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Khalil A, Samara A, Campbell H, Ladhani SN, Amirthalingam G. Recent increase in infant pertussis cases in Europe and the critical importance of antenatal immunizations: We must do better…now. Int J Infect Dis 2024; 146:107148. [PMID: 38960028 DOI: 10.1016/j.ijid.2024.107148] [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: 05/03/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024] Open
Abstract
Recent months have seen an increase in pertussis cases in several countries across the Northern and Southern hemispheres. The lack of immune stimulation during the COVID-19 pandemic due to the reduced circulation of Bordetella pertussis, the pathogen responsible for pertussis, is likely to have led to increased population susceptibility which has been magnified the typical three to five yearly cyclical peaks in activity. Maternal immunization for pertussis proves highly effective in protecting infants under three months of age. It's also critical for immunizers and parents to maintain high and timely immunization uptake to ensure infants receive maximum early protection when they are most at risk of severe disease.
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Affiliation(s)
- Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK; The Royal College of Obstetricians and Gynaecologists, London, UK.
| | - Athina Samara
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; FUTURE, Center for Functional Tissue Reconstruction, University of Oslo, Oslo, Norway
| | - Helen Campbell
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK; Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
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Goh O, Pang D, Tan J, Lye D, Chong CY, Ong B, Tan KB, Yung CF. mRNA SARS-CoV-2 Vaccination Before vs During Pregnancy and Omicron Infection Among Infants. JAMA Netw Open 2023; 6:e2342475. [PMID: 37948079 PMCID: PMC10638647 DOI: 10.1001/jamanetworkopen.2023.42475] [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: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Infants younger than 6 months are at risk of severe SARS-CoV-2 infection. Data are lacking on the optimum timing for maternal vaccination and estimated effectiveness against Omicron variants, including XBB, for infants. Objective To investigate maternal vaccination against Omicron variants, including XBB, and the association of vaccination timing during pregnancy vs prior to pregnancy and risks of SARS-CoV-2 infection among infants aged 6 months or younger. Design, Setting, and Participants This population-based cohort study was conducted between January 1, 2022, and March 31, 2023. Singapore's national dataset was used to study infants born at greater than 32 weeks' gestation between January 1, 2022, and September 30, 2022. The study included infants whose parents had a confirmed SARS-CoV-2 infection from the date of birth up to 6 months of age. Of 21 609 infants born during this period, 7292 (33.7%) had at least 1 parent infected with SARS-CoV-2 before the age of 7 months. Statistical analysis was performed from April to July 2023. Exposure Infants' mothers were unvaccinated, vaccinated prior to pregnancy, or vaccinated with a messenger RNA (mRNA) SARS-CoV-2 vaccine during pregnancy. Main Outcome and Measure Infants were considered infected if they had a positive polymerase chain reaction test. Results Among 7292 infants included in this study, 4522 (62.0%) had mothers who were Chinese, 527 (7.2%) had mothers who were Indian, 2007 (27.5%) had mothers who were Malay, and 236 (3.2%) had mothers who were other ethnicity; 6809 infants (93.4%) were born at full term, and 1272 infants (17.4%) were infected during the study period. There were 7120 infants (97.6%) born to mothers who had been fully vaccinated or boosted as of 14 days prior to delivery. The crude incidence rate was 174.3 per 100 000 person-days among infants born to mothers who were unvaccinated, 122.2 per 100 000 person-days among infants born to mothers who were vaccinated before pregnancy, and 128.5 per 100 000 person-days among infants born to mothers who were vaccinated during pregnancy. The estimated vaccine effectiveness (VE) was 41.5% (95% CI, 22.8% to 55.7%) among infants born to mothers vaccinated during pregnancy. Infants of mothers who received vaccination prior to pregnancy did not have a lower risk for infection (estimated VE, 15.4% [95% CI, -17.6% to 39.1%]). A lower risk for Omicron XBB infection was only observed among mothers vaccinated with the third (booster) dose antenatally (estimated VE, 76.7% [95% CI, 12.8% to 93.8%]). Conclusions and Relevance In this population-based cohort study, maternal mRNA vaccination was associated with a lower risk of Omicron SARS-CoV-2 infection among infants up to 6 months of age only if the vaccine was given during the antenatal period. These findings suggest that mRNA vaccination during pregnancy may be needed for lower risk of SARS-CoV-2 infection among newborns.
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Affiliation(s)
- Orlanda Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore
| | | | | | - David Lye
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Centre for Infectious Disease, Singapore
| | - Chia Yin Chong
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore
- Duke-NUS Medical School, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chee Fu Yung
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore
- Duke-NUS Medical School, Singapore
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Regan AK, Moore HC, Binks MJ, McHugh L, Blyth CC, Pereira G, Lust K, Sarna M, Andrews R, Foo D, Effler PV, Lambert S, Van Buynder P. Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis. Pediatrics 2023; 152:e2023062664. [PMID: 37807881 PMCID: PMC10598625 DOI: 10.1542/peds.2023-062664] [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] [Accepted: 07/19/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Following the introduction of jurisdictional maternal pertussis vaccination programs in Australia, we estimated maternal vaccine effectiveness (VE) and whether maternal pertussis vaccination modified the effectiveness of the first 3 primary doses of pertussis-containing vaccines. METHODS We conducted a population-based cohort study of 279 418 mother-infant pairs using probabilistic linkage of administrative health records in 3 Australian jurisdictions. Infants were maternally vaccinated if their mother had a documented pertussis vaccination ≥14 days before birth. Jurisdictional immunization records were used to identify receipt of the first 3 infant doses of pertussis-containing vaccines. Infant pertussis infections were identified using notifiable disease records. VE was estimated using Cox proportional hazard models. RESULTS Pertussis was administered during 51.7% (n = 144 429/279 418) of pregnancies, predominantly at 28-31 weeks' gestation. VE of maternal pertussis vaccination declined from 70.4% (95% confidence interval [CI], 50.5-82.3) among infants <2 months old to 43.3% (95% CI, 6.8-65.6) among infants 7-8 months old and was not significant after 8 months of age. Although we observed slightly lower VE point estimates for the third dose of infant pertussis vaccine among maternally vaccinated compared with unvaccinated infants (76.5% vs 92.9%, P = .002), we did not observe higher rates of pertussis infection (hazard ratio, 0.70; 95% CI, 0.61-3.39). CONCLUSIONS Pertussis vaccination near 28 weeks' gestation was associated with lower risk of infection among infants through 8 months of age. Although there was some evidence of lower effectiveness of infant vaccination among maternally vaccinated infants, this did not appear to translate to greater risk of disease.
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Affiliation(s)
- Annette K. Regan
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Hannah C. Moore
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
| | - Michael J. Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lisa McHugh
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases
- Division of Pediatrics, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gavin Pereira
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Karin Lust
- Women’s and Newborn Services, Royal Brisbane Women’s Hospital, Brisbane, Queensland, Australia
| | - Mohinder Sarna
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
| | - Ross Andrews
- Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia
| | - Damien Foo
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
- Yale School of Environment, Yale University, New Haven, Connecticut
| | - Paul V. Effler
- Department of Health Western Australia, Communicable Disease Control Directorate, Perth, Western Australia, Australia
| | - Stephen Lambert
- Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia
- National Centre for Immunization Research and Surveillance, Westmead, New South Wales, Australia
| | - Paul Van Buynder
- School of Medicine, Griffith University, Southport, Queensland, Australia
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Niaré D, Debin M, Merdrignac L, Blanchon T, Hanslik T, Steichen O. [Prevention of pertussis in newborns: Should pregnant women be vaccinated at each pregnancy?]. Rev Med Interne 2023; 44:567-570. [PMID: 37400278 DOI: 10.1016/j.revmed.2023.06.007] [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: 05/22/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
Pertussis is a respiratory disease that can be fatal at all ages but especially in infants before their mandatory vaccination. Recent epidemiological data shows a decrease in the number of pertussis cases, but a resurgence cannot be excluded in the coming years due to the cyclic evolution of the disease and the loosening of hygiene measures. Two approaches are used to protect infants before their vaccination: vaccination of the mother during pregnancy and vaccination of all the infant's close relatives (cocooning). The vaccination of the mother during pregnancy is more effective. The uncertain risk of chorioamniotitis associated with vaccination during pregnancy is insufficient to question this strategy.
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Affiliation(s)
- D Niaré
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France.
| | - M Debin
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France
| | - L Merdrignac
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France; Epiconcept, Paris, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France
| | - T Hanslik
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France; Service de médecine interne, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, AP-HP, 92100 Boulogne-Billancourt, France; UFR des sciences de la santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - O Steichen
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012 Paris, France; Service de médecine interne, hôpital Tenon, Assistance publique-Hôpitaux de Paris, AP-HP, 75020 Paris, France; Sorbonne Université, Faculté de médecine, Paris, France
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Levy C, Cohen R, Béchet S, Ravilly S, Werner A, Romain O, Guiso N. Pediatric ambulatory pertussis epidemiology in France, recent updates. Infect Dis Now 2023; 53:104727. [PMID: 37268040 DOI: 10.1016/j.idnow.2023.104727] [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: 04/05/2023] [Revised: 04/11/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Following various changes in the vaccine strategy in 2013 and the mandatory vaccination in 2018, we aimed to analyze the vaccination status, age, and source of contamination of pertussis and parapertussis cases in outpatient surveillance. PATIENTS AND METHODS Confirmed pertussis and parapertussis cases were enrolled by 35 pediatricians. RESULTS From 2014 to 2022, 73 confirmed cases of pertussis (n = 65) and parapertussis (n = 8) were reported. For children below 6 years of age, the number of cases with a 2 + 1 schedule (n = 22) was higher than that of those with a 3 + 1 schedule (n = 7). The age of cases with a 3 + 1 or a 2 + 1 schedule was not significantly different (3.8y ± 1.4 vs 4.2y ± 1.5). The main source of contamination was either adults or adolescents. CONCLUSION Vaccination status and source of contamination are crucial to study the impact of vaccination recommendations.
