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Quincer EM, Cranmer LM, Kamidani S. Prenatal Maternal Immunization for Infant Protection: A Review of the Vaccines Recommended, Infant Immunity and Future Research Directions. Pathogens 2024; 13:200. [PMID: 38535543 PMCID: PMC10975994 DOI: 10.3390/pathogens13030200] [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: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 04/01/2024] Open
Abstract
Prenatal maternal immunization is an effective tool to protect mothers and infants from poor health outcomes due to infectious diseases. We provide an overview of the rationale for the use of prenatal vaccines, discuss the immunologic environment of the maternal-fetal interface including the impact of maternal vaccines prenatally and subsequently on the infant's immune response, and review vaccines currently recommended in pregnancy and landscape for the future of maternal vaccination. This review aims to provide an understanding of the recent history and progress made in the field and highlight the importance of continued research and development into new vaccines for pregnant populations.
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Affiliation(s)
- Elizabeth M. Quincer
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Lisa M. Cranmer
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Satoshi Kamidani
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
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Blanco JCG, Cullen LM, Kamali A, Sylla FYD, Chinmoun Z, Boukhvalova MS, Morrison TG. Correlative outcomes of maternal immunization against RSV in cotton rats. Hum Vaccin Immunother 2022; 18:2148499. [PMID: 36503354 PMCID: PMC9766472 DOI: 10.1080/21645515.2022.2148499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
Maternal anti-respiratory syncytial virus (RSV) antibodies protect neonates from RSV disease throughout first weeks of life. Previous studies of maternal immunization in cotton rats showed that a single immunization during pregnancy of RSV-primed dams with virus-like particles (VLPs) assembled with pre-fusion F protein and the wild type G protein boosted their RSV serum antibody concentration and protected pups early in life against RSV challenge. We extended these findings by evaluating responses to RSV infection in litters from two consecutive pregnancies of immunized dams. Using an RSV-primed population of VLP-vaccinated and unvaccinated dams, we defined correlations between dams' and litters' RSV neutralizing antibodies (NA); between litters' NA and protection; and between litter's NA and their lung expression of selected cytokines, of a first or of a second pregnancy. Lung pathology was also evaluated. We found positive correlation between the NA titers in the dams at delivery and the NA in their first and second litters and negative correlations between the litters' NA and protection from RSV challenge. Vaccination of dams modulated the mRNA expression for IFNγ and IL-6 and lung pathology in the first and in the second litter at different times after birth, even in the absence of detectable NA. Maternal RSV vaccination enhanced the levels of antibodies transferred to offspring and their protection from challenge. Importantly, maternal vaccination also impacted the immunological and inflammatory response of the offspring's lungs well into maturity, and after the antiviral effect of maternally transferred NA waned or was no longer detectable.
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Affiliation(s)
- Jorge C. G. Blanco
- Research Department, Sigmovir Biosystems Inc. Rockville, Rockville, MD, USA
| | - Lori M. Cullen
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Arash Kamali
- Research Department, Sigmovir Biosystems Inc. Rockville, Rockville, MD, USA
| | | | - Zenab Chinmoun
- Research Department, Sigmovir Biosystems Inc. Rockville, Rockville, MD, USA
| | | | - Trudy G. Morrison
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA, USA
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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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Impact of maternal and pre-existing antibodies on immunogenicity of inactivated rotavirus vaccines. Vaccine 2022; 40:3843-3850. [DOI: 10.1016/j.vaccine.2022.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/26/2022] [Accepted: 05/11/2022] [Indexed: 11/20/2022]
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Prenatal influenza vaccination and allergic and autoimmune diseases in childhood: A longitudinal, population-based linked cohort study. PLoS Med 2022; 19:e1003963. [PMID: 35381006 PMCID: PMC9017895 DOI: 10.1371/journal.pmed.1003963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/19/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have evaluated the effect of maternal influenza vaccination on the development of allergic and autoimmune diseases in children beyond 6 months of age. We aimed to investigate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and subsequent diagnosis of allergic and autoimmune diseases. METHODS AND FINDINGS This longitudinal, population-based linked cohort study included 124,760 singleton, live-born children from 106,206 mothers in Western Australia (WA) born between April 2012 and July 2016, with up to 5 years of follow-up from birth. In our study cohort, 64,169 (51.4%) were male, 6,566 (5.3%) were Aboriginal and/or Torres Strait Islander children, and the mean age at the end of follow-up was 3.0 (standard deviation, 1.3) years. The exposure was receipt of seasonal IIV during pregnancy. The outcomes were diagnosis of an allergic or autoimmune disease, including asthma and anaphylaxis, identified from hospital and/or emergency department (ED) records. Inverse probability of treatment weights (IPTWs) accounted for baseline probability of vaccination by maternal age, Aboriginal and/or Torres Strait Islander status, socioeconomic status, body mass index, parity, medical conditions, pregnancy complications, prenatal smoking, and prenatal care. The models additionally adjusted for the Aboriginal and/or Torres Strait Islander status of the child. There were 14,396 (11.5%) maternally vaccinated children; 913 (6.3%) maternally vaccinated and 7,655 (6.9%) maternally unvaccinated children had a diagnosis of allergic or autoimmune