+4 weeks)-83 (48.5%) were immunized in early thrird-trimester (first dose at 27-31 weeks) and 88 (51.5%) were immunized in late third trimester (first dose at 32-36 weeks). All mother-infant paired sera were positive for anti S- and anti-RBD-specific IgG. Anti-RBD-specific IgG concentrations in neonatal sera were higher following early versus late third-trimester vaccination (median 9620 AU/mL (IQR 5131-15332 AU/mL) versus 6697 AU/mL (IQR 3157-14731 AU/mL), p 0.02), and were positively correlated with increasing time since vaccination (r = 0.26; p 0.001). Median antibody placental transfer ratios were increased following early versus late third-trimester immunization (anti-S ratio: 1.3 (IQR 1.1-1.6) versus 0.9 (IQR 0.6-1.1); anti-RBD-specific ratio: 2.3 (IQR 1.7-3.0) versus 0.7 (IQR 0.5-1.2), p < 0.001). Neutralizing antibodies placental transfer ratio was greater following early versus late third-trimester immunization (median 1.9 (IQR 1.7-2.5) versus 0.8 (IQR 0.5-1.1), p < 0.001), and was positively associated with longer duration from vaccination (r = 0.77; p < 0.001). CONCLUSIONS Early compared with late third-trimester maternal SARS-CoV-2 immunization enhanced transplacental antibody transfer and increased neonatal neutralizing antibody levels. Our findings highlight that vaccination of pregnant women early in the third trimester may enhance neonatal seroprotection.
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Rottenstreich A, Zarbiv G, Oiknine-Djian E, Vorontsov O, Zigron R, Kleinstern G, Wolf DG, Porat S. The effect of gestational age at BNT162b2 mRNA vaccination on maternal and neonatal SARS-CoV-2 antibody levels. Clin Infect Dis 2022; 75:e603-e610. [PMID: 35171998 PMCID: PMC8903394 DOI: 10.1093/cid/ciac135] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 12/11/2022] Open
Abstract
Background COVID-19 during pregnancy and early infancy can result in severe disease. Evaluating the effect of gestational age at the time of SARS-CoV-2 vaccination on maternal antibody levels and transplacental antibody transfer has important implications for maternal care and vaccination strategies. Methods Maternal and cord blood sera were collected from mother/newborn dyads (n=402), following term delivery after antenatal two-dose SARS-CoV-2 BNT162b2 mRNA vaccination. SARS-CoV-2 spike protein (S) and receptor binding domain (RBD)-specific IgG levels were evaluated in the samples collected. Results Median anti-S and anti-RBD-specific IgG levels in maternal sera at the time of delivery were lowest following 1 st trimester vaccination (n=90) (anti-S IgG: 76 AU/mL, anti-RBD-specific IgG: 478 AU/mL), intermediate in those vaccinated in the 2 nd trimester (n=124) (anti-S IgG: 126 AU/mL, anti-RBD-specific IgG: 1263 AU/mL), and highest after 3 rd trimester vaccination (n=188) (anti-S IgG: 240 AU/mL, anti-RBD-specific IgG: 5855 AU/mL). Antibody levels in neonatal sera followed a similar pattern and were lowest following antenatal vaccination in the 1 st trimester (anti-S IgG: 126 AU/mL, anti-RBD-specific IgG: 1140 AU/mL). In a subgroup of parturients vaccinated in the 1 st trimester (n=30), a third booster dose was associated with significantly higher maternal and neonatal antibody levels. Conclusions These results suggest a considerable antibody waning throughout pregnancy in those vaccinated at early gestation. The observed boosting effect of a third vaccine dose, hints to its potential benefit in those who completed the two-dose vaccine series at early pregnancy or prior to conception. The impact of antenatal immunization timing on SARS-CoV-2 transplacental antibody transfer may influence neonatal seroprotection.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Gila Zarbiv
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical virology unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Olesya Vorontsov
- Clinical virology unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Roy Zigron
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | - Dana G Wolf
- Clinical virology unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Jog P, Memon IA, Thisyakorn U, Hozbor D, Heininger U, von König CHW, Tan T. Pertussis in Asia: Recent country-specific data and recommendations. Vaccine 2022; 40:1170-1179. [PMID: 35074239 DOI: 10.1016/j.vaccine.2021.12.004] [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: 03/08/2021] [Revised: 10/30/2021] [Accepted: 12/02/2021] [Indexed: 11/24/2022]
Abstract
The Global Pertussis Initiative (GPI) Roundtable Meeting held in 2019, which preceded the COVID-19 pandemic, focused on the incidence, surveillance, and immunization practices for pertussis in the Asian region. Participants from China, India, Indonesia, Malaysia, Pakistan, Philippines, South Korea, Taiwan, and Thailand presented country-specific information on pertussis prevalence, diagnosis, surveillance, vaccine administration and schedules, maternal and neonatal disease rates, and policies and practice of vaccination during pregnancy. In recent years, many Asian countries have seen an increase in pertussis cases, although underreporting of the disease is a concern. Currently, most Asian countries have only passive surveillance for pertussis in place. There is a need for improved surveillance to determine the disease burden and justify vaccination policies and recommendations, such as essential vaccination, boosters, and vaccination during pregnancy. Better awareness of the disease in adolescents and adults is necessary, and infant and childhood vaccination schedules need to be improved in many countries. Differences between private versus public sector vaccination schedules and between whole-cell and acellular pertussis vaccines should continue to be examined. It can be anticipated that unmet needs in the prevention and management of pertussis will continue as the COVID-19 pandemic evolves and that key recommendations highlighted in this meeting report will be of ongoing importance.