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Affiliation(s)
- C Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.
| | - R Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - S Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - S Ravilly
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - A Werner
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - O Romain
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - N Guiso
- Independent Expert, Paris, France
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Juscamayta-López E, Valdivia F, Soto MP, Horna H, Pajuelo M. Case-Control Study to Estimate the Association Between Tdap Vaccination During Pregnancy and Reduced Risk of Pertussis in Newborn Infants in Peru, 2019-2021. Open Forum Infect Dis 2023; 10:ofad325. [PMID: 37469614 PMCID: PMC10352646 DOI: 10.1093/ofid/ofad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
Background Despite widespread vaccination, pertussis has re-emerged as a serious public health concern worldwide. Since 2017, Peru has experienced an increase in pertussis cases exhibiting a higher risk of severity and death in young infants. Thus, a dose of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine is recommended for pregnant women in the third trimester. Although evidence suggests the maternal Tdap vaccine is safe and effective, its association with a reduced risk of pertussis in developing countries remains poorly investigated. Methods We conducted a case-control study to evaluate the association between Tdap vaccination during pregnancy and reduction in the risk of pertussis among infants aged <2 months in Peru. Pertussis cases and controls treated in healthcare facilities nationwide between 2019 and 2021 and confirmed by real-time polymerase chain reaction were included. The controls were randomly selected from test-negative patients. Odds ratios (ORs) and vaccine effectiveness (VE) were calculated using a multiple logistic regression model and 1 - (OR) × 100%, respectively. Results Fifty cases and 150 controls were included in the analysis. The mothers of 4% of cases and 16.7% of controls received Tdap vaccination during pregnancy, resulting in an OR of 0.19 (95% confidence interval [CI], .04-.86) and VE of 81% (95% CI, 14%-96%) for preventing pertussis in infants. Conclusions Peruvian infants <2 months old whose mothers received the Tdap vaccine in the third trimester of pregnancy had a significantly lower risk of pertussis. The Tdap vaccination is thus an effective intervention to reduce the burden of pertussis in at-risk populations.
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Affiliation(s)
- Eduardo Juscamayta-López
- Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
- Facultad de Salud Pública y Administración (GA, AGL), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Faviola Valdivia
- Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
| | - María Pía Soto
- Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
| | - Helen Horna
- Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
| | - Mónica Pajuelo
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
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Lipschuetz M, Guedalia J, Cohen SM, Sompolinsky Y, Shefer G, Melul E, Ergaz-Shaltiel Z, Goldman-Wohl D, Yagel S, Calderon-Margalit R, Beharier O. Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization. Nat Med 2023; 29:1155-1163. [PMID: 36959421 DOI: 10.1038/s41591-023-02270-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/22/2023] [Indexed: 03/25/2023]
Abstract
Infants are at a higher risk of Coronavirus Disease 2019 (COVID-19)-related hospitalizations compared to older children. In this study, we investigated the effect of the recommended third maternal dose of BNT162b2 COVID-19 vaccine during pregnancy on rates of infant COVID-19-related hospitalizations. We conducted a nationwide cohort study of all live-born infants delivered in Israel between 24 August 2021 and 15 March 2022 to estimate the effectiveness of the third booster dose versus the second dose against infant COVID-19-related hospitalizations. Data were analyzed for the overall study period, and the Delta and Omicron periods were analyzed separately. Cox proportional hazard regression models estimated hazard ratios and 95% confidence intervals (CIs) for infant hospitalizations according to maternal vaccination status at delivery. Among 48,868 live-born infants included in the analysis, rates of COVID-19 hospitalization were 0.4%, 0.6% and 0.7% in the third-dose, second-dose and unvaccinated groups, respectively. Compared to the second dose, the third dose was associated with reduced infant hospitalization with estimated effectiveness of 53% (95% CI: 36-65%). Greater protection was associated with a shorter interval between vaccination and delivery. A third maternal dose during pregnancy reduced the risk of infant hospitalization for COVID-19 during the first 4 months of life, supporting clinical and public health guidance for maternal booster vaccination to prevent infant COVID-19 hospitalization.
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Affiliation(s)
- Michal Lipschuetz
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
- Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Joshua Guedalia
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Shefer
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | | | - Debra Goldman-Wohl
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
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Amirthalingam G, Campbell H, Ribeiro S, Stowe J, Tessier E, Litt D, Fry NK, Andrews N. Optimization of Timing of Maternal Pertussis Immunization From 6 Years of Postimplementation Surveillance Data in England. Clin Infect Dis 2023; 76:e1129-e1139. [PMID: 35959786 DOI: 10.1093/cid/ciac651] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/31/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND England's third-trimester maternal pertussis vaccination, introduced in October 2012, was extended to the second trimester in 2016. Maternal vaccination provides high protection against infant disease, but routine second-trimester vaccination has not previously been assessed. METHODS National laboratory-confirmed pertussis case surveillance determined vaccination history, maternal vaccination history and hospitalization. Pertussis hospital admissions between 2012 and 2019 were extracted from the Hospital Episode Statistics data set. Vaccine effectiveness (VE) was calculated for pertussis case patients born between October 2012 and September 2018 using the screening method and matching with a nationally representative data set. RESULTS Higher coverage was observed after earlier maternal vaccination with approximately 40% of pregnant women vaccinated ≥13 weeks before delivery. Cases and hospitalizations stabilized at low levels in younger infants but remained elevated in older infants, children, and adults. No deaths occurred in infants with vaccinated mothers after 2016. Of 1162 laboratory-confirmed pertussis cases in the study, 599 (52%) were in infants aged <93 days: 463 (77%) with unvaccinated and 136 (23%) with vaccinated mothers. The VE was equivalent in infants with mothers vaccinated at different gestational periods except in those with mothers vaccinated between 7 days before and 41 days after delivery. Children whose mothers were unvaccinated but with vaccination in a previous pregnancy had a VE against disease of 44% (95% confidence interval, 19%-75%). There was no increased disease risk after primary vaccination in children with mothers vaccinated at least 7 days before delivery. CONCLUSIONS National policy recommending vaccination in the second trimester increased earlier maternal vaccine uptake with sustained high VE and impact against early infant disease.
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Affiliation(s)
- Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Helen Campbell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Sonia Ribeiro
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Elise Tessier
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - David Litt
- Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Specialised Microbiology and Laboratories Directorate, UK Health Security Agency, London, United Kingdom
| | - Norman K Fry
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom.,Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Specialised Microbiology and Laboratories Directorate, UK Health Security Agency, London, United Kingdom
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
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Namazova-Baranova LS, Fedoseenko MV, Selimzyanova LR, Kaliuzhnaia TA, Shakhtakhtinskaya FC, Tolstova SV, Selvyan AM. Modern Approaches in Immunoprophylaxis of Infectious Diseases During Pregnancy. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v19i5.2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Every year more countries recommend vaccination for pregnant women. Nowadays, the spectrum of vaccines that can be used during pregnancy is expanding. Experts of the Union of Pediatricians of Russia have completely updated the section about the pregnant women immunoprophylaxis within updating clinical guidelines on normal pregnancy management. This section is presented in the following article.
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Affiliation(s)
- Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Marina V. Fedoseenko
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Liliya R. Selimzyanova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Tatiana A. Kaliuzhnaia
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Firuza Ch. Shakhtakhtinskaya
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Svetlana V. Tolstova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | - Arevaluis M. Selvyan
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
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10
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Yang Y, Xing H, Zhao Y. Transplacental transmission of SARS-CoV-2 immunoglobulin G antibody to infants from maternal COVID-19 vaccine immunization before pregnancy. J Med Virol 2023; 95:e28296. [PMID: 36367230 PMCID: PMC9877834 DOI: 10.1002/jmv.28296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) vaccine generates functional antibodies in maternal circulation that are detectable in infants, while the information is restricted to the usage of COVID-19 vaccine during pregnancy. In this study, we aimed to evaluate the effect of maternal COVID-19 vaccines before pregnancy. Infants were included from mothers with no inactivated COVID-19 vaccine, 1-, 2-, and 3-dose before pregnancy, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies were tested. Comparative analysis was done between the groups. A total of 130 infants were enrolled in the study. Significantly higher levels of SARS-CoV-2 IgG antibodies in infants born to mothers with 3-dose COVID-19 vaccine before pregnancy compared with 1- and 2-dose groups (p < 0.0001). The levels of antibodies decreased significantly with age in infants born to mothers with the 3-dose COVID-19 vaccine before pregnancy (r = -0.338, p = 0.035), and it was still higher than that 2-dose COVID-19 vaccine group. The maternal SARS-CoV-2 antibodies produced from the inactivated COVID-19 vaccine before pregnancy can be transferred to newborns via the placenta. Maternal immunization with 3-dose of the COVID-19 vaccine before pregnancy could be more beneficial for both mothers and infants.
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Affiliation(s)
- Yuting Yang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Pediatric Research InstituteChildren's Hospital of Chongqing Medical UniversityChongqingChina
| | - Huiwu Xing
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Pediatric Research InstituteChildren's Hospital of Chongqing Medical UniversityChongqingChina
| | - Yao Zhao
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders, Pediatric Research InstituteChildren's Hospital of Chongqing Medical UniversityChongqingChina
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11
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Safety and Immunogenicity of Pertussis Vaccine Immunization during Pregnancy: A Meta-Analysis of Randomized Clinical Trials. J Trop Med 2022; 2022:4857872. [PMID: 36588977 PMCID: PMC9797314 DOI: 10.1155/2022/4857872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/24/2022] Open
Abstract
The objective of this meta-analysis is to assess the safety and immunogenicity of maternal pertussis vaccination based on randomized clinical trials. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, and Wan Fang Database were searched from inception up to the 8th of October 2021, using a protocol registered on PROSPERO with no. 42021287717, and a meta-analysis was conducted. We measured pooled geometric mean concentrations (GMCs) for IgG antibodies against pertussis and the incidence of serious adverse events (SAEs). We identified a total of 522 publications, and after a strict screening, we found that 6 RCTs were eligible for our meta-analysis. GMCs were determined with a standardized mean difference (SMD), and the pooled SMD of anti-PT, anti-FHA, and anti-PRN IgG from cord blood were 0.91 (95% CI: 0.58, 1.24), 1.03 (95% CI: (0.70, 1.35)), and 1.55(95% CI: 1.22, 1.88), respectively. The pooled OR of SAEs of women and infants did not show a statistical difference; the pooled ORs were 1.26 (95% CI: 0.78, 2.05); P = 0.35) and 0.61 (95% CI: 0.37, 1.01); p = 0.053), respectively. Infants of immunized women have significantly higher transplacental antibodies for protection against pertussis disease during the first 2 months of life.