disease, respectively. Overall, maternal influenza vaccination was not associated with diagnosis of an allergic or autoimmune disease (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.95 to 1.09). In trimester-specific analyses, we identified a negative association between third trimester influenza vaccination and the diagnosis of asthma (n = 40; aHR, 0.70; 95% CI, 0.50 to 0.97) and anaphylaxis (n = 36; aHR, 0.67; 95% CI, 0.47 to 0.95).We did not capture outcomes diagnosed in a primary care setting; therefore, our findings are only generalizable to more severe events requiring hospitalization or presentation to the ED. Due to small cell sizes (i.e., <5), estimates could not be determined for all outcomes after stratification. CONCLUSIONS In this study, we observed no association between in utero exposure to influenza vaccine and diagnosis of allergic or autoimmune diseases. Although we identified a negative association of asthma and anaphylaxis diagnosis when seasonal IIV was administered later in pregnancy, additional studies are needed to confirm this. Overall, our findings support the safety of seasonal inactivated influenza vaccine during pregnancy in relation to allergic and autoimmune diseases in early childhood and support the continuation of current global maternal vaccine programs and policies.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C. Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K. Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States of America
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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Jensen KJ, Tolstrup LK, Knobel DL, Aaby P, Jungersen G, Larsen LE, Kristensen CS, Benn CS. Non-specific effects of maternal and offspring rabies vaccination on mortality and antibiotic use in a Danish pig herd: A randomized trial. Vaccine 2022; 40:1665-1673. [PMID: 33840563 DOI: 10.1016/j.vaccine.2021.03.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Human non-live vaccines have been associated with detrimental non-specific effects (NSE), particularly in females. A large trial found 2-fold increased overall mortality in girls receiving a new malaria vaccine compared to the rabies vaccine used as a coontrol; a beneficial NSE of the rabies vaccine was proposed. Conversely, in dogs increased mortality was seen in females but not males following rabies vaccination of puppies born to immunized mothers. We investigated NSE of non-live rabies vaccine in piglets and the potential modifying effect of maternal priming with rabies vaccine. METHODS In a Danish herd of commercial rabies virus-free pigs, 575 pregnant sows (2-3 weeks before scheduled farrowing) and 5747 of their offspring (median 6-day-old) were allocated (1:1) to non-live rabies vaccine (Versiguard rabies vet) or no rabies vaccine. Outcomes were overall mortality and antibiotic treatment until departure from the nursery (approximately age 12 weeks/30 kgs). RESULTS Until weaning, overall offspring mortality was 2.2% (127 piglets died, rabies vaccine: n = 69; control: n = 58), the proportion ratio (PR) being 1.19 (95% confidence interval: 0.84-1.68). Until end of follow-up, mortality was 4.1% (233, rabies vaccine: n = 115; control = 118, PR: 0.97 (0.76-1.25)). Prior sow rabies vaccination did not affect piglet mortality. For mortality as well as risk of antibiotic treatment before weaning, there was indication of a beneficial effect of rabies vaccine in female piglets, but a negative effect in (castrated) male piglets from rabies-naïve sows. Prior sow vaccination significantly modified the vaccine effect estimate in female piglets toward a detrimental effect of rabies vaccine on treatment risk. These effects had waned by 12 weeks of age. CONCLUSION The study did not support the hypothesized beneficial NSE of rabies vaccine. Although under-powered for subgroup analyses, the study indicated effect modification by sex and maternal vaccination. Results could be different in a herd with higher mortality and infectious burden.
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Affiliation(s)
- Kristoffer Jarlov Jensen
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark, Copenhagen, Denmark; Copenhagen Phase IV Unit, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark; Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark.
| | | | - Darryn L Knobel
- Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis; Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Gregers Jungersen
- Center for Vaccine Research, Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Erik Larsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Christine Stabell Benn
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark, Copenhagen, Denmark; Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
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Poly (lactic-co-glycolic acid) nanoparticle-based vaccines delivery systems as a novel adjuvant for H9N2 antigen enhance immune responses. Poult Sci 2022; 101:101791. [PMID: 35358927 PMCID: PMC8968667 DOI: 10.1016/j.psj.2022.101791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Poly (lactic-co-glycolic acid) (PLGA) nanoparticle used as vaccine adjuvants have been widely investigated due to their safety, antigen slow-release ability, and good adjuvants activity. In this study, immunopotentiator Alhagi honey polysaccharide encapsulated PLGA nanoparticles (AHPP) and assembled pickering emulsion with AHPP as shell and squalene as core (PPAS) were prepared. Characterization of AHPP and PPAS were investigated. H9N2 absorbed nanoparticles formulations were immunized to chicken, then the magnitude and kinetics of antibody and cellular immune responses were assessed. Our results showed that PPAS had rough strawberry-like surfaces, a large number of antigens could be absorbed on their surfaces through simple mixing. Adjuvant activity of PPAS showed that, PPAS/H9N2 can induce long-lasting and high HI titers, high thymus, spleen, and bursa of fabricius organ index. Moreover, chicken immunized with PPAS/H9N2 showed a mixed high differentiation of CD4+ and CD8a+ T cell, and strong Th1 and Th2-type cytokines mRNA expression. Thus, these findings demonstrated that PPAS could induce a strong and long-term cellular and humoral immune response, and has the potential to serve as an effective vaccine delivery adjuvant system for H9N2 antigen.