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Affiliation(s)
| | | | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand.
| | - Daniela Hozbor
- Instituto de Biotecnología y Biología Molecular, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Ulrich Heininger
- Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | | | - Tina Tan
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
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Menu E, Kopec L, Luciani L, Legrand S, L’Ollivier C. Measurement of the IgG Avidity Index in the Diagnosis of Clinical Toxocariasis Patients. Pathogens 2021; 10:pathogens10091086. [PMID: 34578119 PMCID: PMC8468318 DOI: 10.3390/pathogens10091086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/01/2022] Open
Abstract
Toxocara spp. are parasitic nematodes responsible for human toxocariasis, a common zoonotic helminth infection. The five main features of human toxocariasis are the classical ocular toxocariasis and visceral larva migrans syndrome, followed by covert toxocariasis, common toxocariasis and neurotoxocariasis. The diagnosis of toxocariasis is feasible by considering clinical symptoms, anamnestic history and serology laboratory results; however, serological criteria cannot be used to distinguish active Toxocara infection from past exposure, which is an area of much discussion in clinical practice. In this context, we developed avidity tests (ELISA and immunoblotting) and evaluated their clinical usefulness in distinguishing past from active toxocariasis. Our study involved 46 patients divided into two groups: “active toxocariasis” (n = 14) and “chronic toxocariasis” (n = 32). According to the avidity indices obtained for both the chronic and active toxocariasis groups, we proposed two thresholds: first, an AI lower than 32% supports an active infection; secondly, a threshold above 42% can exclude an active infection. In order to use this assay in routine clinical practice, however, is still requires standardisation with regards to the method and threshold values, which can be established through studies involving larger populations.
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Affiliation(s)
- Estelle Menu
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France
| | - Lora Kopec
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
| | - Léa Luciani
- Unité des Virus Emergents (UVE), Aix Marseille Université, IRD 190, INSERM 1207, 13385 Marseille, France;
| | - Sophie Legrand
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
| | - Coralie L’Ollivier
- Laboratoire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire Méditerranée Infection, 13385 Marseille, France; (E.M.); (L.K.); (S.L.)
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France
- Correspondence:
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Godoy P, García-Cenoz M, Rius C, Muñoz-Almagro C, Carmona G, Alsedà M, Jané M, Vidal MJ, Rodríguez R, Álvarez J, Camps N, Minguell S, Carol M, Sala MR, Castilla J, Domínguez À. Effectiveness of maternal pertussis vaccination in protecting newborn: A matched case-control study. J Infect 2021; 83:554-558. [PMID: 34407422 DOI: 10.1016/j.jinf.2021.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/15/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective was to estimate the effectiveness of maternal pertussis vaccination in protecting infants aged < 2 months. METHODS We performed a case-control study. Laboratory-confirmed cases aged <8 weeks at disease onset were identified and 2-4 matched-controls born within ± 15 days of the case were included. Information was obtained from healthcare providers and maternal interviews. Odds ratios (OR) were calculated using multivariable conditional logistic regression. Vaccine effectiveness (VE) was estimated as (1 - OR) × 100%. RESULTS 47 cases and 124 controls were studied. The mean age (in days) (39.8 ± 12.7 vs. 40.8 ± 13.2), weeks of gestation (38.8 vs. 39.1, p = 0.43) and mean birth weight (3.309 vs. 3.253 kg, p = 0.55) were comparable between cases and controls. Mothers of cases were less frequently vaccinated in the third trimester (59.6% vs. 83.9%, p <0.001). The VE of maternal vaccination in pregnancy was 88.0% (95%CI 53.8% -96.5%), and was slightly higher in those vaccinated before the 32nd week of gestation (88.5% vs 87.8%). CONCLUSION Pertussis vaccination in pregnancy is very effective in reducing pertussis in children aged < 2 months. Vaccination before and after the 32nd week of pregnancy are equally effective in reducing the risk of pertussis.
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Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Institut de Recerca Biomèdica de Lleida. IRBLleida. Lleida, Spain.
| | - Manuel García-Cenoz
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Instituto de Salud Pública de Navarra - idiSNA, Pamplona, Spain
| | - Cristina Rius
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Agència de Salut Pública de Barcelona. Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Institut de Recerca Pediàtrica, Hospital de Sant Joan de Dèu, Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya
| | | | - Miquel Alsedà
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Institut de Recerca Biomèdica de Lleida. IRBLleida. Lleida, Spain
| | - Mireia Jané
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain
| | | | | | - Josep Álvarez
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | - Neus Camps
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | | | - Mónica Carol
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | | | - Jesús Castilla
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Instituto de Salud Pública de Navarra - idiSNA, Pamplona, Spain
| | - Àngela Domínguez
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Departament de Medicina, Universitat de Barcelona. Barcelona, Spain
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Barkoff AM, Knuutila A, Mertsola J, He Q. Evaluation of Anti-PT Antibody Response after Pertussis Vaccination and Infection: The Importance of Both Quantity and Quality. Toxins (Basel) 2021; 13:toxins13080508. [PMID: 34437379 PMCID: PMC8402585 DOI: 10.3390/toxins13080508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022] Open
Abstract
Pertussis toxin (PT) is considered the main virulence factor causing whooping cough or pertussis. The protein is widely studied and its composition was revealed and sequenced already during the 1980s. The human immune system creates a good response against PT when measured in quantity. However, the serum anti-PT antibodies wane rapidly, and only a small amount of these antibodies are found a few years after vaccination/infection. Therefore, multiple approaches to study the functionality (quality) of these antibodies, e.g., avidity, neutralizing capacity, and epitope specificity, have been investigated. In addition, the long-term B cell memory (Bmem) to PT is crucial for good protection throughout life. In this review, we summarize the findings from functional PT antibody and Bmem studies. These results are discussed in line with the quantity of serum anti-PT antibodies. PT neutralizing antibodies and anti-PT antibodies with proper avidity are crucial for good protection against the disease, and certain epitopes have been identified to have multiple functions in the protection. Although PT-specific Bmem responses are detectable at least five years after vaccination, long-term surveillance is lacking. Variation of the natural boosting of circulating Bordetella pertussis in communities is an important confounding factor in these memory studies.
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Affiliation(s)
- Alex-Mikael Barkoff
- Research Center for Infection and Immunity, Institute of Biomedicine, University of Turku, 20520 Turku, Finland; (A.-M.B.); (A.K.); (J.M.)
| | - Aapo Knuutila
- Research Center for Infection and Immunity, Institute of Biomedicine, University of Turku, 20520 Turku, Finland; (A.-M.B.); (A.K.); (J.M.)
| | - Jussi Mertsola
- Research Center for Infection and Immunity, Institute of Biomedicine, University of Turku, 20520 Turku, Finland; (A.-M.B.); (A.K.); (J.M.)
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, 20520 Turku, Finland
| | - Qiushui He
- Research Center for Infection and Immunity, Institute of Biomedicine, University of Turku, 20520 Turku, Finland; (A.-M.B.); (A.K.); (J.M.)