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12
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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: 11] [Impact Index Per Article: 5.5] [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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13
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Tsurane K, Umehara N, Nakayama T, Okada K, Inoue M, Ogawa K, Sago H, Miyasaka N, Yamaguchi K. Pertussis, diphtheria, and tetanus antibodies seroprevalence in pregnant women and neonates, as a preliminary data for introduction of preconception or prenatal DTaP vaccination among Japanese society. Vaccine 2022; 40:7122-7129. [PMID: 36404430 DOI: 10.1016/j.vaccine.2022.09.092] [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: 03/07/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
An increasing number of countries have been introducing acellular pertussis vaccination during pregnancy for the prevention of neonatal pertussis. In response to the fact that infantile pertussis cases of 0-5 months age groups remained unchanged despite the universal vaccination program, prenatal pertussis vaccination has been a rising issue in Japan. Hence, we investigated the seroprevalence of pertussis, diphtheria, and tetanus antibodies in Japanese pregnant women and neonates, and evaluated the necessity of diphtheria-tetanus-acellular pertussis (DTaP) vaccination during the preconception or prenatal period. Maternal PT-IgG (EIA) and FHA-IgG (EIA) for the first trimester, within 1 week after delivery, and cord blood were collected, along with colostrum pertussis-IgA (ELISA), diphtheria-IgG (EIA), tetanus-IgG (EIA), and blood samples from the first trimester. The maternal seroprevalence of PT-IgG and FHA-IgG was 69 % and 75 %, respectively. All tested participants were positive for diphtheria-IgG and tetanus-IgG (100 %). First trimester PT-IgG/FHA-IgG antibody titers were significantly associated with cord blood PT-IgG/FHA-IgG titers (P < 0.001). We found that pertussis seroprevalence among pregnant Japanese women was approximately 70 %. The antibody seropositivity rate of pertussis was lower than that of diphtheria and tetanus. Fetal acquired passive immunity against pertussis is higher when the level of maternal antibody in the first trimester is sufficient. At least 30 % of study population did not reach to the threshold value to provide sufficient pertussis immunity for the neonates and themselves. The acellular pertussis vaccine (DTaP) approved in Japan lacks safety information for pregnancy, hence, a solution for prompt administration of prenatal acellular pertussis vaccination might be introducing DTaP in the preconception period.
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Affiliation(s)
- Kotoi Tsurane
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan; Perinatal and Women's Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8510, Japan
| | - Nagayoshi Umehara
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Tetsuo Nakayama
- Laboratory of Viral Infection, Kitasato Institute for Life Sciences, 5-9-1 Shirogane Minato-ku, Tokyo 108-8641, Japan
| | - Kenji Okada
- Division of Basic Medical Science and Fundamental Nursing, Fukuoka Nursing College, 2-15-1 Tamura, Sawara-ku, Fukuoka 814-0193, Japan
| | - Momoko Inoue
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan; Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kohei Ogawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Naoyuki Miyasaka
- Perinatal and Women's Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8510, Japan
| | - Koushi Yamaguchi
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
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14
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Zavala E, Rhodes M, Christian P. Pregnancy Interventions to Improve Birth Outcomes: What Are the Effects on Maternal Outcomes? A Scoping Review. Int J Public Health 2022; 67:1604620. [PMID: 36405527 PMCID: PMC9666362 DOI: 10.3389/ijph.2022.1604620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Interventions in pregnancy are commonly evaluated for their effects on birth outcomes because maternal infection and poor nutrition are the primary contributors to adverse pregnancy outcomes, especially in low- and middle-income countries (LMICs). However, the extent to which such interventions directly impact maternal health and nutrition has not been succinctly characterized. Methods: We conducted a scoping review of systematic reviews and meta-analyses of 27 pregnancy interventions to summarize the evidence of impact on maternal outcomes. Results: Overall, these were reported incompletely, and we failed to find any evidence for eight interventions. Influenza vaccination, insecticide-treated bed nets, intermittent preventive treatment for malaria, anthelmintic therapy, and treatment of bacterial vaginosis, asymptomatic bacteriuria, and periodontal disease during pregnancy provided direct benefit to women, with reductions in infection risk. Nutritional interventions such as micronutrient supplementation and balanced energy and protein improved outcomes of maternal anemia and gestational weight gain, particularly in deficient populations. Calcium and low dose aspirin significantly reduced the risk of pre-eclampsia. Conclusion: These findings highlight antenatal interventions benefitting maternal health and provide insights into pathways for impacting birth and infant outcomes.
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15
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Effectiveness of pertussis vaccination in pregnancy to prevent hospitalisation in infants aged <2 months and effectiveness of both primary vaccination and mother's vaccination in pregnancy in infants aged 2-11 months. Vaccine 2022; 40:6374-6382. [PMID: 36182617 PMCID: PMC9589240 DOI: 10.1016/j.vaccine.2022.09.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND PERTINENT is an active hospital-based surveillance system for pertussis in infants. In 2019, four of the six participating European countries recommended pertussis vaccination in pregnancy. Among infants aged <2 months, we measured the vaccine effectiveness (VE) in pregnancy; among infants aged 2-11 months, VE of vaccination in pregnancy and of primary vaccination (PV). METHODS From December 2015 to 2019, we included all infants aged <1 year presenting with pertussis-like symptoms. Using a test-negative-design, cases were infants testing positive for Bordetella pertussis by PCR or culture. Controls were those testing negative for all Bordetella species. Vaccinated mothers were those who received vaccine in pregnancy. Vaccinated infants were those who received ≥1 dose of PV > 14 days before symptom onset. We excluded infants with unknown maternal or PV status or with mothers vaccinated ≤14 days before delivery. We calculated pooled VE as 100 * (1-odds ratio of vaccination) adjusted for study site, onset date in quarters and infants' age group. RESULTS Of 829 infants presenting with pertussis-like symptoms, 336 (41%) were too young for PV. For the VE in pregnancy analysis, we included 75 cases and 201 controls. Vaccination in pregnancy was recorded for 9 cases (12%) and 92 controls (46%), adjusted VE was between 75% [95%CI: 35-91%] and 88% [95%CI: 57-96%]. Of 493 infants eligible for PV, we included 123 cases and 253 controls. Thirty-one cases and 98 controls recorded both PV with ≥ 1 dose and vaccination in pregnancy, adjusted VE was between 74% [95%CI: 33-90] and 95% [95%CI: 69-99]; 27 cases and 53 controls recorded PV only, adjusted VE was between 68% [95%CI: 27-86] and 94% [95%CI: 59-99]. CONCLUSION Our findings suggest that vaccination in pregnancy reduces pertussis incidence in infants too young for PV. In infants aged 2-11 months, PV only and both PV and vaccination in pregnancy provide significant protection against severe pertussis.
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16
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Carlsen EØ, Magnus MC, Oakley L, Fell DB, Greve-Isdahl M, Kinge JM, Håberg SE. Association of COVID-19 Vaccination During Pregnancy With Incidence of SARS-CoV-2 Infection in Infants. JAMA Intern Med 2022; 182:825-831. [PMID: 35648413 PMCID: PMC9161123 DOI: 10.1001/jamainternmed.2022.2442] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Pregnant women are recommended to receive COVID-19 vaccination to reduce risk of severe COVID-19. Whether vaccination during pregnancy also provides passive protection to infants after birth remains unclear. OBJECTIVE To determine whether COVID-19 vaccination in pregnancy was associated with reduced risk of COVID-19 in infants up to age 4 months during COVID-19 pandemic periods dominated by Delta and Omicron variants. DESIGN, SETTING, AND PARTICIPANTS This nationwide, register-based cohort study included all live-born infants born in Norway between September 1, 2021, and February 28, 2022. EXPOSURES Maternal messenger RNA COVID-19 vaccination during second or third trimester compared with no vaccination before or during pregnancy. MAIN OUTCOMES AND MEASURES The risk of a positive polymerase chain reaction test result for SARS-CoV-2 during an infant's first 4 months of life by maternal vaccination status during pregnancy with either dose 2 or 3 was estimated, as stratified by periods dominated by the Delta variant (between September 1 and December 31, 2021) or Omicron variant (after January 1, 2022, to the end of follow-up on April 4, 2022). A Cox proportional hazard regression was used, adjusting for maternal age, parity, education, maternal country of birth, and county of residence. RESULTS Of 21 643 live-born infants, 9739 (45.0%) were born to women who received a second or third dose of a COVID-19 vaccine during pregnancy. The first 4 months of life incidence rate of a positive test for SARS-CoV-2 was 5.8 per 10 000 follow-up days. Infants of mothers vaccinated during pregnancy had a lower risk of a positive test compared with infants of unvaccinated mothers and lower risk during the Delta variant-dominated period (incidence rate, 1.2 vs 3.0 per 10 000 follow-up days; adjusted hazard ratio, 0.29; 95% CI, 0.19-0.46) compared with the Omicron period (incidence rate, 7.0 vs 10.9 per 10 000 follow-up days; adjusted hazard ratio, 0.67; 95% CI, 0.57-0.79). CONCLUSIONS AND RELEVANCE The results of this Norwegian population-based cohort study suggested a lower risk of a positive test for SARS-CoV-2 during the first 4 months of life among infants born to mothers who were vaccinated during pregnancy. Maternal COVID-19 vaccination may provide passive protection to young infants, for whom COVID-19 vaccines are currently not available.
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Affiliation(s)
- Ellen Øen Carlsen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Laura Oakley
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - 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
| | | | - Jonas Minet Kinge
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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17
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Sun YP, Qiang HS, Lei SY, Zheng XY, Zhang HX, Su YY, Zheng ZZ, Zhang J, Lin XZ, Zhou YL. Epidemiological features, risk factors and disease burden of respiratory viruses among hospitalized children with acute respiratory tract infections in Xiamen, China. Jpn J Infect Dis 2022; 75:537-542. [PMID: 35768274 DOI: 10.7883/yoken.jjid.2022.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Well-established surveillance and monitoring system for respiratory viruses need be improved and epidemiological data about respiratory viruses is scarce in China. This study aimed to investigate epidemiological characteristics of respiratory viruses among hospitalized children ≤ 2 years old with acute respiratory tract infections (ARTIs) in Xiamen, China from October 2014 to September 2017. The clinical records of 7248 children hospitalized for ARTIs were analyzed retrospectively. Respiratory syncytial virus (RSV) (22.3%) was the most common virus among hospitalized children ≤ 2 years old, followed by parainfluenza (5.0%), adenovirus (3.5%) and influenza (1.7%). RSV-infected children possessed a higher disease burden including higher ICU admission rate (12.7%) and hospital charges ($635.36). Especially, infants < 6 months of age had the highest risk of RSV infection (OR= 2.4, 95% CI: 1.9-2.9) and higher ICU admission rate (12.1% vs. 4.5%, 4.6%) and hospital costs ($923.3 vs. $785.5, $811.7) than other age groups. Therefore, infants aged 0-6 months, especially premature infants and children with congenital diseases, should receive more concern. There is an urgent need to develop effective immunization strategies to protect these infants through the first 6 months of life or RSV season.