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Longitudinal, population-based cohort study of prenatal influenza vaccination and influenza infection in childhood. Vaccine 2022; 40:656-665. [PMID: 35000794 DOI: 10.1016/j.vaccine.2021.11.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza vaccination is recommended to protect mothers and their infants from influenza infection. Few studies have evaluated the health impacts of in utero exposure to influenza vaccine among children more than six months of age. METHODS We used probabilistically linked administrative health records to establish a mother-child cohort to evaluate the risk of influenza and acute respiratory infections associated with maternal influenza vaccination. Outcomes were laboratory-confirmed influenza (LCI) and hospitalization for influenza or acute respiratory infection (ARI). Adjusted hazard ratios (aHRs) accounted for child's Aboriginal status and were weighted by the inverse-probability of treatment. RESULTS 14,396 (11.5%) children were born to vaccinated mothers. Maternally vaccinated infants aged < 6 months had lower risk of LCI (aHR: 0.33; 95% CI: 0.13, 0.85), influenza-associated hospitalization (aHR: 0.39; 95% CI: 0.16, 0.94) and ARI-associated hospitalization (aHR: 0.85; 95% CI: 0.77, 0.94) compared to maternally unvaccinated infants. With the exception of an increased risk of LCI among children aged 6 months to < 2 years old following first trimester vaccination (aHR: 2.28; 95% CI: 1.41, 3.69), there were no other differences in the risk of LCI, influenza-associated hospitalization or ARI-associated hospitalization among children aged > 6 months. CONCLUSION Study results show that maternal influenza vaccination is effective in preventing influenza in the first six months and had no impact on respiratory infections after two years of age.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States; Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
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Orije MRP, García-Fogeda I, Van Dyck W, Corbière V, Mascart F, Mahieu L, Hens N, Van Damme P, Cools N, Ogunjimi B, Maertens K, Leuridan E. Impact of maternal pertussis antibodies on the infants' cellular immune responses. Clin Infect Dis 2021; 75:442-452. [PMID: 34849638 DOI: 10.1093/cid/ciab972] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Maternal antibody interference of the infant's humoral immune responses raises some concern to the strategy of maternal Tdap (tetanus, diphtheria, acellular pertussis [aP]) vaccination. This study assessed the impact of maternal Tdap antibodies on the infant's pertussis-specific T lymphocyte responses following infant vaccination with an aP containing vaccine, in a term and preterm born cohort. METHODS Heparin samples (±0.5mL) were conveniently drawn from infants of a Belgian prospective cohort study (N=79, NCT02511327), including Tdap vaccinated (Boostrix®) and non-vaccinated women (no Tdap vaccine in the last 5 years) that delivered at term or prematurely. Sampling was performed before and one month after primary (8-12-16 weeks) and booster vaccination (13 or 15 months) with DTaP-IPV-HB-PRP~T vaccine (Hexyon®). Pertussis toxin (PT)-specific CD3 +, CD3 +CD4 + and CD3 +CD8 + lymphoblasts and their cytokine secretions were measured using a flow cytometric assay on whole blood (FASCIA) and multiplex technology (Meso Scale Discovery), respectively. RESULTS 57% of all infants were considered PT-specific CD3 +CD4 + lymphoblasts responders after primary and booster vaccination, whereas 17% were CD3 +CD8 + lymphoblast responders. IFN-γ, IL-13, IL-17A and IL-5 cytokine secretions after primary and booster vaccination were indicative of a mixed T helper (Th) 1/Th2/Th17 cell profile. Lymphoblast and cytokine levels were comparable between term and preterm infants. Non-responders for IL-13 after booster vaccination had higher maternal PT IgG levels at birth when compared to responders. CONCLUSIONS Term and preterm born infants are capable of inducing Th1, Th2 and Th17 responses after aP vaccination, yet maternal vaccination modulate these responses. Evaluation of this effect in larger trials is needed.
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Affiliation(s)
- Marjolein R P Orije
- Centre for the Evaluation of Vaccination (CEV); Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Irene García-Fogeda
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID); Vaccine & Infectious Diseases Institute (VAXINFECTIO); University of Antwerp, Antwerp, Belgium
| | - Wouter Van Dyck
- Centre for the Evaluation of Vaccination (CEV); Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Véronique Corbière
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (U.L.B.), Faculty of Medicine, Belgium
| | - Françoise Mascart
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (U.L.B.), Faculty of Medicine, Belgium
| | - Ludo Mahieu
- Department of Paediatrics, Division of Neonatology; University Hospital Antwerp, Antwerp, Belgium
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID); Vaccine & Infectious Diseases Institute (VAXINFECTIO); University of Antwerp, Antwerp, Belgium.,Interuniversity Institute of Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV); Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Nathalie Cools
- Immune Regulation and tolerance-inducing Strategies (IRiS); Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Benson Ogunjimi
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID); Vaccine & Infectious Diseases Institute (VAXINFECTIO); University of Antwerp, Antwerp, Belgium.,Antwerp Center for Translational Immunology and Virology (ACTIV); Vaccine & Infectious Diseases Institute (VAXINFECTIO); University of Antwerp, Antwerp, Belgium.,Department of Paediatrics; University Hospital Antwerp, Antwerp, Belgium
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination (CEV); Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination (CEV); Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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Abu-Raya B, Maertens K, Munoz FM, Zimmermann P, Curtis N, Halperin SA, Rots N, Barug D, Holder B, Rice TF, Kampmann B, Leuridan E, Sadarangani M. Factors affecting antibody responses to immunizations in infants born to women immunized against pertussis in pregnancy and unimmunized women: Individual-Participant Data Meta-analysis. Vaccine 2021; 39:6545-6552. [PMID: 34598822 DOI: 10.1016/j.vaccine.