- InFLAMES Research Flagship Center, University of Turku, 20520 Turku, Finland
- Correspondence: ; Tel.: +358-40-472-2255
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22
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Mott K, Huybrechts KF, Glynn RJ, Mogun H, Hernández-Díaz S. Tetanus, Diphtheria, Acellular Pertussis Vaccination During Pregnancy and Risk of Pertussis in the Newborn in Publicly and Privately Insured Mother-infant Pairs in the United States. Pediatr Infect Dis J 2021; 40:681-687. [PMID: 33657597 DOI: 10.1097/inf.0000000000003099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the United States, pertussis circulation persists and primarily infects infants and children, despite routine vaccinations. To minimize infant morbidity and mortality from the disease before the first DTaP dose, the Advisory Committee on Immunization Practices recommends maternal Tdap vaccination in weeks 27-36 of pregnancy. METHODS Cohorts of mother-infant pairs in the Medicaid Analytic eXtract (MAX) (2010-2014) and IBM MarketScan (2011-2015) databases were analyzed to estimate the effectiveness of prenatal Tdap vaccination compared with no vaccination to prevent infant pertussis in the first 6 months. Hazard ratios were estimated with Cox proportional hazards models and adjusted for potential confounders via inverse probability weights. The impact of preterm delivery on the risk of pertussis was analyzed. Results from the 2 databases were pooled. RESULTS In MarketScan, women received Tdap vaccination before delivery in 114,067 (25.6%) of 445,638 pregnancies and in MAX, 33,286 (4.8%) of 695,262 pregnancies. Among pregnancies with preterm delivery, only 21.2% and 3.8% in MarketScan and MAX had been vaccinated. The risk of pertussis in unvaccinated term infants was 3.5 (MarketScan) and 17 (MAX) per 10,000; and in preterm infants, it was 8.4 (MarketScan) and 19.8 (MAX) per 10,000. The pooled hazard ratio for Tdap vaccination any time before delivery versus no vaccination was 0.64 [95% confidence interval (CI): 0.41-1.00]. The hazard ratio was 0.11 (95% CI: 0.03-0.36) for preterm and 0.78 (95% CI: 0.48-1.29) for term infants vaccinated before 37 weeks. The incidence of pertussis was higher and the protective hazard ratio stronger during pertussis outbreaks. CONCLUSIONS Prenatal Tdap vaccination reduces the risk of pertussis infections in the infants' first 6 months by 36%. Vaccination soon after 27 weeks of pregnancy, before when deliveries began, ensures vaccination includes those born preterm, who are at highest risk for pertussis and benefit particularly from this vaccination.
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Affiliation(s)
- Katrina Mott
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert J Glynn
- Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helen Mogun
- Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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23
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Abu-Raya B, Maertens K. Protection of the Newborn Through Vaccination in Pregnancy. Neoreviews 2021; 22:e25-e39. [PMID: 33386312 DOI: 10.1542/neo.22-1-e25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Newborns and infants are at risk for severe infections with some pathogens (eg, Bordetella pertussis, influenza, respiratory syncytial virus, group B Streptococcus) during early life. To decrease this window of high susceptibility to some infections during early life and protect young infants, vaccination in pregnancy against some vaccine-preventable diseases (eg, influenza, pertussis, tetanus) has been recommended in an increasing number of countries with notable success. In addition, recent advances have been made in developing vaccines for pregnant women with the aim of reducing the respiratory syncytial virus and group B Streptococcus burden in infancy. In this article, we review the vaccines currently recommended during pregnancy and their benefits to newborns and infants. We also discuss progress made in the development of other vaccines that are expected to be evaluated in pregnant women in the near future.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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24
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Saso A, Kampmann B. Maternal Immunization: Nature Meets Nurture. Front Microbiol 2020; 11:1499. [PMID: 32849319 PMCID: PMC7396522 DOI: 10.3389/fmicb.2020.01499] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
Vaccinating women in pregnancy (i.e., maternal immunization) has emerged as a promising tool to tackle infant morbidity and mortality worldwide. This approach nurtures a 'gift of nature,' whereby antibody is transferred from mother to fetus transplacentally during pregnancy, or postnatally in breast milk, thereby providing passive, antigen-specific protection against infections in the first few months of life, a period of increased immune vulnerability for the infant. In this review, we briefly summarize the rationale for maternal immunization programs and the landscape of vaccines currently in use or in the pipeline. We then direct the focus to the underlying biological phenomena, including the main mechanisms by which maternally derived antibody is transferred efficiently to the infant, at the placental interface or in breast milk; important research models and methodological approaches to interrogate these processes, particularly in the context of recent advances in systems vaccinology; the potential biological and clinical impact of high maternal antibody titres on neonatal ontogeny and subsequent infant vaccine responses; and key vaccine- and host-related factors influencing the maternal-infant dyad across different environments. Finally, we outline important gaps in knowledge and suggest future avenues of research on this topic, proposing potential strategies to ensure optimal testing, delivery and implementation of maternal vaccination programs worldwide.
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Affiliation(s)
- Anja Saso
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Banjul, Gambia
| | - Beate Kampmann
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Banjul, Gambia
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25
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Abu-Raya B, Giles ML, Kollmann TR, Sadarangani M. Profiling avidity of antibodies elicited by vaccination using enzyme-linked immunosorbent assay-based elution - Insights into a novel experimental and analytical approach. Vaccine 2020; 38:5389-5392. [PMID: 32620372 DOI: 10.1016/j.vaccine.2020.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/14/2020] [Accepted: 06/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, Canada; Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Tobias R Kollmann
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Telethon Kids Institute, Perth, Australia
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, Canada; Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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26
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Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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Immunobiological aspects of vaccines in pregnancy: Maternal perspective. MATERNAL IMMUNIZATION 2020. [PMCID: PMC7149477 DOI: 10.1016/b978-0-12-814582-1.00003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immunization during pregnancy is an efficient strategy to protect both the mother and the newborn infant against infectious pathogens. Pregnant women have an increased susceptibility to severe infections caused by some pathogens, but the mechanisms involved remain poorly understood. Pregnancy is associated with dynamic changes in maternal immune system that are critical for tolerance of the fetus. These changes could also play an important role in shaping maternal immune components that are transferred to the newborn infant following natural infection or vaccination to prevent infectious diseases in early life. As the momentum for maternal immunization is growing, there is a need to increase our understanding of the immunobiology of maternal immunization in order to better prevent infectious diseases in the pregnant women and the young infant.