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Affiliation(s)
- Yong-Peng Sun
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, China
| | - Hong-Sheng Qiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, China
| | - Si-Yu Lei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, China
| | - Xin-Yi Zheng
- Department of Endemic Diseases Prevention and Control, Fujian Provincial Center for Disease Control and Prevention, China
| | - Hai-Xia Zhang
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, China
| | - Ying-Ying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, China
| | - Zi-Zheng Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, China
| | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, China
| | - Xin-Zhu Lin
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, China
| | - Yu-Lin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, China
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18
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Hattabi H, Bouchez C, Dubos F, Martinot A, Faure K, Dessein R, Bartolo S, Subtil D. [Should French pregnant women be vaccinated against pertussis during pregnancy?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:486-493. [PMID: 35483610 DOI: 10.1016/j.gofs.2022.02.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
Many countries with a high perinatal level have started a policy of vaccination of pregnant women against pertussis. To date, France has not chosen this policy. The objective was to review knowledge on pertussis mortality in infants. Compare the strategies available to protect the infant before his first vaccination, scheduled for two months of age. We proceeded to a litterature analysis, from January 1998 to 2021. Search by the following keywords used ; "Whooping cough, vaccination, pregnancy, strategy, cocooning", on the scientific basis of "Pubmed", as well as French and foreign vaccination recommendations. Currently 90% of whooping cough deaths are concerning infants under six months of age and this mortality represents 2% of mortality in the first year of life. Vaccination at birth is not effective. The cocooning strategy, which consists of vaccinating those around the child, is expensive and difficult to implement. A systematic vaccination policy for pregnant women is effective and reasonably expensive when compared to the cocooning strategy. In England, it was recently accompanied by a 78% reduction in confirmed cases of pertussis in infants under six months of age. In conclusion, compared to cocooning strategy, pertussis vaccination of pregnant women appears more effective and cost-effective, and this with each pregnancy.
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Affiliation(s)
- H Hattabi
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France.
| | - C Bouchez
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France
| | - F Dubos
- University Lille, CHU Lille, pôle enfant, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
| | - A Martinot
- University Lille, CHU Lille, pôle enfant, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
| | - K Faure
- University Lille, CHU Lille, service de maladies infectieuses, rue Michel Polonowski, 59000 Lille, France; University Lille, EA7366, recherche translationnelle relation hôte-pathogènes, faculté de médecine pôle recherche, 59045 Lille, France
| | - R Dessein
- University Lille, EA7366, recherche translationnelle relation hôte-pathogènes, faculté de médecine pôle recherche, 59045 Lille, France
| | - S Bartolo
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
| | - D Subtil
- University Lille, CHU Lille, pôle femme mère nouveau-né, hôpital Jeanne de Flandre, 59000 Lille, France; University Lille, EA 2694, METRICS, Evaluation des technologies de santé et des pratiques médicales. CHU Lille, hôpital Jeanne de Flandre, 59000 Lille, France
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19
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Nakabembe E, Abu-Raya B, Kyohere M, Tusubira V, Amone A, Nakibuuka L, Cochet M, Nakimuli A, Voysey M, Gorringe A, Heath PT, Musoke P, Andrews N, Sekikubo M, Sadarangani M, Le Doare K. The safety and immunogenicity of a combined pertussis containing vaccine Tdap for HIV infected pregnant women and their newborns (WoMANPOWER) – A study protocol for a randomized clinical trial. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17749.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Globally there are an estimated 24.1 million cases and 160,700 deaths from pertussis annually in children under five years. The disease burden is higher in low- and middle-income countries, especially the African region, which contributes the largest proportions of cases and deaths. Immunization against pertussis in pregnancy is a recommended strategy for the prevention of infant pertussis in many high-income countries. However, vaccine immunogenicity and effectiveness may be different in immunocompromised individuals such as women living with HIV. There is a need to generate data on the impact of HIV infection in pregnancy on maternal and infant immunity to vaccines against pertussis. Methods: This is a phase II, randomized controlled observer blind clinical trial of 100 women living with HIV and 100 uninfected women randomized to either standard vaccines (tetanus diphtheria vaccine, Td) or a tetanus diphtheria-pertussis vaccine (Tdap). Participants aged 18-40 years carrying a low-risk singleton pregnancy with a gestational age between 16 and 26 weeks confirmed on ultrasound scan, with no history of receipt of tetanus or pertussis vaccines in the current pregnancy will be recruited. Women will receive either two doses of Td or a first dose of Td and second dose of Tdap vaccine. Participants will complete 14-day diary cards to monitor reactogenicity. Mother-infant dyads will be followed up until the infant is one year old. The outcomes include: safety for the pregnant woman and infant; anti-pertussis toxin (PT) and anti-filamentous haemagglutinin (FHA) IgG concentrations in maternal, cord and infant blood and breastmilk, compared by maternal HIV status. Discussion: This study will investigate whether vaccines given to women living with HIV have similar immunogenicity and reactogenicity to vaccines given to pregnant women without HIV and monitor the effect of Tdap in pregnancy on infant immune responses. clinicalTrials.gov registration: NCT04589312 (19/10/2020)
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20
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Abstract
Neonatal bacterial meningitis is a devastating disease, associated with high mortality and neurological disability, in both developed and developing countries. Streptococcus agalactiae, commonly referred to as group B Streptococcus (GBS), remains the most common bacterial cause of meningitis among infants younger than 90 days. Maternal colonization with GBS in the gastrointestinal and/or genitourinary tracts is the primary risk factor for neonatal invasive disease. Despite prophylactic intrapartum antibiotic administration to colonized women and improved neonatal intensive care, the incidence and morbidity associated with GBS meningitis have not declined since the 1970s. Among meningitis survivors, a significant number suffer from complex neurological or neuropsychiatric sequelae, implying that the pathophysiology and pathogenic mechanisms leading to brain injury and devastating outcomes are not yet fully understood. It is imperative to develop new therapeutic and neuroprotective approaches aiming at protecting the developing brain. In this review, we provide updated clinical information regarding the understanding of neonatal GBS meningitis, including epidemiology, diagnosis, management, and human evidence of the disease's underlying mechanisms. Finally, we explore the experimental models used to study GBS meningitis and discuss their clinical and physiologic relevance to the complexities of human disease.
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21
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Sunarno S, Sofiah SN, Amalia N, Hartoyo Y, Rizki A, Puspandari N, Saraswati RD, Febriyana D, Febrianti T, Susanti I, Khariri K, Sariadji K, Muna F, Rukminiati Y, Sulistyaningrum N, Riana DA, Maha MS, Fitriana F, Voronika V, Muslih M, Kamal M, Setiawaty V. Laboratory and epidemiology data of pertussis cases and close contacts: A 5-year case-based surveillance of pertussis in Indonesia, 2016–2020. PLoS One 2022; 17:e0266033. [PMID: 35442946 PMCID: PMC9020744 DOI: 10.1371/journal.pone.0266033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Pertussis cases have been reported most frequently in developed countries, but they are predicted to be the most prevalent in developing countries. Indonesia, a developing country, routinely conducts case-based surveillance for pertussis. We reviewed the data on pertussis cases and close contacts based on clinical sample documents examined in the National Reference Laboratory for pertussis, Indonesia (2016–2020). Our objective was to analyze the laboratory and epidemiological aspects of pertussis cases and close contacts, particularly to evaluate the implementation of a 5-year case-based surveillance of pertussis in Indonesia. Data were collected from sample documents and annual laboratory reports between January 2016 and December 2020. We analyzed the proportion of pertussis cases and close contacts by geographic region, year, age, and sex. We used the χ2 test to correlate the laboratory and epidemiological data. In total, 274 clinical cases of pertussis and 491 close contacts were recorded in 15 provinces. The peak number of cases occurred in 2019, with a positivity rate (percentage of laboratory-confirmed cases) of 41.23% (47/114). Clinical cases were dominated by infants aged <1 year (55.5%), and 52.9% of them were aged <6 months. Similarly, 72.3% (68/94) of the laboratory-confirmed cases were infants. Both clinical cases and positivity rates tended to be higher in females (155 cases, 38.1%) than in males (119 cases, 29.4%). No confirmed cases were found in children aged ≥10 years, although positive results still occurred in close contact. Age-group and laboratory-confirmed cases were correlated (p = 0.00). Clinical and confirmed cases of pertussis occurred mostly in the early age group and may be lower in those aged ≥10 years, especially in confirmed cases. New policies are needed for pertussis prevention at an early age, as well as the application of serology tests to increase laboratory-confirmed cases in children aged ≥10 years.
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Affiliation(s)
- Sunarno Sunarno
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
- National Research and Innovation Agency (BRIN), Jakarta, Indonesia
- * E-mail:
| | - Sundari Nur Sofiah
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Novi Amalia
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Yudi Hartoyo
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Aulia Rizki
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Nelly Puspandari
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Ratih Dian Saraswati
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Dwi Febriyana
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Tati Febrianti
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Ida Susanti
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Khariri Khariri
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
- National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - Kambang Sariadji
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Fauzul Muna
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Yuni Rukminiati
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Novi Sulistyaningrum
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Dyah Armi Riana
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Masri Sembiring Maha
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
- National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - Fitriana Fitriana
- National Research and Innovation Agency (BRIN), Jakarta, Indonesia
- Centre for Research and Development of Health Resources and Services, National Institute of Health Research and Development, Jakarta, Indonesia
| | - Vivi Voronika
- Directorate General of Disease Prevention and Control, Ministry of Health, Jakarta, Indonesia
| | - Muamar Muslih
- Directorate General of Disease Prevention and Control, Ministry of Health, Jakarta, Indonesia
| | - Mushtofa Kamal
- World Health Organization Country Office for Indonesia, Jakarta, Indonesia
| | - Vivi Setiawaty
- Centre for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Jakarta, Indonesia
- Sulianti Saroso Hospital, Jakarta, Indonesia
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22
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Gragnani CM, Fernandes P. Promoting Healthy Lifestyles and Well-Being in Autistic Youth. Pediatrics 2022; 149:185637. [PMID: 35363282 DOI: 10.1542/peds.2020-049437h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
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23
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Falkenstein-Hagander K, Appelqvist E, Cavefors ASF, Källberg H, Nilsson LJ, Silfverdal SA, Storsaeter J, Aronsson B. Waning infant pertussis during COVID-19 pandemic. Arch Dis Child 2022; 107:e19. [PMID: 34857511 DOI: 10.1136/archdischild-2021-323055] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Measures to reduce the spread of COVID-19 have been associated with reduction in other respiratory infections. Results of a national Swedish cohort study of infant pertussis during April 2020-September 2021 were compared with those during January 2014-March 2020. The number of pertussis cases decreased significantly during the COVID-19 pandemic, from an average of 21 infant cases per quarter of a year before the pandemic to an average of 1 case per quarter during the pandemic. Swedish strategies to mitigate the spread of COVID-19 seem to have had an impact on pertussis incidence in infants.