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exploring factors that affect immune responses to immunizations in infants born to women immunized with tetanus-diphtheria-acellular-pertussis (Tdap) in pregnancy compared with unimmunized women is important in designing immunization programs. METHODS Individual-participant data meta-analysis of 8 studies reporting post-immunization immunoglobulin G (IgG) levels to vaccine antigens in infants born to either women immunized with Tdap in pregnancy or unimmunized women, using mixed-effects models. RESULTS In infants of Tdap-immunized women, two-fold higher levels of anti-pertussis toxin (PT) and anti-diphtheria-toxoid (DT) IgG pre-primary immunization were associated with 9% and 10% lower post-primary immunization levels, (geometric mean ratio [GMR], PT: 0.91; 95% CI, 0.88-0.95,n = 494, DT: 0.9; 0.87-0.93,n = 519). Timing of immunization in pregnancy did not affect post-primary immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-primary immunization anti-B. pertussis and anti-DT levels. In infants of Tdap-immunized women, two-fold higher levels of anti-PT and anti-filamentous haemagglutinin (FHA) IgG pre-primary immunization were associated with lower post-booster immunization levels, (GMR, PT: 0.91; 0.85-0.97,n = 224, FHA: 0.92; 0.85-0.99,n = 232). Timing of immunization in pregnancy did not affect post-booster immunization anti-Bordetella pertussis, anti-tetanus-toxoid (TT) and anti-DT IgG levels. Spacing of infant immunization did not affect post-booster immunization anti-PT, anti-pertactin (PRN), anti-TT and anti-DT IgG levels. In infants of unimmunized women, two-fold higher IgG levels of some vaccine antigens pre-primary immunization were associated with 8-17% lower post-primary immunization levels (GMR, PT 0.92, 95% CI:0.88-0.97, n = 373; FHA:0.88, 95% CI:0.85-0.92,n = 378; PRN:0.84, 95% CI:0.81-0.88, n = 367; TT:0.88, 95% CI:0.83-0.93, n = 241; DT: 0.83, 95% CI:0.79-0.87,n = 278). Two-fold higher levels of anti-FHA IgG pre-primary immunization were associated with 8% lower post-booster immunization levels (GMR, 0.92; 95% CI: 0.86-0.99,n = 138). DISCUSSION Increased IgG levels pre-primary immunization is associated with reduced post-primary and post-booster immunization levels for some antigens in infants of women immunized or unimmunized in pregnancy, but their clinical significance is uncertain.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Belgium.
| | - Flor M Munoz
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Petra Zimmermann
- Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, Australia; Department of Pediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Parkville, Australia
| | - 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
| | - Nynke Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Daan Barug
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Beth Holder
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom; Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - Thomas F Rice
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia; The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Belgium
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Saso A, Kampmann B, Roetynck S. Vaccine-Induced Cellular Immunity against Bordetella pertussis: Harnessing Lessons from Animal and Human Studies to Improve Design and Testing of Novel Pertussis Vaccines. Vaccines (Basel) 2021; 9:877. [PMID: 34452002 PMCID: PMC8402596 DOI: 10.3390/vaccines9080877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Pertussis ('whooping cough') is a severe respiratory tract infection that primarily affects young children and unimmunised infants. Despite widespread vaccine coverage, it remains one of the least well-controlled vaccine-preventable diseases, with a recent resurgence even in highly vaccinated populations. Although the exact underlying reasons are still not clear, emerging evidence suggests that a key factor is the replacement of the whole-cell (wP) by the acellular pertussis (aP) vaccine, which is less reactogenic but may induce suboptimal and waning immunity. Differences between vaccines are hypothesised to be cell-mediated, with polarisation of Th1/Th2/Th17 responses determined by the composition of the pertussis vaccine given in infancy. Moreover, aP vaccines elicit strong antibody responses but fail to protect against nasal colonisation and/or transmission, in animal models, thereby potentially leading to inadequate herd immunity. Our review summarises current knowledge on vaccine-induced cellular immune responses, based on mucosal and systemic data collected within experimental animal and human vaccine studies. In addition, we describe key factors that may influence cell-mediated immunity and how antigen-specific responses are measured quantitatively and qualitatively, at both cellular and molecular levels. Finally, we discuss how we can harness this emerging knowledge and novel tools to inform the design and testing of the next generation of improved infant pertussis vaccines.
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Affiliation(s)
- Anja Saso
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1 7HT, UK; (B.K.); (S.R.)
- Vaccines and Immunity Theme, MRC Unit, The Gambia at London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Beate Kampmann
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1 7HT, UK; (B.K.); (S.R.)
- Vaccines and Immunity Theme, MRC Unit, The Gambia at London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Sophie Roetynck
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1 7HT, UK; (B.K.); (S.R.)
- Vaccines and Immunity Theme, MRC Unit, The Gambia at London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, The Gambia
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12
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Sawyer L. β-Lactoglobulin and Glycodelin: Two Sides of the Same Coin? Front Physiol 2021; 12:678080. [PMID: 34093238 PMCID: PMC8173191 DOI: 10.3389/fphys.2021.678080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/14/2021] [Indexed: 12/22/2022] Open
Abstract
The two lipocalins, β-lactoglobulin (βLg) and glycodelin (Gd), are possibly the most closely related members of the large and widely distributed lipocalin family, yet their functions appear to be substantially different. Indeed, the function of β-lactoglobulin, a major component of ruminant milk, is still unclear although neonatal nutrition is clearly important. On the other hand, glycodelin has several specific functions in reproduction conferred through distinct, tissue specific glycosylation of the polypeptide backbone. It is also associated with some cancer outcomes. The glycodelin gene, PAEP, reflecting one of its names, progestagen-associated endometrial protein, is expressed in many though not all primates, but the name has now also been adopted for the β-lactoglobulin gene (HGNC, www.genenames.org). After a general overview of the two proteins in the context of the lipocalin family, this review considers the properties of each in the light of their physiological functional significance, supplementing earlier reviews to include studies from the past decade. While the biological function of glycodelin is reasonably well defined, that of β-lactoglobulin remains elusive.