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Switzer C, D'Heilly C, Macina D. Immunological and Clinical Benefits of Maternal Immunization Against Pertussis: A Systematic Review. Infect Dis Ther 2019; 8:499-541. [PMID: 31535327 PMCID: PMC6856250 DOI: 10.1007/s40121-019-00264-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Indexed: 11/17/2022] Open
Abstract
Infants are vulnerable to pertussis infection particularly before initiation of pertussis vaccination. Maternal pertussis vaccination during pregnancy has been introduced in a number of countries in order to confer on young infants indirect protection from the disease through transplacental transfer of maternal antibodies. We reviewed the evidence on the immunogenicity and efficacy of maternal pertussis vaccination during pregnancy. A systematic search of PubMed/MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews, ProQuest, and Science Direct was undertaken to identify studies published between January 1995 and December 2018. This review was not specific to any particular pertussis vaccine but included applicable data on available pertussis vaccines administered to pregnant women. The search identified 40 publications for inclusion in this review. Vaccination during pregnancy elicited robust maternal immune responses against all vaccine antigens and resulted in high placental transfer of pertussis antibodies to the infant that persisted well beyond delivery. Vaccination during the second or early third trimesters was considered ideal for antibody quantity and functionality. Although blunting of immune responses to some antigens in the primary immunization series was documented in neonates born to women vaccinated during pregnancy, there was no apparent adverse effect on vaccine efficacy. Multiple studies conducted in diverse settings have confirmed the effectiveness of maternal pertussis vaccination during pregnancy in preventing pertussis in infants prior to receipt of their first primary vaccine dose and beyond. These findings collectively underscore the value of maternal pertussis vaccination during pregnancy in protecting vulnerable infants too young to be vaccinated.Funding Sanofi Pasteur.Plain Language Summary Plain language summary available for this article.
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Affiliation(s)
| | | | - Denis Macina
- Sanofi Pasteur, Vaccines Epidemiology and Modeling, Lyon, France.
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29
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Brosio F, Kuhdari P, Cocchio S, Stefanati A, Baldo V, Gabutti G. Impact of Pertussis on the Italian population: Analysis of hospital discharge records in the period 2001-2014. Int J Infect Dis 2019; 91:143-148. [PMID: 31678191 DOI: 10.1016/j.ijid.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The study aimed to analyze and update the impact of pertussis on the Italian population by evaluating pertussis-related hospital admissions in the period 2001-2014. DESIGN OR METHODS Hospital Discharge Records (HDR) were provided by the National Archive of HDR data of the Ministry of Health. Only hospitalizations included in the primary diagnosis were evaluated. Significant trends over the considered years were assessed as average annual percent changes (AAPC) applying the Joinpoint model. RESULTS A total of 7,102 hospital admissions for pertussis (main diagnosis) were registered; the trend of hospitalizations progressively decreased from >1/100,000 inhabitants in the years 2001-2004 to 0.64/100,000 inhabitants in 2014. A great part of hospitalizations (63.6%) involved subjects <1 year of life; almost 20% of cases were registered in the age class 5-14 years. The Joinpoint analysis showed a statistically significant variation in some age classes. CONCLUSIONS Even if this study shows a decreasing trend in the number of pertussis-related hospitalizations, the impact of the disease in Italy in terms of hospital admissions continues to be relevant, especially in the <1 year age class. Pertussis therefore continues to be, in Italy as well as in other European countries, an important public health issue.
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Affiliation(s)
- Federica Brosio
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64b, 44121 Ferrara, Italy.
| | - Parvanè Kuhdari
- Azienda USL of Ferrara, Via A. Cassoli 30, 44121 Ferrara, Italy.
| | - Silvia Cocchio
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, Via Loredan 18, 35100 Padua, Italy.
| | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64b, 44121 Ferrara, Italy.
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, Via Loredan 18, 35100 Padua, Italy.
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64b, 44121 Ferrara, Italy.
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30
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Abu-Raya B, Giles ML, Kollmann TR, Sadarangani M. The Effect of Timing of Tetanus-Diphtheria-Acellular Pertussis Vaccine Administration in Pregnancy on the Avidity of Pertussis Antibodies. Front Immunol 2019; 10:2423. [PMID: 31681310 PMCID: PMC6798090 DOI: 10.3389/fimmu.2019.02423] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/27/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Optimal timing of gestational tetanus-diphtheria-acellular pertussis (Tdap) vaccination is not well-defined. No well-established specific anti-pertussis antibody level correlates with protection, suggesting the importance of antibody quality such as avidity. We aimed to determine the effect of timing of vaccination with Tdap in pregnancy on the avidity of cord anti-pertussis toxin (PT) immunoglobulin G (IgG). Methods: Prospective study of newborns in a tertiary hospital (Melbourne, Australia) born to women vaccinated with Tdap in pregnancy. Ammonium thiocyanate was used as a bond-breaking agent to measure the avidity of anti-PT IgG using concentrations between 0.25 M (to measure low avidity antibodies) and 3 M (to measure very high avidity antibodies). Anti-PT IgG levels achieved at each ammonium thiocyanate concentration in cord samples of women vaccinated during 28–32 weeks gestation (WG) vs. 33–36 WG, and women vaccinated 5–12 vs. 1–4 weeks prior to delivery were compared using t-tests. Results: Newborns of women vaccinated with Tdap during 28–32 WG (n = 43) had statistically significant higher concentrations of medium and high avidity anti-PT IgG compared with newborns of women vaccinated during 33–36 WG (n = 47), 11.6 IU/ml (95% CI, 8.8–15.2) IU/ml vs. 6.7 IU/ml (95% CI, 5.2–8.6) and 10.1 IU/ml (95% CI, 7.4–13.8) vs. 5.7 (95% CI, 3.6–8.9) IU/ml (p = 0.007 and p = 0.035), respectively. Newborns of women vaccinated 5–12 weeks before delivery (n = 64) had statistically significant higher concentrations of high and very high avidity anti-PT IgG compared with newborns of women vaccinated within 4 weeks before delivery (n = 25), 10.3 IU/mL (95% CI, 7.9–13.4) vs. 3.3 IU/mL (95% CI, 1.7–6.4), 12.6 IU/mL (95% CI, 9.4–16.9) vs. 4.3 IU/mL (95% CI, 2.2–8.5) (all p < 0.03), respectively. Conclusions: Quantification of levels of anti-PT IgG with different avidities demonstrated that pertussis vaccination 5–12 weeks before delivery was associated with higher anti-PT IgG avidity compared with vaccination within 4 weeks before delivery. Pertussis vaccination during 28–32 WG was associated with higher anti-PT IgG avidity compared with vaccination during 33–36 WG, supporting vaccination at 28–32 over 33–36 WG for optimal protection against pertussis in infancy.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Tobias R Kollmann