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Affiliation(s)
| | - Emma Appelqvist
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Lennart Jan Nilsson
- Allergy Center, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Sven-Arne Silfverdal
- Unit of Pediatrics, Department of Clinical Sciences/Paediatrics, Sven-Arne Silfverdal, Umeå University, Umeå, Sweden
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24
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Voss G, Jacquet JM, Tornieporth N, Kampmann B, Karron R, Meulen AST, Chen R, Gruber M, Lurie N, Weller C, Cramer JP, Saville M, Darko M. Meeting report: CEPI consultation on accelerating access to novel vaccines against emerging infectious diseases for pregnant and lactating women, London, 12-13 February 2020. Vaccine 2021; 39:7357-7362. [PMID: 34799142 PMCID: PMC8595925 DOI: 10.1016/j.vaccine.2021.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/28/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
Infectious diseases may cause serious morbidity and mortality in pregnant women, their foetuses, and infants; the risk associated with any newly emerging infectious disease (EID) is likely unknown at the time of its emergence. While the ongoing SARS-CoV-2 pandemic shows that the development of vaccines against new pathogens can be considerably accelerated, the immunization of pregnant women generally lags behind the general population. Guided by the priority pathogen list for WHO’s R&D Blueprint for Action to Prevent Epidemics, this workshop sought to define the evidence needed for use of vaccines against EIDs in pregnant and lactating women, using Lassa fever as a model. Close to 60 maternal immunization (MI) and vaccine safety experts, regulators, vaccine developers, Lassa fever experts, and investigators from Lassa-affected countries examined the critical steps for vaccine development and immunization decisions for pregnant and lactating women. This paper reports on key themes and recommendations from the workshop. Current practice still assumes the exclusion of pregnant women from early vaccine trials. A shift in paradigm is needed to progress towards initial inclusion of pregnant women in Phase 2 and 3 trials. Several practical avenues were delineated. Participants agreed that vaccine platforms should be assessed early for their suitability for maternal immunization. It was noted that, in some cases, nonclinical data derived from assessing a given platform using other antigens may be adequate evidence to proceed to a first clinical evaluation and that concurrence from regulators may be sought with supporting rationale. For clinical trials, essential prerequisites such as documenting the disease burden in pregnant women, study site infrastructure, capabilities, and staff experience were noted. Early and sustained communication with the local community was considered paramount in any program for the conduct of MI trials and planned vaccine introduction.
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Affiliation(s)
- Gerald Voss
- Coalition for Epidemic Preparedness and Innovation, London, UK.
| | | | | | - Beate Kampmann
- The Vaccine Centre, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Karron
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Robert Chen
- Brighton Collaboration, Task Force for Global Health, Decatur, GA, USA
| | - Marion Gruber
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nicole Lurie
- Coalition for Epidemic Preparedness and Innovation, London, UK
| | | | - Jakob P Cramer
- Coalition for Epidemic Preparedness and Innovation, London, UK
| | - Melanie Saville
- Coalition for Epidemic Preparedness and Innovation, London, UK
| | - Mimi Darko
- Food and Drugs Authority, Cantonments, Accra, Ghana
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25
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Fry NK, Campbell H, Amirthalingam G. JMM Profile: Bordetella pertussis and whooping cough (pertussis): still a significant cause of infant morbidity and mortality, but vaccine-preventable. J Med Microbiol 2021; 70. [PMID: 34668853 PMCID: PMC8604168 DOI: 10.1099/jmm.0.001442] [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] [Indexed: 12/26/2022] Open
Abstract
Whooping cough (pertussis) is a highly contagious respiratory bacterial infection caused by Bordetella pertussis and is an important cause of morbidity and mortality worldwide, particularly in infants. Bordetella parapertussis can cause a similar, but usually less severe pertussis-like disease. Bordetella pertussis has a number of virulence factors including adhesins and toxins which allow the organism to bind to ciliated epithelial cells in the upper respiratory tract and interfere with host clearance mechanisms. Typical symptoms of pertussis include paroxysmal cough with characteristic whoop and vomiting. Severe complications and deaths occur mostly in infants. Laboratory confirmation can be performed by isolation, detection of genomic DNA or specific antibodies. Childhood vaccination is safe, effective and remains the best control method available. Many countries have replaced whole-cell pertussis vaccines (wP) with acellular pertussis vaccines (aP). Waning protection following immunisation with aP is considered to be more rapid than that from wP. Deployed by resource-rich countries to date, maternal immunisation programmes have also demonstrated high efficacy in preventing hospitalisation and death in infants by passive immunisation through transplacental transfer of maternal antibodies.
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Affiliation(s)
- Norman K Fry
- Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK.,Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK
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26
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Kang KR, Huh DH, Kim JA, Kang JH. Immunogenicity of a new enhanced tetanus-reduced dose diphtheria-acellular pertussis (Tdap) vaccine against Bordetella pertussis in a murine model. BMC Immunol 2021; 22:68. [PMID: 34641798 PMCID: PMC8506493 DOI: 10.1186/s12865-021-00457-1] [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: 12/01/2020] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background The necessity of the tetanus-reduced dose diphtheria-acellular pertussis (Tdap) vaccine in adolescence and adults has been emphasized since the resurgence of small-scale pertussis in Korea and worldwide due to the waning effect of the vaccine and variant pathogenic stains in the late 1990s. GreenCross Pharma (GC Pharma), a Korean company, developed the Tdap vaccine GC3111 in 2010. Recently, they enhanced the vaccine, GC3111, produced previously in 2010 to reinforce the antibody response against filamentous hemagglutinin (FHA). In this study, immunogenicity and efficacy of the enhanced Tdap vaccine compared and evaluated with two Tdap vaccines, GC3111 vaccine produced in 2010 previously and commercially available Tdap vaccine in a murine model. Methods Two tests groups and positive control group of Balb/c mice were primed with two doses of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine followed by a single booster Tdap vaccine at 9 week using the commercially available Tdap vaccine or 2 Tdap vaccines from GC Pharma (GC3111, enhanced GC3111). Humoral response was assessed 1 week before and 2 and 4 weeks after Tdap booster vaccination. The enhanced GC3111 generated similar humoral response compare to the commercial vaccine for filamentous hemagglutinin (FHA). The interferon gamma (IFN-γ) (Th1), interleukin 5 (IL-5) (Th2) and interleukin 17 (IL-17) (Th17) cytokines were assessed 4 weeks after booster vaccination by stimulation with three simulators: heat inactivated Bordetella pertussis (hBp), vaccine antigens, and hBp mixed with antigens (hBp + antigen). A bacterial challenge test was performed 4 weeks after booster vaccination. Results Regarding cell-mediated immunity, cytokine secretion differed among the three simulators. However, no difference was found between two test groups and positive control group. All the vaccinated groups indicated a Th1 or Th1/Th2 response. On Day 5 post-bacterial challenge, B. pertussis colonies were absent in the lungs in two test groups and positive control group. Conclusions Our results confirmed the immunogenicity of GC Pharma’s Tdap vaccine; enhanced GC3111 was equivalent to the presently used commercial vaccine in terms of humoral response as well as cell-mediated cytokine expression. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-021-00457-1.
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Affiliation(s)
- Kyu Ri Kang
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Annex to Seoul Saint Mary Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Dong Ho Huh
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Annex to Seoul Saint Mary Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Ji Ahn Kim
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Annex to Seoul Saint Mary Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Jin Han Kang
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Annex to Seoul Saint Mary Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea. .,Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
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27
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Zerbo O, Fireman B, Klein NP. Lessons from a mature acellular pertussis vaccination program and strategies to overcome suboptimal vaccine effectiveness. Expert Rev Vaccines 2021; 21:899-907. [PMID: 34555994 DOI: 10.1080/14760584.2021.1984891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Despite high vaccination coverage among children and adolescents, pertussis remains a public health problem, with large outbreaks occurring periodically in the US and other developed countries. AREAS COVERED We examine lessons learned more than 20 years after implementation of programs which use only acellular pertussis vaccines and propose avenues for possible effective use of acellular pertussis vaccine to prevent large outbreaks. EXPERT OPINION Acellular pertussis vaccines were introduced more than 20 years ago, yet the incidence of pertussis has been increasing over the past decade, with periodic large outbreaks marked by notable shifts in disease burden from infants and young children toward fully vaccinated adolescents and young adults. This age shift is mainly driven by the waning of vaccine immunity. To better protect adolescents against pertussis, modification of the current acellular pertussis vaccination schedule or adoption of new vaccination strategies should be considered. For infants not yet eligible to be vaccinated, maternal vaccination against pertussis during pregnancy is an effective way to protect infants from infection, severe disease and death. Implementation of maternal vaccination programs should be encouraged in countries without one or efforts to improve coverage should be supported in countries with existing program.
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Affiliation(s)
- Ousseny Zerbo
- Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Bruce Fireman
- Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Nicola P Klein
- Division of Research, Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
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28
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Nascimento RMD, Baptista PN, Lopes KADM, Pimentel AM, Cruz FDSP, Ximenes RADA. Protective effect of exclusive breastfeeding and effectiveness of maternal vaccination in reducing pertussis-like illness. J Pediatr (Rio J) 2021; 97:500-507. [PMID: 33465336 PMCID: PMC9432170 DOI: 10.1016/j.jped.2020.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/24/2020] [Accepted: 10/10/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the protective effect of exclusive breastfeeding and the effectiveness of maternal vaccination in reducing pertussis-like illness. METHOD This was a case-control study conducted in sentinel hospitals for pertussis in Recife between July 2016 and July 2018. Cases included children aged under six months with symptoms compatible with pertussis (pertussis-like illness). Controls included children aged under six months, living in the metropolitan region of Recife with no diagnosis of pertussis-like illness and matched by the same hospital and birth date. RESULTS Seventy-three cases and 194 controls were included. The diagnosis of pertussis-like illness was predominantly clinical (97,2%). Amongst the main symptoms, paroxysmal cough was observed in 95.89% of cases and vomiting in 53.4%. There were 29 hospitalized cases and no deaths. Out of the 73 cases, 47 were born to mothers vaccinated against pertussis during pregnancy, and the mothers of 144 of the 194 controls had been vaccinated. The protective effect of breastfeeding was of 74% (95% CI;38%, 89%). Children younger than six months, who were exclusively breastfed and with mothers vaccinated against pertussis during pregnancy were 5 times less likely to develop pertussis-like illness, corresponding to a protection of 79% (95% CI;31%, 94%). The effectiveness of maternal vaccination against pertussis-like illness in children under six months was low (27%) and not statistically significant (CI 95%; -34% a 60%). CONCLUSIONS Exclusive breastfeeding protects children under six months from pertussis-like illness and may be enhanced when associated with maternal vaccination. These strategies should be encouraged because they also protect against pertussis-like illnesses.
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Affiliation(s)
| | - Paulo Neves Baptista
- Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Recife, PE, Brazil
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29
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Chang YW, Chou FH. Acceptance of Pertussis Vaccination among Pregnant Women in Taiwan. J Community Health Nurs 2021; 38:85-102. [PMID: 33949260 DOI: 10.1080/07370016.2021.1887565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This cross-sectional study assessed prenatal pertussis vaccination acceptance in Taiwan. A sample of pregnant women from five private clinics in Taiwan was recruited. Demographics, experience of prenatal vaccinations, key considerations, knowledge, and attitude about pertussis and its vaccination were measured. Among 505 participants, the vaccination rate, including planned vaccination, was 29.7%. Factors associated with acceptance included clinic location, primary caregiver of the newborn, newborns with siblings, previous influenza vaccination history, knowledge and attitude toward pertussis and its vaccination. Public health agencies should provide free vaccinations, clarify misinformation, and publicize prevention information, to improve prenatal pertussis vaccination acceptance.