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Affiliation(s)
- Lindsay Sawyer
- School of Biological Sciences, IQB3, The University of Edinburgh, Edinburgh, United Kingdom
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13
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Herzog C, Van Herck K, Van Damme P. Hepatitis A vaccination and its immunological and epidemiological long-term effects - a review of the evidence. Hum Vaccin Immunother 2021; 17:1496-1519. [PMID: 33325760 PMCID: PMC8078665 DOI: 10.1080/21645515.2020.1819742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccines have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.
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Affiliation(s)
- Christian Herzog
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Koen Van Herck
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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14
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Sadarangani M, Kollmann T, Bjornson G, Heath P, Clarke E, Marchant A, Levy O, Leuridan E, Ulloa-Gutierrez R, Cutland CL, Kampmann B, Chaithongwongwatthana S, Dinleyici E, van Damme P, Munoz FM. The Fifth International Neonatal and Maternal Immunization Symposium (INMIS 2019): Securing Protection for the Next Generation. mSphere 2021; 6:e00862-20. [PMID: 33504658 PMCID: PMC7885317 DOI: 10.1128/msphere.00862-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite significant progress in reaching some milestones of the United Nations Sustainable Development Goals, neonatal and early infant morbidity and mortality remain high, and maternal health remains suboptimal in many countries. Novel and improved preventative strategies with the potential to benefit pregnant women and their infants are needed, with maternal and neonatal immunization representing effective approaches. Experts from immunology, vaccinology, infectious diseases, clinicians, industry, public health, and vaccine-related social sciences convened at the 5th International Neonatal and Maternal Immunization Symposium (INMIS) in Vancouver, Canada, from 15 to 17 September 2019. We critically evaluated the lessons learned from recent clinical studies, presented cutting-edge scientific progress in maternal and neonatal immunology and vaccine development, and discussed maternal and neonatal immunization in the broader context of infectious disease epidemiology and public health. Focusing on practical aspects of research and implementation, we also discussed the safety, awareness, and perception of maternal immunization as an existing strategy to address the need to improve maternal and neonatal health worldwide. The symposium provided a comprehensive scientific and practical primer as well as an update for all those with an interest in maternal and neonatal infection, immunity, and vaccination. The summary presented here provides an update of the current status of progress in maternal and neonatal immunization.
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Affiliation(s)
- Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tobias Kollmann
- Telethon Kids Institute, Perth Children's Hospital, University of Western Perth, Perth, Australia
| | - Gordean Bjornson
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Paul Heath
- St. George's University of London, London, United Kingdom
| | - Ed Clarke
- Vaccines & Immunity Theme, Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Banjul, The Gambia
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Charleroi, Belgium
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT & Harvard, Cambridge, Massachusetts, USA
| | - Elke Leuridan
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Rolando Ulloa-Gutierrez
- Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Centro de Ciencias Médicas C.C.S.S., San José, Costa Rica
| | - Clare L Cutland
- African Leadership in Vaccinology Expertise (ALIVE), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Beate Kampmann
- Vaccines & Immunity Theme, Medical Research Council Unit, The Gambia, London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Banjul, The Gambia
- The Vaccine Centre, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Surasith Chaithongwongwatthana
- Division of Infectious Disease in Gynecology and Obstetrics (InDiGO), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ener Dinleyici
- Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | - Pierre van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Flor M Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
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15
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Jiang R, Liu X, Sun X, Wang J, Huang Z, Li C, Li Z, Zhou J, Pu Y, Ying Z, Yin Q, Zhao Z, Zhang L, Lei J, Bao W, Jiang Y, Dou Y, Li J, Yang H, Cai W, Deng Y, Che Y, Shi L, Sun M. Immunogenicity and safety of the inactivated poliomyelitis vaccine made from Sabin strains in a phase IV clinical trial for the vaccination of a large population. Vaccine 2021; 39:1463-1471. [PMID: 33487470 DOI: 10.1016/j.vaccine.2021.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
As a recently launched novel vaccine used as one of the vaccines for the final eradication of polios worldwide, complete data on the consistency and immunogenicity characteristics of the inactivated poliomyelitis vaccine made from the Sabin strain (sIPV) and its safety in large-scale populations are required to support the future use of this vaccine worldwide. A phase IV clinical trial was conducted to perform an immunogenicity evaluation of lot-to-lot consistency of three commercial batches of sIPV in 1200 infants and to investigate the vaccine's safety on a large-scale in 20,019 infants for active monitoring and 29,683 infants for passive monitoring through the Adverse Event Following Immunization (AEFI) reporting system in China. In the immunogenicity evaluation, the average seroconversion rates for type I, type II and type III of the three groups were 99.83%, 98.93% and 99.44%, respectively. No differences in the seroconversion rate and the GMT ratios were noted in the pair-to-pair comparisons. In the large-scale safety evaluation, most adverse reactions occurred 0-30 days after the first doses, and the common local and systemic reactions were similar to those in the phase III clinical trial, with low incidence in both activated and passive monitoring. In conclusion, sIPV exhibits good lot-to-lot consistency and safety in large-scale populations; thus, it is qualified to serve as one of the vaccines for use in eradicating all wild and vaccine-derived polioviruses worldwide in the near future. Clinic Trial Registration. NCT04224519 and NCT04220515.