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Langel SN, Paim FC, Alhamo MA, Buckley A, Van Geelen A, Lager KM, Vlasova AN, Saif LJ. Stage of Gestation at Porcine Epidemic Diarrhea Virus Infection of Pregnant Swine Impacts Maternal Immunity and Lactogenic Immune Protection of Neonatal Suckling Piglets. Front Immunol 2019; 10:727. [PMID: 31068924 PMCID: PMC6491507 DOI: 10.3389/fimmu.2019.00727] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/18/2019] [Indexed: 01/22/2023] Open
Abstract
During pregnancy, the maternal immune response changes dramatically over the course of gestation. This has implications for generation of lactogenic immunity and subsequent protection in suckling neonates against enteric viral infections. For example, porcine epidemic diarrhea virus (PEDV) is an alphacoronavirus that causes acute diarrhea in neonatal piglets. Due to the high virulence of PEDV and the naïve, immature immune system of neonatal suckling piglets, passive lactogenic immunity to PEDV induced during pregnancy, via the gut-mammary gland (MG)-secretory IgA (sIgA) axis, is critical for piglet protection. However, the anti-PEDV immune response during pregnancy and stage of gestation required to optimally stimulate the gut-MG-sIgA axis is undefined. We hypothesize that there is a gestational window in which non-lethal PEDV infection of pregnant gilts influences maximum lymphocyte mucosal trafficking to the MG, resulting in optimal passive lactogenic protection in suckling piglets. To understand how the stages of gestation affect maternal immune responses to PEDV, three groups of gilts were orally infected with PEDV in the first, second or third trimester. Control (mock) gilts were inoculated with medium in the third trimester. To determine if lactogenic immunity correlated with protection, all piglets were PEDV-challenged at 3–5 days postpartum. PEDV infection of gilts at different stages of gestation significantly affected multiple maternal systemic immune parameters prepartum, including cytokines, B cells, PEDV antibodies (Abs), and PEDV antibody secreting cells (ASCs). Pregnant second trimester gilts had significantly higher levels of circulating PEDV IgA and IgG Abs and ASCs and PEDV virus neutralizing (VN) Abs post PEDV infection. Coinciding with the significantly higher PEDV Ab responses in second trimester gilts, the survival rate of their PEDV-challenged piglets was 100%, compared with 87.2, 55.9, and 5.7% for first, third, and mock litters, respectively. Additionally, piglet survival positively correlated with PEDV IgA Abs and ASCs and VN Abs in milk and PEDV IgA and IgG Abs in piglet serum. Our findings have implications for gestational timing of oral attenuated PEDV maternal vaccines, whereby PEDV intestinal infection in the second trimester optimally stimulated the gut-MG-sIgA axis resulting in 100% lactogenic immune protection in suckling piglets.
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Affiliation(s)
- Stephanie N Langel
- Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, College of Food, Agriculture and Environmental Sciences, College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States
| | - Francine C Paim
- Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, College of Food, Agriculture and Environmental Sciences, College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States
| | - Moyasar A Alhamo
- Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, College of Food, Agriculture and Environmental Sciences, College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States
| | - Alexandra Buckley
- National Animal Disease Center, Agricultural Research Service, USDA, Ames, IA, United States
| | - Albert Van Geelen
- National Animal Disease Center, Agricultural Research Service, USDA, Ames, IA, United States
| | - Kelly M Lager
- National Animal Disease Center, Agricultural Research Service, USDA, Ames, IA, United States
| | - Anastasia N Vlasova
- Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, College of Food, Agriculture and Environmental Sciences, College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States
| | - Linda J Saif
- Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, College of Food, Agriculture and Environmental Sciences, College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States
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32
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Age-related differences in antibody avidities to pertussis toxin and filamentous hemagglutinin in a healthy Japanese population. Vaccine 2019; 37:2463-2469. [PMID: 30930008 DOI: 10.1016/j.vaccine.2019.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 02/06/2023]
Abstract
To gain insights into the current Japanese pertussis immunization schedule, we examined the distributions of antibody titers and avidities to pertussis toxin (PT) and filamentous hemagglutinin (FHA) in 460 Japanese healthy subjects (aged 1-60 years) based on age category. Our avidity enzyme-linked immunosorbent assays revealed that young children aged 1-2 years, which corresponded to ages after receiving primary and/or booster pertussis vaccinations, had relatively high-avidity anti-PT IgG (mean avidity index [AI], 40.5%) compared with other age groups (AI, 26.5-31.9%); however, they had relatively low-avidity anti-FHA IgG (AI, 41.8%). In contrast, children aged 3-6 years had both low-avidity anti-PT IgG (AI, 26.5%) and low-avidity anti-FHA IgG (AI, 40.4%). A significant age-related difference in anti-PT IgG avidity was observed between children aged 1-2 years and 3-6 years (P < 0.05); however, the difference in anti-FHA IgG avidity was not significant. The anti-PT IgG avidity was positively correlated with the antibody titer, especially among children aged 1-15 years (rs = 0.508-0.685; P < 0.01), indicating that the avidity of vaccine-induced anti-PT IgG decreases with decreasing IgG antibody titer to PT. Our findings strongly suggest that vaccine-induced anti-PT IgG avidity rapidly wanes after vaccination, but this is not observed for anti-FHA IgG avidity. Because children aged 3-6 years have both low-quantity and low-quality antibodies against PT, an additional booster vaccination with acellular pertussis vaccines is required for such children in Japan.