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Affiliation(s)
- Ya-Wen Chang
- College of Nursing, Kaohsiung Medical University, Taiwan, R.O.C.,Department of Nursing, National Tainan Institute of Nursing, Taiwan, R.O.C
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Taiwan, R.O.C
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30
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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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Sandmann F, Jit M, Andrews N, Buckley HL, Campbell H, Ribeiro S, Sile B, Stowe J, Tessier E, Ramsay M, Amirthalingam G, Choi YH. Evaluating the impact of a continued maternal pertussis immunisation programme in England: A modelling study and cost-effectiveness analysis. Vaccine 2021; 39:4500-4509. [PMID: 34183204 DOI: 10.1016/j.vaccine.2021.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION An unexpected resurgence of pertussis cases and infant deaths was observed in some countries that had switched to acellular pertussis vaccines in the primary immunisation schedule. In response to the outbreaks, maternal pertussis vaccination programmes in pregnant women have been adopted worldwide, including the USA in 2011 and the UK in 2012. Following the success of the programme in England, we evaluated the health and economic impact of stopping versus continuing the maternal pertussis immunisation to inform public health policy making. METHODS We used a mathematical model to estimate the number of infant hospitalisations and deaths related to pertussis in England over 2019-2038. Losses in quality-adjusted life years, QALYs, were considered for infants (aged 0-2 months) who survived or died from pertussis, bereaved parents (of infants who died from pertussis), and women with pertussis (aged 20-44 years). Direct medical costs to the National Health Service included infant hospitalisations, maternal vaccinations, and disease in women. Costs and QALYs were discounted at 3.5%. Changes in the incremental cost-effectiveness ratio, ICER, were explored in sensitivity analyses. RESULTS The model supports continuing the maternal pertussis immunisation programme as a cost-effective intervention at an ICER of £14,500/QALY (2.5% and 97.5%-quantile: £7,300/QALY to £32,400/QALY). Stopping versus continuing the maternal programme results in an estimated mean of 972 (range 582 to 1489) versus 308 (184 to 471) infant hospitalisations annually. Results were most sensitive to the number of hospitalisations and deaths when stopping the maternal programme. At a cost-effectiveness threshold of £30,000/QALY, the probability of the maternal programme being cost-effective was 96.2%. CONCLUSION Our findings support continuing the maternal pertussis vaccination programme as otherwise higher levels of disease activity and infant mortality are expected to return. These results have led policy makers to decide to continue the maternal programme in the UK routine immunisation schedule.
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Affiliation(s)
- Frank Sandmann
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mark Jit
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK; School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | | | - Helen Campbell
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Bersabeh Sile
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Julia Stowe
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Elise Tessier
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Yoon H Choi
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK
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Scatigna M, Appetiti A, Pasanisi M, D'Eugenio S, Fabiani L, Giuliani AR. Experience and attitudes on vaccinations recommended during pregnancy: survey on an Italian sample of women and consultant gynecologists. Hum Vaccin Immunother 2021; 18:1-8. [PMID: 33956557 PMCID: PMC8920149 DOI: 10.1080/21645515.2021.1894061] [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] [Indexed: 10/29/2022] Open
Abstract
Active immunization in pregnancy is recommended for the influenza and the tetanus, diphtheria, and acellular pertussis (Tdap) vaccines. Evidence indicates vaccine effectiveness in preventing influenza-related hospitalizations and pertussis in early infancy. We investigate vaccine uptake in pregnant and non-pregnant women through a sample of young women and consultant gynecologists, along with the potential predisposing and/or enabling factors affecting attitudes to vaccination (knowledge, beliefs, barriers). A cross-sectional study was conducted between June and September 2019, with a sample of 251 women and 14 consultant gynecologists at the Local Health Authority (ASL01) of the Abruzzo Region (Italy), using an anonymous, self-report questionnaire survey. Among the participants, 5.6% of women had received influenza vaccination, 16.4% had received Tdap during pregnancy and only 1.2% had received both vaccines. The assessment of the psychometric attitudinal variables has suggested a more positive willingness to receive Tdap than influenza vaccine among women, as the former is considered more important for the maternal and neonatal health. Health care workers have reported vaccine safety concerns, lack of information, and misconceptions about the need for vaccination as barriers to immunization in pregnant women. The results of this study will contribute to defining the goals and strategies to increase vaccine uptake under the current recommendations, through promoting effective training programs for all health care workers involved (gynecologists, obstetricians, public health physicians).
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Affiliation(s)
- Maria Scatigna
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Appetiti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Silvia D'Eugenio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Leila Fabiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Rita Giuliani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Vaz-de-Lima LR, Sato APS, Pawloski LC, Fernandes EG, Rajam G, Sato HK, Patel D, Li H, de Castilho EA, Tondella ML, Schiffer J. Effect of maternal Tdap on infant antibody response to a primary vaccination series with whole cell pertussis vaccine in São Paulo, Brazil. Vaccine X 2021; 7:100087. [PMID: 33817624 PMCID: PMC8010450 DOI: 10.1016/j.jvacx.2021.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Maternal Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination provides antibody transfer to newborn infants and may affect their antibody response to the primary vaccination series. This study aimed to assess the effect of Tdap vaccination during pregnancy on infant antibody response to the whole cell pertussis (DTwP) primary series. METHODS Plasma from 318 pregnant women (243 Tdap-vaccinated and 75 unvaccinated) and their infants (cord blood) was collected at delivery; infant blood was again collected at 2 and 7 months, before and after their primary DTwP series. Anti-pertussis toxin (PT), pertactin (PRN), filamentous hemagglutinin (FHA), fimbriae 2/3 (FIM) and adenylate cyclase toxin (ACT) IgG antibodies were quantified by a microsphere-based multiplex antibody capture assay and anti-PT neutralizing antibodies by the Real Time Cell analysis system. RESULTS Infant geometric mean concentrations (GMCs) of IgG anti-Tdap antigens were significantly higher (p < 0.001) among the Tdap-vaccinated (PT: 57.22 IU/mL; PRN: 464.86 IU/mL; FHA: 424.0 IU/mL), versus the unvaccinated group (4 IU/mL, 15.43 IU/mL, 31.99 IU/mL, respectively) at delivery. Anti-FIM and ACT GMCs were similar between the two groups. At 2 months of age, anti-PT, PRN, and FHA GMCs remained higher (p < 0.001) in the Tdap-vaccinated group (12.64 IU/mL; 108.76 IU/mL; 87.41 IU/mL, respectively) than the unvaccinated group (1.02 IU/mL; 4.46 IU/mL; 6.89 IU/mL). However, at 7 months, after receiving the third DTwP dose, the anti-PT GMC was higher (p = 0.016) in the unvaccinated group (7.91 IU/mL) compared to the vaccinated group (2.27 IU/mL), but without differences for anti-PRN, FHA, FIM and ACT GMCs. CONCLUSION Elevated antibody levels suggest that maternal Tdap vaccination might protect infants until 2 months of age. Reduced anti-PT levels at 7 months indicate potential blunting of immune response in infants. Surveillance would help determine if blunting alters vaccine immunity and impacts pertussis prevention in infants.
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Affiliation(s)
- Lourdes R.A. Vaz-de-Lima
- Centro de Imunologia, Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde, São Paulo, Brazil
| | - Ana Paula S. Sato
- Departmento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo – USP, Brazil
| | - Lucia C. Pawloski
- Division of Bacterial Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eder G. Fernandes
- Divisão de Imunização, Centro de Vigilância Epidemiológica Prof. Alexandre Vranjac, Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde SP, Brazil
| | - Gowrisankar Rajam
- Division of Bacterial Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helena K. Sato
- Divisão de Imunização, Centro de Vigilância Epidemiológica Prof. Alexandre Vranjac, Coordenadoria de Controle de Doenças da Secretaria de Estado da Saúde SP, Brazil
| | - Divya Patel
- Division of Bacterial Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Han Li
- Division of Bacterial Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Maria Lucia Tondella
- Division of Bacterial Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jarad Schiffer
- Division of Bacterial Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Liu D, Du Q, Yuan L, Wang Q, Shi W, Meng Q, Yu D, Yao K. Retrospective analysis of bacterial culture-confirmed pertussis cases in Beijing Children's hospital from 2014 to 2019 reveals prevention and control of the grim situation in mainland China. Expert Rev Vaccines 2021; 20:577-583. [PMID: 33691571 DOI: 10.1080/14760584.2021.1899822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Our study aims to explore the epidemiological features of children with bacterial culture-confirmed pertussis visiting Beijing Children's Hospital, China. METHODS From 2014 through 2019, patients with suspected pertussis coming from mainland China provided nasopharyngeal swabs and bacterial culture that was subsequently cultivated. RESULTS During the study period, 6956 children with suspected pertussis from 30 different administrative provinces of mainland China were investigated, of which 1494 cases (21.5%) had positive B. pertussis culture. The number of pertussis cases increased year-on-year, from 122 in 2014 to 279 in 2019. Of the confirmed cases, 38.2% and 26.8% were identified in the summer and autumn, respectively. The age distribution of children with pertussis showed that 77.2% were <12 months old, including 56.0% <6 months old. Only thirteen B. parapertussis isolates and one B. bronchiseptica isolates were collected in the present samples. CONCLUSIONS The present culture-confirmed cases reveal the severe epidemic situation of pertussis spreading over the whole country and mainly affecting the infants. It is necessary to set up hospital-based surveillance with reliable laboratory methods to promote clinical awareness and to monitor the disease.
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Affiliation(s)
- Dandan Liu
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qianqian Du
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lin Yuan
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qing Wang
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Shi
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qinghong Meng
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Dan Yu
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kaihu Yao
- MOE Key Laboratory of Major Diseases in Children, National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Laboratory of Microbiology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Crowcroft NS, Bolotin S, Li Y, Campbell H, Amirthalingam G. Infant pertussis and maternal immunity: The curious case of Canada. Vaccine 2021; 39:1977-1981. [PMID: 33750589 DOI: 10.1016/j.vaccine.2021.02.050] [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: 12/13/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The United Kingdom (UK) and Canada use the same acellular pertussis vaccine and both experienced large pertussis outbreaks in the past, occurring in the 1980s in the UK and 1990s in Canada, yet current epidemiology differs. A national outbreak with infant deaths occurred in the UK in 2012, yet outbreaks remain localized and death from pertussis rare in Canada. AIM We explored whether past outbreaks in children may influence future risk when those children become parents. METHODS We conducted an ecological within-country birth cohort analysis in women of childbearing age of the relative risk of ever having pertussis infection by two points in time, 2002 and 2012, comparing with 1992 as the baseline. We used notified cases of pertussis in England and Wales and Canada to compare trends in relative risk. We projected forward to 2022 in Canada assuming incidence remained stable. RESULTS In Canada, the cumulative risk of previous pertussis was similar in 2002 and 2012 and, in both periods, was higher than in 1992. In England and Wales, the cumulative risk of pertussis fell stepwise from 1992 to 2012. Projecting forwards, the pattern of risk in Canada becomes similar to England and Wales in 2022. CONCLUSIONS Widespread pertussis outbreaks in children may reduce the risk of pertussis in infants when those children become parents. Further research is needed to determine the mechanism. As birth cohorts that experienced outbreaks grow past childbearing age, pertussis burden in infants in Canada may increase, following trends observed in England and Wales.