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Affiliation(s)
- Ruiju Jiang
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infections Diseases, Kunming, Yunnan, China
| | - Xiaoqiang Liu
- Vaccine Clinical Research Center, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Xiaodong Sun
- Shanghai Center for Disease Control and Prevention, Shanghai, China.
| | - Jianfeng Wang
- Division of Respiratory Virus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Zhuoying Huang
- Shanghai Center for Disease Control and Prevention, Shanghai, China.
| | - Changgui Li
- Division of Respiratory Virus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Zhi Li
- Shanghai Center for Disease Control and Prevention, Shanghai, China.
| | - Jianmei Zhou
- Mile Center for Disease Control and Prevention, Mile, Yunnan, China
| | - Yi Pu
- Gejiu Center for Disease Control and Prevention, Gejiu, Yunnan, China
| | - Zhifang Ying
- Division of Respiratory Virus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Qiongzhou Yin
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China
| | - Zhimei Zhao
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China
| | - Lifeng Zhang
- Vaccine Clinical Research Center, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Jing Lei
- Gejiu Center for Disease Control and Prevention, Gejiu, Yunnan, China
| | - Wenmei Bao
- Gejiu Center for Disease Control and Prevention, Gejiu, Yunnan, China
| | - Ya Jiang
- Mile Center for Disease Control and Prevention, Mile, Yunnan, China
| | - Youjian Dou
- Mile Center for Disease Control and Prevention, Mile, Yunnan, China
| | - Jingyu Li
- Vaccine Clinical Research Center, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Haitao Yang
- Vaccine Clinical Research Center, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Wei Cai
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infections Diseases, Kunming, Yunnan, China.
| | - Yan Deng
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China.
| | - Yanchun Che
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China.
| | - Li Shi
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China.
| | - Mingbo Sun
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, Yunnan, China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infections Diseases, Kunming, Yunnan, China.
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16
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Cinicola B, Conti MG, Terrin G, Sgrulletti M, Elfeky R, Carsetti R, Fernandez Salinas A, Piano Mortari E, Brindisi G, De Curtis M, Zicari AM, Moschese V, Duse M. The Protective Role of Maternal Immunization in Early Life. Front Pediatr 2021; 9:638871. [PMID: 33996688 PMCID: PMC8113393 DOI: 10.3389/fped.2021.638871] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/26/2021] [Indexed: 12/16/2022] Open
Abstract
With birth, the newborn is transferred from a quasi-sterile environment to the outside world. At this time, the neonatal immune system is inexperienced and continuously subject to a process of development as it encounters different antigenic stimuli after birth. It is initially characterized by a bias toward T helper 2 phenotype, reduced T helper 1, and cytotoxic responses to microbial stimuli, low levels of memory, and effector T and B cells and a high production of suppressive T regulatory cells. The aim of this setting, during fetal life, is to maintain an anti-inflammatory state and immune-tolerance. Maternal antibodies are transferred during pregnancy through the placenta and, in the first weeks of life of the newborn, they represent a powerful tool for protection. Thus, optimization of vaccination in pregnancy represents an important strategy to reduce the burden of neonatal infections and sepsis. Beneficial effects of maternal immunization are universally recognized, although the optimal timing of vaccination in pregnancy remains to be defined. Interestingly, the dynamic exchange that takes place at the fetal-maternal interface allows the transfer not only of antibodies, but also of maternal antigen presenting cells, probably in order to stimulate the developing fetal immune system in a harmless way. There are still controversial effects related to maternal immunization including the so called "immunology blunting," i.e., a dampened antibody production following infant's vaccination in those infants who received placentally transferred maternal immunity. However, clinical relevance of this phenomenon is still not clear. This review will provide an overview of the evolution of the immune system in early life and discuss the benefits of maternal vaccination. Current maternal vaccination policies and their rationale will be summarized on the road to promising approaches to enhance immunity in the neonate.