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33
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Argondizo-Correia C, Rodrigues AKS, de Brito CA. Neonatal Immunity to Bordetella pertussis Infection and Current Prevention Strategies. J Immunol Res 2019; 2019:7134168. [PMID: 30882004 PMCID: PMC6387735 DOI: 10.1155/2019/7134168] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 01/10/2023] Open
Abstract
Bordetella pertussis is the bacterial agent of whooping cough, an infectious disease that is reemerging despite high vaccine coverage. Newborn children are the most affected, not only because they are too young to be vaccinated but also due to qualitative and quantitative differences in their immune system, which makes them more susceptible to infection and severe manifestations, leading to a higher mortality rate comparing to other groups. Until recently, prevention consisted of vaccinating children in the first year of life and the herd vaccination of people directly in touch with them, but the increase in cases demands more effective strategies that can overcome the developing immune response in early life and induce protection while children are most vulnerable.
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Affiliation(s)
- Carolina Argondizo-Correia
- Institute of Tropical Medicine, University of São Paulo, Dr. Enéas de Carvalho Aguiar Avenue 470 Jardim América, São Paulo, SP 05403-000, Brazil
- Immunology Centre, Adolfo Lutz Institute, Dr. Arnaldo Avenue 351 Cerqueira César, São Paulo, SP 01246-000, Brazil
| | - Ana Kelly Sousa Rodrigues
- Immunology Centre, Adolfo Lutz Institute, Dr. Arnaldo Avenue 351 Cerqueira César, São Paulo, SP 01246-000, Brazil
| | - Cyro Alves de Brito
- Institute of Tropical Medicine, University of São Paulo, Dr. Enéas de Carvalho Aguiar Avenue 470 Jardim América, São Paulo, SP 05403-000, Brazil
- Immunology Centre, Adolfo Lutz Institute, Dr. Arnaldo Avenue 351 Cerqueira César, São Paulo, SP 01246-000, Brazil
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Human Immune Responses to Pertussis Vaccines. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1183:99-113. [PMID: 31342460 DOI: 10.1007/5584_2019_406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pertussis still represents a major cause of morbidity and mortality worldwide. Although vaccination is the most powerful tool in preventing pertussis and despite nearly 70 years of universal childhood vaccination, incidence of the disease has been rising in the last two decades in countries with high vaccination coverage. Two types of vaccines are commercially available against pertussis: whole-cell pertussis vaccines (wPVs) introduced in the 1940s and still in use especially in low and middle-income countries; less reactogenic acellular pertussis vaccines (aPVs), licensed since the mid-1990s.In the last years, studies on pertussis vaccination have highlighted significant gaps and major differences between the two types of vaccines in the induction of protective anti-pertussis immunity in humans. This chapter will discuss the responses of the immune system to wPVs and aPVs, with the aim to enlighten critical points needing further efforts to reach a good level of protection in vaccinated individuals.
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35
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Abu Raya B, Giles M. Timing of Prenatal Tdap Immunization and Protection Against Pertussis. Clin Infect Dis 2018; 64:821-822. [PMID: 28362952 DOI: 10.1093/cid/cix027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bahaa Abu Raya
- Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Michelle Giles
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
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36
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Campbell H, Gupta S, Dolan GP, Kapadia SJ, Kumar Singh A, Andrews N, Amirthalingam G. Review of vaccination in pregnancy to prevent pertussis in early infancy. J Med Microbiol 2018; 67:1426-1456. [PMID: 30222536 DOI: 10.1099/jmm.0.000829] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Maternal pertussis vaccination has been introduced in several countries to protect infants from birth until routine infant vaccination takes place. This review assesses existing evidence on the effectiveness and safety of immunization in pregnancy. The search was finalized in April 2017 and was based on searches using several databases. The selection criteria included any experimental or observational study reporting on the immunogenicity, effectiveness or safety of vaccination with a pertussis-containing vaccine in pregnant women and their infants. Following de-duplication and exclusions, we identified 8395 studies, which were reduced to 46 for inclusion. The overall risk of bias was low, with the exception of some early studies and pharmacovigilance safety data. The evidence demonstrates efficient transplacental transfer of maternal antibodies in infants whose mothers were vaccinated with Tdap or Tdap/IPV in pregnancy, with good evidence that this protects against disease in young infants. Safety studies covering more than 150 000 women vaccinated mostly in the late second or third trimesters are generally consistent and provide reassurance of no significant increased risk of recognized maternal conditions or of adverse events (including congenital anomalies) in infants born to vaccinated women. The clinical significance of reduced seroconversion to pertussis following routine immunization is not yet clear, but no increased risk of pertussis in infants whose mothers were vaccinated in pregnancy was found following primary immunizations in North American and English studies. Most post-booster studies suggest that any blunting effect is short-lived and that longer-term protection in infants from active immunization is not compromised.
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Affiliation(s)
- Helen Campbell
- 1Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
| | - Saurabh Gupta
- 2Public Health, Epidemiology and Biostatistics, Ambition Health Private Limited, Gurgaon, India
- 3National Technical Advisory Group on Immunization Secretariat, National Institute of Health and Family Welfare, New Delhi, India
| | - Gayle P Dolan
- 4North East PHE Centre, Public Health England, Newcastle upon Tyne, UK
| | - Smita J Kapadia
- 5Health Protection Team, Public Health England, East of England, Harlow, UK
| | - Awnish Kumar Singh
- 3National Technical Advisory Group on Immunization Secretariat, National Institute of Health and Family Welfare, New Delhi, India
| | - Nick Andrews
- 6Department of Statistics Modelling and Economics, Public Health England, London, UK
| | - Gayatri Amirthalingam
- 1Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, UK
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37
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Affiliation(s)
- Paul Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Paris, France
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivia Anselem
- AP-HP, Maternité Port-Royal, Département de Gynécologie-Obstétrique, Hôpital Cochin Broca Hôtel-Dieu, Paris, France
- DHU Risk in pregnancy, Université Paris Descartes, Paris, France
| | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
- Inserm, CIC 1417, Université Paris Descartes, Paris, France
- AP-HP, Département de maladies infectieuses, CIC Cochin Pasteur, Paris, France
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38
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No 357 – Immunisation pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:490-502. [DOI: 10.1016/j.jogc.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE To review the evidence and provide recommendations on immunization in pregnancy. OUTCOMES Outcomes evaluated include effectiveness of immunization and risks and benefits for mother and fetus. EVIDENCE The Medline and Cochrane databases were searched for articles published up to January 2017 on the topic of immunization in pregnancy. VALUES The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS Implementation of the recommendations in this guideline should result in more appropriate immunization of pregnant and breastfeeding women, decreased risk of contraindicated immunization, and better disease prevention. RECOMMENDATIONS
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40
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Abstract
PURPOSE OF REVIEW Vaccination in pregnancy boosts maternal vaccine-specific antibody concentration and therefore increases transplacental transfer of antibody to optimize protection of the infant. The purpose of this review is to describe what is known about placental transfer of antibody in the context of vaccination in pregnancy, focussing on the recent literature and areas of debate, particularly about the timing of vaccination. RECENT FINDINGS There is a debate about the timing of pertussis vaccination in pregnancy with some studies reporting that vaccination in the third trimester results in higher pertussis antigen-specific IgG concentrations in cord blood and others finding that the concentration is higher following vaccination in the second trimester. The impact of timing of vaccination on antibody avidity in cord blood has also been investigated and one study suggests that avidity may be increased following vaccination at 27-30 gestational weeks compared with later vaccination. SUMMARY Understanding placental transfer of antibody is vital in informing maternal vaccination strategy. There has been recent research about the timing of pertussis vaccination in pregnancy that has implications for the timing of both current and future vaccines to be used in pregnancy.