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Affiliation(s)
- Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Canada; ICES, Toronto, Canada.
| | - Shelly Bolotin
- Dalla Lana School of Public Health, University of Toronto, Canada; Laboratory Medicine and Pathobiology, University of Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Ye Li
- Dalla Lana School of Public Health, University of Toronto, Canada; ICES, Toronto, Canada
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, United Kingdom
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Russell LB, Sobanjo-Ter Meulen A, Toscano CM. Evaluating the cost-effectiveness of maternal pertussis immunization in low- and middle-income countries: A review of lessons learnt. Vaccine 2021; 39:121-124. [PMID: 33303179 PMCID: PMC7735408 DOI: 10.1016/j.vaccine.2020.10.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This issue of Vaccine is devoted to papers from a research project that developed two types of simulation models, static and dynamic transmission, to evaluate the cost-effectiveness of maternal immunization to prevent pertussis in infants in low- and middle-income countries (LMICs). The research was conducted by a multinational team of investigators and funded by the Bill & Melinda Gates Foundation to gain an understanding of when and where maternal immunization might be a good public health investment for LMICs. Here we review the project's central lessons for vaccine policy and research. Models require a lot of data. As most LMICs lack good data, the models were built using pertussis disease burden data from Brazil, a middle-income country with three long-established, independent information systems (disease surveillance, hospitalization, and mortality), on the hypothesis that the disease process is similar across countries. Values for key parameters, particularly infant mortality, infant vaccine coverage, and costs of vaccination and treatment, were then varied to represent other LMICs. The results show that coverage levels of infant whole cell pertussis (wP) vaccine are key to the cost-effectiveness of maternal pertussis immunization. In settings where infant wP coverage is below the threshold thought necessary to eliminate pertussis in the population, 90-95%, maternal immunization is cost-effective, even cost-saving. By contrast, it is very expensive in countries capable of maintaining infant vaccination in or above the threshold range. The research also suggests that, while static models may serve to explore an intervention's cost-effectiveness initially, dynamic transmission models are essential for more accurate estimates. These findings can help guide policies toward maternal pertussis immunization, but also show that developing better data on neonatal pertussis mortality burden and infant vaccine coverage in LMICs, and on the duration of immunity of currently available pertussis vaccines, are key priorities to support better vaccine policy.
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Affiliation(s)
- Louise B Russell
- University of Pennsylvania, Department of Medical Ethics and Health Policy, 423 Guardian Drive, c/o Lauren Counterman, Philadelphia, PA 19104, USA.
| | | | - Cristiana M Toscano
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil. (Instituto de Patologia Tropical e Saúde Pública,Universidade Federal de Goiás, Rua 235, S/N - Setor Universitário, Goiânia-GO CEP 74605-050 Brazil.
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Pertussis (Keuchhusten). DER PNEUMOLOGE 2020; 17:465-476. [PMID: 33041739 PMCID: PMC7537784 DOI: 10.1007/s10405-020-00345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pertussis wird durch das gramnegative Bakterium Bordetella pertussis verursacht. Die Krankheitsmanifestationen reichen von unspezifischem Husten bis zu lebensbedrohlichen Verläufen mit Hyperleukozytose und respiratorischer Insuffizienz, v.a. bei jungen Säuglingen. Die Diagnose basiert auf klinischer Symptomatik und mikrobiologischen Nachweisverfahren. Die Therapie besteht aus Makrolidantibiotika; bei Apnoen kann Koffein versucht werden. Die Inzidenz beträgt 10–40 Fälle/100.000 Bevölkerung und Jahr, bei Säuglingen ist sie am höchsten (ca. 50), gefolgt von Jugendlichen (30–35). Mehr als 50 % der in den ersten 5 Lebensmonaten an Pertussis erkrankten Kinder werden hospitalisiert. Die Impfprävention umfasst Grundimmunisierung und regelmäßige Auffrischimpfungen mit azellulären Impfstoffen. Um schwere Verläufe bei jungen Säuglingen zu verhindern, ist die Impfung schwangerer Frauen am erfolgversprechendsten. Säuglinge geimpfter Mütter sollen zeitgerecht ab dem Alter von 2 Monaten für den Eigenschutz immunisiert werden.
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Zar HJ, Moore DP, Andronikou S, Argent AC, Avenant T, Cohen C, Green RJ, Itzikowitz G, Jeena P, Masekela R, Nicol MP, Pillay A, Reubenson G, Madhi SA. Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.104. [PMID: 34471872 PMCID: PMC7433705 DOI: 10.7196/ajtccm.2020.v26i3.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. OBJECTIVES To produce revised guidelines for pneumonia in South African children under 5 years of age. METHODS The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. RECOMMENDATIONS Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. VALIDATION The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - D P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Andronikou
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Pediatric Radiology, Perelman School of Medicine, University of Philadephia, USA
| | - A C Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Avenant
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - C Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - R J Green
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - G Itzikowitz
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - P Jeena
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - R Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; and Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - A Pillay
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - G Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Noel G, Badmasti F, Nikbin VS, Zahraei SM, Madec Y, Tavel D, Aït-Ahmed M, Guiso N, Shahcheraghi F, Taieb F. Transversal sero-epidemiological study of Bordetella pertussis in Tehran, Iran. PLoS One 2020; 15:e0238398. [PMID: 32870922 PMCID: PMC7462262 DOI: 10.1371/journal.pone.0238398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/15/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives Pertussis remains endemic despite high vaccine coverage in infants and toddlers. Pertussis vaccines confer protection but immunity wanes overtime and boosters are needed in a lifetime. Iran, eligible for the Expanded Program on Immunization that includes the primary immunization, implemented two additional booster doses using a whole-cell vaccine (wPV) at 18 months-old and about 6 years-old. Duration of protection induced by the wPVs currently in use and their impact as pre-school booster are not well documented. This study aimed at assessing vaccination compliance and at estimating the duration of protection conferred by vaccination with wPV in children aged < 15 years in Tehran, Iran. Methods Detailed information on vaccination history and capillary blood samples were obtained from 1047 children aged 3–15 years who completed the 3 doses-primary pertussis immunization, in Tehran. Anti-pertussis toxin IgG levels were quantified by ELISA. Results Compliance was very high with 93.3% of children who received the three primary and 1st booster doses in a timely manner. Timeliness of the 2nd booster was lower (63.3%). Rate of seropositive samples continuously and significantly increased from 1–2 to 5–6 years after 1st booster attaining 30.4% of children exhibiting serological sign of recent contact with B. pertussis. Second booster dating back 1 or 2 years was associated with high antibody titers, which significantly decreased within 3 years from injection. Among children who received 2nd booster injection more than 2 years before serum analysis, seroprevalence of pertussis infection was 8.4% and seropositivity rate was higher from the 10 years-old group. Conclusion Seropositivity in children aged 6–7 years with no 2nd booster supports the need for a vaccination at that age. Adolescent booster may also be considered.
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Affiliation(s)
- Gaelle Noel
- Institut Pasteur, Center for Translational Research, Paris, France
| | - Farzad Badmasti
- Department of Bacteriology, Pertussis Reference Laboratory, Pasteur Institute of Iran, Tehran, Iran
| | - Vajihe S. Nikbin
- Department of Bacteriology, Pertussis Reference Laboratory, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed M. Zahraei
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Yoann Madec
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - David Tavel
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Mohand Aït-Ahmed
- Institut Pasteur, Centre for Translational Science, Clinical Coordination, Paris, France
| | - Nicole Guiso
- Institut Pasteur, Center for Translational Research, Paris, France
| | - Fereshteh Shahcheraghi
- Department of Bacteriology, Pertussis Reference Laboratory, Pasteur Institute of Iran, Tehran, Iran
| | - Fabien Taieb
- Institut Pasteur, Center for Translational Research, Paris, France
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- * E-mail:
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Bhattacharya D, Dash N, Kavitha TK, Sharma M, Gautam V, Verma S. Lurking Infantile Pertussis: Experience from a Tertiary Care Center in Northern India. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1714709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Objectives The aim is to study the clinical laboratory profile and outcome of infants with laboratory confirmed pertussis.
Methods In this retrospective study, records of 30 infants with laboratory confirmed pertussis, admitted to the pediatric department of a tertiary care hospital, were reviewed. Clinical features, laboratory parameters, and outcomes were noted.
Results Median (interquartile range age was 10 (7–24.5) weeks, with a male preponderance. Large majority (60%) of enrolled infants were less than 16 weeks of age and nine (30%) developed pertussis even before 8 weeks of age. Cough was universal (100%), followed by rapid breathing (73%), fever (70%), and apnea (10%). Bubble continuous positive airway pressure (CPAP), nasal prongs oxygen, and invasive ventilation were required in 15 (54%), 11 (39%), and 2 (7%) infants, respectively; 12 (40%) needed to be admitted to the pediatric intensive care unit. Anemia was observed in 28 (93%) and leukemoid reaction in 15 (50%). All except one were discharged successfully. None of the mothers had received tetanus, diphtheria, and pertussis or Tdap vaccination during pregnancy.
Conclusion Our study reports the continued occurrence of infantile pertussis in the community, suggesting reconsideration of our vaccination policy, including maternal immunization.