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Affiliation(s)
- Bianca Cinicola
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy.,Ph.D. Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Reem Elfeky
- Department of Clinical Immunology, Royal Free Hospital, London, United Kingdom.,Infection, Immunity & Inflammation Department, Institute of Child Health, University College London (UCL), London, United Kingdom
| | - Rita Carsetti
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ane Fernandez Salinas
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.,Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eva Piano Mortari
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Brindisi
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mario De Curtis
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy.,Department Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Marzia Duse
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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17
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Hefele L, Syphan S, Xayavong D, Homsana A, Kleine D, Chanthavilay P, Nouanthong P, Xaydalasouk K, Phathammavong O, Billamay S, Xeuatvongsa A, Reinharz D, Black AP, Muller CP. Timeliness of immunisation with the pentavalent vaccine at different levels of the health care system in the Lao People's Democratic Republic: A cross-sectional study. PLoS One 2020; 15:e0242502. [PMID: 33290386 PMCID: PMC7723256 DOI: 10.1371/journal.pone.0242502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background The timely administration of vaccines is considered to be important for both individual and herd immunity. In this study, we investigated the timeliness of the diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine, scheduled at 6, 10 and 14 weeks of age in the Lao People’s Democratic Republic. We also investigated factors associated with delayed immunization. Methods 1162 children aged 8–28 months who had received the full course of the pentavalent vaccine at different levels of the health care system were enrolled. Vaccination dates documented in hospital records and/or immunisation cards were recorded. Age at vaccination and time intervals between doses were calculated. Predictors for timely completion with the pentavalent vaccine at 24 weeks were assessed by bivariate and multivariable analyses. Results Several discrepancies in dates between vaccination documents were observed. In general, vaccination with the pentavalent vaccine was found to be delayed, especially in health care settings below the provincial hospital level. Compared to the central hospital level, less participants who were vaccinated at the district/health center level received the third dose by 16 (48% at the central hospital level vs. 7.1% at the district and 12.4% at the health center level) and 24 weeks of age (94.4% at the central hospital level vs 64.6% at the district-outreach and 57.4% at the health center level) respectively. In logistic regression analyses, lower education level of the mother as well as vaccination by outreach service, were independently associated with delayed completion of vaccination. Conclusion We observed a general delay of vaccination, especially at lower ranked facilities, which correlated with indicators of poor access to health services. This highlights the need for further improving health equity in rural areas. Age-appropriate vaccination should become a quality indicator for the national immunization programme. In addition, we recommend further training of the health care staff regarding the importance of reliable documentation of dates.
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Affiliation(s)
- Lisa Hefele
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
- * E-mail:
| | | | | | - Anousin Homsana
- Lao Tropical and Public Health Institute, Vientiane, Lao PDR
| | - Daria Kleine
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | | | | | | | | | | | - Anonh Xeuatvongsa
- Expanded Programme on Immunisation, Vientiane, Lao People’s Democratic Republic
| | - Daniel Reinharz
- Lao Tropical and Public Health Institute, Vientiane, Lao PDR
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Antony P. Black
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
| | - Claude P. Muller
- Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
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18
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Foo DYP, Sarna M, Pereira G, Moore HC, Fell DB, Regan AK. Early Childhood Health Outcomes Following In Utero Exposure to Influenza Vaccines: A Systematic Review. Pediatrics 2020; 146:peds.2020-0375. [PMID: 32719088 DOI: 10.1542/peds.2020-0375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Vaccination during pregnancy is an effective strategy for preventing infant disease; however, little is known about early childhood health after maternal vaccination. OBJECTIVES To systematically review the literature on early childhood health associated with exposure to influenza vaccines in utero. DATA SOURCES We searched CINAHL Plus, Embase, Medline, Scopus, and Web of Science for relevant articles published from inception to July 24, 2019. STUDY SELECTION We included studies published in English reporting original data with measurement of in utero exposure to influenza vaccines and health outcomes among children <5 years of age. DATA EXTRACTION Two authors independently assessed eligibility and extracted data on study design, setting, population, vaccines, outcomes, and results. RESULTS The search yielded 3647 records, of which 9 studies met the inclusion criteria. Studies examined infectious, atopic, autoimmune, and neurodevelopmental outcomes, and all-cause morbidity and mortality. Authors of 2 studies reported an inverse association between pandemic influenza vaccination and upper respiratory tract infections, gastrointestinal infections, and all-cause hospitalizations; and authors of 2 studies reported modest increased association between several childhood disorders and pandemic or seasonal influenza vaccination, which, after adjusting for confounding and multiple comparisons, were not statistically significant. LIMITATIONS Given the small number of studies addressing similarly defined outcomes, meta-analyses were deemed not possible. CONCLUSIONS Results from the few studies in which researchers have examined outcomes in children older than 6 months of age did not identify an association between exposure to influenza vaccines in utero and adverse childhood health outcomes.
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Affiliation(s)
- Damien Y P Foo
- School of Public Health, Curtin University, Perth, Western Australia, Australia; .,Wesfarmers Centre of Vaccines & Infectious Diseases
| | - Mohinder Sarna
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; and
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases.,School of Public Health, Texas A&M University, College Station, Texas
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19
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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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20
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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: 63] [Impact Index Per Article: 15.8] [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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Pasetti MF, Ackerman ME, Hoen AG, Alter G, Tsang JS, Marchant A. Maternal determinants of infant immunity: Implications for effective immunization and maternal-child health. Vaccine 2020; 38:4491-4494. [PMID: 32111530 PMCID: PMC9946685 DOI: 10.1016/j.vaccine.2020.01.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/09/2019] [Accepted: 01/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Marcela F. Pasetti
- Center for Vaccine Development and Global Health, University of Maryland, Baltimore, MD, USA
| | | | - Annie G. Hoen
- Ragon Institute of MGH, Harvard, and MIT, Cambridge, MA, USA
| | | | - John S. Tsang
- Systems Genomics and Bioinformatics Unit, Laboratory of Immune System Biology and Center for Human Immunology, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, NIH, Bethesda, MD, USA
| | - Arnaud Marchant
- Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium.