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41
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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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Marshall H, McMillan M, Andrews RM, Macartney K, Edwards K. Vaccines in pregnancy: The dual benefit for pregnant women and infants. Hum Vaccin Immunother 2017; 12:848-56. [PMID: 26857450 DOI: 10.1080/21645515.2015.1127485] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Maternal immunization has the potential to reduce the burden of infectious diseases in the pregnant woman and her infant. Many countries now recommend immunization against influenza at any stage of pregnancy and against pertussis in the third trimester. Despite evidence of the safety and effectiveness of these vaccines when administered during pregnancy, uptake generally remains low for influenza and moderate for pertussis vaccine. Enhancing confidence in both immunization providers and pregnant women by increasing the evidence-base for the safety and effectiveness of vaccines during pregnancy, improving communication and access by incorporating immunization into standard models of antenatal care are likely to improve uptake. Developing a framework for implementation of vaccines for pregnant women which is cognizant of local and national cultural, epidemiological, behavioral and societal factors will enable a smooth transition and high uptake for new vaccines currently in development for pregnant women.
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Affiliation(s)
- H Marshall
- a Paediatrics, Women's and Children's Health Network , Adelaide, South Australia and Robinson Research Institute and School of Medicine, University of Adelaide , Adelaide , South Australia , Australia
| | - M McMillan
- a Paediatrics, Women's and Children's Health Network , Adelaide, South Australia and Robinson Research Institute and School of Medicine, University of Adelaide , Adelaide , South Australia , Australia
| | - R M Andrews
- b Menzies School of Health Research , Brisbane , Queensland , Australia
| | - K Macartney
- c Sydney Medical School, Sydney, New South Wales, Australia; Department of Infectious Diseases and Microbiology , The Children's Hospital at Westmead, Sydney, New South Wales, Australia; National Centre for Immunization Research and Surveillance , Sydney , New South Wales , Australia
| | - K Edwards
- d Vanderbilt University , Nashville , TN , USA
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Rice T, Kampmann B, Holder B. One size fits all? Antibody avidity measurement against multiple antigens in maternal vaccination studies. Virulence 2017; 8:1066-1068. [PMID: 28441089 DOI: 10.1080/21505594.2017.1321192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Thomas Rice
- a Paediatrics, Division of Infectious Diseases , Centre for International Child Health, Imperial College London , London , UK
| | - Beate Kampmann
- a Paediatrics, Division of Infectious Diseases , Centre for International Child Health, Imperial College London , London , UK
| | - Beth Holder
- a Paediatrics, Division of Infectious Diseases , Centre for International Child Health, Imperial College London , London , UK
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Khodr ZG, Bukowinski AT, Gumbs GR, Conlin AMS. Tetanus, diphtheria, and acellular pertussis vaccination during pregnancy and reduced risk of infant acute respiratory infections. Vaccine 2017; 35:5603-5610. [DOI: 10.1016/j.vaccine.2017.08.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
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Marchant A, Sadarangani M, Garand M, Dauby N, Verhasselt V, Pereira L, Bjornson G, Jones CE, Halperin SA, Edwards KM, Heath P, Openshaw PJ, Scheifele DW, Kollmann TR. Maternal immunisation: collaborating with mother nature. THE LANCET. INFECTIOUS DISEASES 2017; 17:e197-e208. [PMID: 28433705 DOI: 10.1016/s1473-3099(17)30229-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 10/07/2016] [Accepted: 01/18/2017] [Indexed: 12/15/2022]
Abstract
Maternal immunisation has the potential to substantially reduce morbidity and mortality from infectious diseases after birth. The success of tetanus, influenza, and pertussis immunisation during pregnancy has led to consideration of additional maternal immunisation strategies to prevent group B streptococcus and respiratory syncytial virus infections, among others. However, many gaps in knowledge regarding the immunobiology of maternal immunisation prevent the optimal design and application of this successful public health intervention. Therefore, we did an innovative landscape analysis to identify research priorities. Key topics were delineated through review of the published literature, consultation with vaccine developers and regulatory agencies, and a collaborative workshop that gathered experts across several maternal immunisation initiatives-group B streptococcus, respiratory syncytial virus, pertussis, and influenza. Finally, a global online survey prioritised the identified knowledge gaps on the basis of expert opinion about their importance and relevance. Here we present the results of this worldwide landscape analysis and discuss the identified research gaps.
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Affiliation(s)
- Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium.
| | - Manish Sadarangani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Division of Infectious Diseases, Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada; Vaccine Evaluation Center, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | - Mathieu Garand
- Vaccine Evaluation Center, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada; Vaccine and Immunity Theme, Medical Research Council Unit, Fajara, The Gambia
| | - Nicolas Dauby
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium; Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Valerie Verhasselt
- Faculty of Molecular Science, University of Western Australia, Perth, WA, Australia
| | | | - Gordean Bjornson
- Vaccine Evaluation Center, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | - Christine E Jones
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, Izaak Walton Killam Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Kathryn M Edwards
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Paul Heath
- St George's Vaccine Institute, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Peter J Openshaw
- Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - David W Scheifele
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada; Vaccine Evaluation Center, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | - Tobias R Kollmann
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada; Vaccine Evaluation Center, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.