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22
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Kandeil W, Savic M, Ceregido MA, Guignard A, Kuznetsova A, Mukherjee P. Immune interference (blunting) in the context of maternal immunization with Tdap-containing vaccines: is it a class effect? Expert Rev Vaccines 2020; 19:341-352. [PMID: 32237928 DOI: 10.1080/14760584.2020.1749597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Maternal immunization with reduced antigen content tetanus-diphtheria-acellular pertussis (Tdap)-containing vaccines has been recommended to prevent infant pertussis. However, maternal antibodies may interfere with infant responses to routine immunization with diphtheria-tetanus-acellular pertussis (DTaP)-containing vaccines, raising concerns of suboptimal protection after infant vaccination. We performed a narrative literature review to assess whether blunting occurs regardless of the manufacturer of maternal and infant vaccines. Because internationally agreed correlates of protection are lacking, the clinical significance of blunting is not yet fully understood. We have reviewed the evidence available to date. AREAS COVERED Thirteen studies that evaluated blunting after maternal immunization and infant primary/booster series were identified. Blunting was observed with various combinations of Tdap- and DTaP-containing vaccines for maternal and pediatric immunization. Studies assessing the effectiveness of maternal Tdap immunization beyond the primary infant immunization series in England and in the United States suggested no evidence of a clinically relevant blunting effect so far. EXPERT COMMENTARY This review indicates that the phenomenon of blunting does not depend on the manufacturer/brand of the pertussis-containing vaccines used for immunizing mothers or children. Currently, there is no epidemiological evidence that children whose mothers received Tdap are at increased risk of pertussis after pediatric vaccinations, although longer follow-up is required.
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23
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Baroncelli S, Galluzzo CM, Liotta G, Andreotti M, Orlando S, Ciccacci F, Jere H, Luhanga R, Sagno JB, Amici R, Marazzi MC, Giuliano M. Dynamics of immunoglobulin G subclasses during the first two years of life in Malawian infants born to HIV-positive mothers. BMC Pediatr 2020; 20:181. [PMID: 32326903 PMCID: PMC7178742 DOI: 10.1186/s12887-020-02091-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background Maternal antibodies are key components of the protective responses of infants who are unable to produce their own IgG until 6 months of life. There is evidence that HIV-exposed uninfected children (HEU) have IgG levels abnormalities, that can be partially responsible for the higher vulnerability to infections in the first 2 years of the life of this population. This retrospective study aimed to characterize the dynamics in plasma levels of total IgG and their isotypes during the first 2 years of life in HEU infants exclusively breastfed through 6 months of age. Methods Total IgG, IgG1, IgG2, IgG3 and IgG4 isotypes, and IgM and IgA plasma concentrations were determined by nephelometric methods in 30 Malawian infants born to HIV-positive women at month 1, 6 and 24 of life. Results At 1-month infants had a median concentration of total IgG of 8.48 g/l, (IQR 7.57–9.15), with an overrepresentation of the IgG1 isotype (89.0% of total) and low levels of IgG2 (0.52 g/l, IQR, 0.46–0.65). Total IgG and IgG1 concentrations were lower at 6 months (− 2.1 and − 1.12 g/dl, respectively) reflecting disappearance of maternal antibodies, but at 24 months their levels were higher with respect to the reported reference values for age-matched pairs. Abnormal isotype distribution was still present at 24 months with IgG2 remaining strongly underrepresented (0.87 g/l, 7.5% of total IgG). Conclusion HIV exposure during pregnancy and breastfeeding seems to influence the IgG maturation and isotype distribution that persist in 2-year old infants.
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Affiliation(s)
- Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Clementina Maria Galluzzo
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Preventio, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Andreotti
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Preventio, University of Rome Tor Vergata, Rome, Italy
| | - Fausto Ciccacci
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Haswell Jere
- DREAM Program, Community of S. Egidio, Blantyre, Malawi
| | | | | | - Roberta Amici
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | | | - Marina Giuliano
- National Center for Global Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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24
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Maertens K, Orije MRP, Van Damme P, Leuridan E. Vaccination during pregnancy: current and possible future recommendations. Eur J Pediatr 2020; 179:235-242. [PMID: 31912233 PMCID: PMC7222942 DOI: 10.1007/s00431-019-03563-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/15/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022]
Abstract
Immunizing pregnant women to protect the mother, fetus and infant from infection has increasingly been used over the last decade. Protection against infectious diseases in neonates is mainly provided by maternal antibodies transferred from mother to infant during pregnancy through transplacental transport or after delivery via breastfeeding. Both the transplacental- and breast milk-derived maternal antibodies function as the primary source of protection against infectious diseases in neonates during the first vulnerable weeks of life. During recent infectious disease outbreaks (influenza, pertussis, Zika…) and for other infectious diseases (CMV, GBS…), pregnant women are increasingly identified as an important target for vaccination. For some of these diseases, vaccines are already on the market, and recommended during pregnancy. For others, vaccines are currently under development; furthermore, some are even specifically designed to be administered during pregnancy.Conclusion: This review article provides an overview on the rationale and main mechanism of the maternal vaccination strategy and gives a summary about the current and possible future recommendations for maternal vaccination.What is Known:• Maternal vaccination has a far-reaching potential in the protection of both women and offspring.• Currently, tetanus, pertussis and influenza vaccination during pregnancy is recommended in some countries. Several new vaccines specifically designed for use in pregnancy are currently under development.What is New:• Review providing a timely overview of the rationale and main mechanisms of the maternal vaccination strategy• Up-to-date summary of the current and possible future recommendations for maternal vaccination.
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Affiliation(s)
- Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Marjolein Rozemarie Paulien Orije
- grid.5284.b0000 0001 0790 3681Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Pierre Van Damme
- grid.5284.b0000 0001 0790 3681Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Elke Leuridan
- grid.5284.b0000 0001 0790 3681Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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