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46
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Abu Raya B, Edwards KM, Scheifele DW, Halperin SA. Pertussis and influenza immunisation during pregnancy: a landscape review. THE LANCET. INFECTIOUS DISEASES 2017; 17:e209-e222. [DOI: 10.1016/s1473-3099(17)30190-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 01/25/2017] [Accepted: 02/07/2017] [Indexed: 12/21/2022]
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Voysey M, Kelly DF, Fanshawe TR, Sadarangani M, O’Brien KL, Perera R, Pollard AJ. The Influence of Maternally Derived Antibody and Infant Age at Vaccination on Infant Vaccine Responses : An Individual Participant Meta-analysis. JAMA Pediatr 2017; 171:637-646. [PMID: 28505244 PMCID: PMC5710349 DOI: 10.1001/jamapediatrics.2017.0638] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The design of infant immunization schedules requires an understanding of the factors that determine the immune response to each vaccine antigen. DATA SOURCES Deidentified individual participant data from GlaxoSmithKline clinical trials were obtained through Clinical Study Data Request. The data were requested on January 2, 2015, and final data were received on April 11, 2016. STUDY SELECTION Immunogenicity trials of licensed or unlicensed vaccines administered to infants were included if antibody concentrations in infants were measured prior to the first dose of vaccine. DATA EXTRACTION AND SYNTHESIS The database was examined; studies that appeared to have appropriate data were reviewed. MAIN OUTCOMES AND MEASURES Antigen-specific antibody concentration measured 1 month after priming vaccine doses, before booster vaccination, and 1 month after booster vaccine doses. RESULTS A total of 7630 infants from 32 studies in 17 countries were included. Mean (SD) age at baseline was 9.0 (2.3) weeks; 3906 (51.2%) were boys. Preexisting maternal antibody inhibited infant antibody responses to priming doses for 20 of 21 antigens. The largest effects were observed for inactivated polio vaccine, where 2-fold higher maternal antibody concentrations resulted in 20% to 28% lower postvaccination antibody concentration (geometric mean ratios [GMRs], type 1: 0.80; 95% CI, 0.78-0.83; type 2: 0.72; 95% CI, 0.69-0.74; type 3: 0.78; 95% CI, 0.75-0.82). For acellular pertussis antigens, 2-fold higher maternal antibody was associated with 11% lower postvaccination antibody for pertussis toxoid (GMR, 0.89; 95% CI, 0.87-0.90) and filamentous hemagglutinin (GMR, 0.89; 95% CI, 0.88-0.90) and 22% lower pertactin antibody (GMR, 0.78; 95% CI, 0.77-0.80). For tetanus and diphtheria, these estimates were 13% (GMR, 0.87; 95% CI, 0.86-0.88) and 24% (GMR, 0.76; 95% CI, 0.74-0.77), respectively. The influence of maternal antibody was still evident in reduced responses to booster doses of acellular pertussis, inactivated polio, and diphtheria vaccines at 12 to 24 months of age. Children who were older when first immunized had higher antibody responses to priming doses for 18 of 21 antigens, after adjusting for the effect of maternal antibody concentrations. The largest effect was seen for polyribosylribitol phosphate antibody, where responses were 71% higher per month (GMR, 1.71; 95% CI, 1.52-1.92). CONCLUSIONS AND RELEVANCE Maternal antibody concentrations and infant age at first vaccination both influence infant vaccine responses. These effects are seen for almost all vaccines contained in global immunization programs and influence immune response for some vaccines even at the age of 24 months. These data highlight the potential for maternal immunization strategies to influence established infant programs.
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Affiliation(s)
- Merryn Voysey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England,Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, England,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, England
| | - Dominic F. Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, England,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, England
| | - Thomas R. Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Manish Sadarangani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, England,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, England,Vaccine Evaluation Center, British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Katherine L. O’Brien
- International Vaccine Access Centre, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, England,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, England
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Campbell PT, McVernon J, Geard N. Determining the Best Strategies for Maternally Targeted Pertussis Vaccination Using an Individual-Based Model. Am J Epidemiol 2017; 186:109-117. [PMID: 28453607 DOI: 10.1093/aje/kwx002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/08/2016] [Indexed: 12/13/2022] Open
Abstract
Rising pertussis incidence has prompted a number of countries to implement maternally targeted vaccination strategies to protect vulnerable infants, but questions remain about the optimal design of such strategies. We simulated pertussis transmission within an individual-based model parameterized to match Australian conditions, explicitly linking infants and their mothers to estimate the effectiveness of alternative maternally targeted vaccination strategies (antenatal delivery vs. postnatal delivery) and the benefit of revaccination over the course of multiple pregnancies. For firstborn infants aged less than 2 months, antenatal immunization reduced annual pertussis incidence by 60%, from 780 per 100,000 firstborn children under age 2 months (interquartile range (IQR), 682-862) to 315 per 100,000 (IQR, 260-370), while postnatal vaccination produced a minimal reduction, with an incidence of 728 per 100,000 (IQR, 628-789). Subsequent infants obtained limited protection from a single antenatal dose, but revaccinating mothers during every pregnancy decreased incidence for these infants by 58%, from 1,878 per 100,000 subsequent children under age 2 months (IQR, 1,712-2,076) to 791 per 100,000 (IQR, 683-915). Subsequent infants also benefited from household-level herd immunity when antenatal vaccination for every pregnancy was combined with a toddler booster dose at age 18 months; incidence was reduced to 626 per 100,000 (IQR, 548-691). Our approach provides useful information to aid consideration of alternative maternally targeted vaccination strategies and can inform development of outcome measures for program evaluation.
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Vacunación frente a Bordetella pertussis en embarazadas. ¿Es adecuada nuestra estrategia de vacunación? Med Clin (Barc) 2017; 148:475-476. [DOI: 10.1016/j.medcli.2016.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022]
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Pertussis vaccination in pregnancy: State of the art. Vaccine 2017; 35:4453-4456. [PMID: 28359620 DOI: 10.1016/j.vaccine.2017.03.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 01/27/2023]
Abstract
Pertussis vaccination in pregnancy has been introduced by several national advisory bodies, mostly in industrialized countries, as a means to protect young infants from disease by high titers of maternal antibodies. Most recommendations derive from epidemiological needs, but many knowledge gaps remained after implementation. This report aims to overview the solved and unsolved aspects of prenatal vaccination with a pertussis containing vaccine.
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