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Affiliation(s)
- Deepanjan Bhattacharya
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nabaneeta Dash
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thondi Kkandy Kavitha
- Division of Emergency and Intensive Care, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Verma
- Division of Infectious Diseases, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kandeil W, van den Ende C, Bunge EM, Jenkins VA, Ceregido MA, Guignard A. A systematic review of the burden of pertussis disease in infants and the effectiveness of maternal immunization against pertussis. Expert Rev Vaccines 2020; 19:621-638. [PMID: 32772755 DOI: 10.1080/14760584.2020.1791092] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction Infants too young to be fully immunized are the most vulnerable to severe pertussis disease. To close this susceptibility gap, passive infant immunization through vaccination of pregnant women against pertussis was first introduced in 2011 in the United States and has been extended since then to more than 40 countries. Areas covered We conducted two systematic literature searches to describe the worldwide burden of pertussis disease in infants <6 months of age since 2005, and the effectiveness and impact of maternal pertussis vaccination in preventing infant pertussis since 2011. Expert opinion Pertussis disease incidence rates in infants aged <2-3 months were substantial in all countries with available data, exceeding 1000 cases per 100,000 population during outbreaks. Virtually all pertussis deaths occurred in this age group. Data from Africa, Eastern Mediterranean, and Asia were limited, but suggest a similar or higher disease burden than in Europe or the Americas. Estimates of effectiveness of second/third trimester pertussis vaccination in preventing pertussis disease in <2-3 months old infants were consistently high (69%-93%) across the observational studies reviewed, conducted in various settings with different designs. Maternal vaccination programs appear to be achieving their goal of reducing the burden of disease in very young infants. Plain language summary What is the context? Pertussis, also known as whooping cough, is a highly contagious disease of the respiratory tract. Infants too young to be fully vaccinated are at the highest risk of severe pertussis disease, hospitalization, and death. Vaccinating pregnant women against pertussis with a Tdap vaccine is recommended in more than 40 countries as a safe and effective strategy to protect infants for the first months of life. What is new? This review summarizes recent literature describing the burden of pertussis disease in infants worldwide prior to the introduction of maternal vaccination programs; pertussis disease incidence rates in infants aged <2-3 months were substantial in all countries with available data, exceeding 1000 cases per 100,000 population during outbreaks. Immunization of pregnant women with a Tdap vaccine can prevent about 70-90% of pertussis disease and up to 90.5% of pertussis hospitalizations in infants under 3 months of age. What is the impact? Limited available data suggest that incidence rates of pertussis disease after the introduction of Tdap maternal immunization have declined in infants. Current knowledge supports the implementation of Tdap maternal immunization programs.
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Affiliation(s)
- Walid Kandeil
- GSK , Wavre, Belgium.,Takeda Pharmaceuticals International AG , Zurich, Switzerland
| | | | - Eveline M Bunge
- Health Research and Consultancy , Rotterdam, The Netherlands
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Abstract
Pertussis wird durch das gramnegative Bakterium Bordetella pertussis verursacht. Die Krankheitsmanifestationen reichen von unspezifischem Husten bis zu lebensbedrohlichen Verläufen mit Hyperleukozytose und respiratorischer Insuffizienz, v.a. bei jungen Säuglingen. Die Diagnose basiert auf klinischer Symptomatik und mikrobiologischen Nachweisverfahren. Die Therapie besteht aus Makrolidantibiotika; bei Apnoen kann Koffein versucht werden. Die Inzidenz beträgt 10–40 Fälle/100.000 Bevölkerung und Jahr, bei Säuglingen ist sie am höchsten (ca. 50), gefolgt von Jugendlichen (30–35). Mehr als 50 % der in den ersten 5 Lebensmonaten an Pertussis erkrankten Kinder werden hospitalisiert. Die Impfprävention umfasst Grundimmunisierung und regelmäßige Auffrischimpfungen mit azellulären Impfstoffen. Um schwere Verläufe bei jungen Säuglingen zu verhindern, ist die Impfung schwangerer Frauen am erfolgversprechendsten. Säuglinge geimpfter Mütter sollen zeitgerecht ab dem Alter von 2 Monaten für den Eigenschutz immunisiert werden.
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Affiliation(s)
- Ulrich Heininger
- Universitäts-Kinderspital beider Basel, Spitalstr. 33, 4056 Basel, Schweiz.,Medizinische Fakultät, Universität Basel, Basel, Schweiz
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Falleiros-Arlant LH, Torres JR, Lopez E, Avila-Agüero ML, Ulloa-Gutierrez R, Mascareñas A, Brea J. Current regional consensus recommendations on infant vaccination of the Latin American pediatric infectious diseases society (SLIPE). Expert Rev Vaccines 2020; 19:491-498. [PMID: 32580593 DOI: 10.1080/14760584.2020.1775078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The 1st Regional Experts on Infant Vaccination (REIV) meeting generated updated consensus recommendations to improve the control of various major vaccine preventable diseases (VPD) in Latin America. AREAS COVERED Workshops highlighted recent changes in immunization schedules within the region, experience of countries incorporating combined acellular pertussis vaccines schedules and parenteral inactivated polio vaccine (IPV). The need to definitively replace oral polio vaccine (OPV) by IPV, and potential benefits of introducing new combined vaccines, were extensively discussed. EXPERT OPINION REIV strongly advised immediate adoption of either complete IPV schedules for all Latin America or schedules including at least two initial doses of IPV. Use of fractional doses of intradermally administered IPV (fIPV ID) was not recommended due to lower immunogenicity, lack of evidence on long-term protection, and technical difficulty to implement. Routine pertussis vaccination of pregnant women in addition to health workers of neonatology units and any previously unimmunized parent was encouraged. Administration of HBV vaccine to newborns within the first 24 hours of life, and then at 2, 4, and 6 months, and of a booster dose of conjugate Hib vaccine at age 12 through 15 months, was also recommended. Incorporation of combined vaccines (CV) was considered potentially advantageous.
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Affiliation(s)
- Luiza H Falleiros-Arlant
- Departament of Children's Health, Faculdade De Medicina, Universidade Metropolitana De Santos , Santos, Brazil
| | - Jaime R Torres
- Infectious Diseases Section, Tropical Medicine Institute, Universidad Central De Venezuela , Caracas, Venezuela
| | - Eduardo Lopez
- Departamento De Medicina, Hospital De Niños "Dr. Ricardo Gutiérrez" , Buenos Aires, Argentina
| | - Maria L Avila-Agüero
- Servicio De Infectología, Hospital Nacional De Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense De Seguro Social (CCSS) , San José, Costa Rica.,Affiliated Researcher Center for Infectious Disease Modeling and Analysis (CIDMA) at Yale University , New Haven, CT, USA
| | - Rolando Ulloa-Gutierrez
- Servicio De Infectología Pediátrica, Hospital Nacional De Niños "Dr. Carlos Sáenz Herrera", Centro De Ciencias Médicas, Caja Costarricense Del Seguro Social (CCSS) , San José, Costa Rica
| | - Abiel Mascareñas
- Department of Pediatric Infectious Diseases, Hospital Universitario "José E. Gonzalez", Universidad Autónoma De Nuevo Leon , México
| | - Jose Brea
- Pediatrics Department, Centro Médico UCE , Santo Domingo, República Dominicana
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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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45
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Tessier E, Campbell H, Ribeiro S, Fry NK, Brown C, Stowe J, Andrews N, Ramsay M, Amirthalingam G. Impact of extending the timing of maternal pertussis vaccination on hospitalized infant pertussis in England, 2014 - 2018. Clin Infect Dis 2020; 73:e2502-e2508. [PMID: 32569365 PMCID: PMC8563224 DOI: 10.1093/cid/ciaa836] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In October 2012 a maternal pertussis vaccination program was introduced in England for women between 28 and 32 weeks of pregnancy. In April 2016, the recommended optimal window was extended to 20-32 weeks to improve vaccine coverage and protect preterm infants.This study assesses the impact of offering maternal pertussis vaccination earlier in pregnancy on hospitalized infant pertussis cases. METHODS Hospitalized pertussis cases ≤60 days old in England were extracted from Hospital Episode Statistics pre-policy change and post policy change. Data were linked to laboratory-confirmed cases and clinical records were reviewed where cases were not matched. Maternal vaccine status of identified cases was established. Median hospital duration was calculated, and a competing risk survival analysis undertaken to assess multiple factors. RESULTS A total of 201 cases were included in the analysis. Of the 151 cases with reported gestational age, the number of hospitalizations amongst full-term infants was 60 cases pre-policy and 62 cases post policy, respectively while preterm cases declined from 20 to 9 (p=0.06). Length of hospital stay did not differ significantly after the policy change. Significantly longer hospital stays were seen in cases aged 0- 4 weeks (median of 3 more days than infants 5-8 weeks), premature infants (median of 4 more days than term infants) and cases with coinfections (median of 1 more day than those without coinfection). CONCLUSIONS The number of preterm infants hospitalized with pertussis in England halved after the policy change and preterm infants were no longer over-represented amongst hospitalized cases.
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Affiliation(s)
- Elise Tessier
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Norman K Fry
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Colin Brown
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK
| | - Julia Stowe
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
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Chitkara AJ, Pujadas Ferrer M, Forsyth K, Guiso N, Heininger U, Hozbor DF, Muloiwa R, Tan TQ, Thisyakorn U, Wirsing von König CH. Pertussis vaccination in mixed markets: Recommendations from the Global Pertussis Initiative. Int J Infect Dis 2020; 96:482-488. [PMID: 32413606 DOI: 10.1016/j.ijid.2020.04.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/14/2022] Open
Abstract
The Global Pertussis Initiative is an expert scientific forum that publishes consensus recommendations concerning pertussis for many regions of the world. Here, we give recommendations for the primary vaccination of infants in those countries where whole-cell pertussis (wP)- and acellular pertussis (aP)-containing combination vaccines are used in parallel. A selective literature review was performed concerning the influence on safety, immunogenicity, and effectiveness of mixing wP- and aP-containing vaccines for primary immunization of infants. In addition, local data were collected from various countries and the results discussed in a face-to-face meeting. Very few data addressing issues of mixing combination vaccines were identified, and no data were available concerning the effectiveness or duration of protection. It was also found that pharmacovigilance data are scarce or lacking in those countries where they would be needed the most. We then identified frequent problems occurring in low- and middle-income countries (LMICs) where both vaccine types are used. Relying on local knowledge, we give practical recommendations for a variety of situations in different settings. Specific needs for additional data addressing these issues were also identified. International bodies, such as the World Health Organization (WHO), as well as vaccine producers should try to find ways to highlight the problems of mixing wP- and aP-containing combination vaccines with robust data. Countries are urged to improve on their pharmacovigilance for vaccines. For practicing physicians, our recommendations offer guidance when wP- and aP-containing vaccines are used in parallel during primary immunization.
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Affiliation(s)
| | | | | | | | | | - Daniela Flavia Hozbor
- Laboratorio VacSal, Instituto de Biotecnología y Biología Molecular, Universidad Nacional de La Plata y CCT-La Plata, La Plata, Argentina
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Tina Q Tan
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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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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48
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Contardo MV. Vacunación de la embarazada. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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49
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Rasmussen SA, Kancherla V, Conover E. Joint position statement on vaccines from the Society for Birth Defects Research and Prevention and the Organization of Teratology Information Specialists. Birth Defects Res 2020; 112:527-534. [PMID: 32270605 DOI: 10.1002/bdr2.1674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, Florida, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth Conover
- Department of Genetic Medicine, Munroe Meyer Institute, University of Nebraska Medical Center Omaha, Omaha, Nebraska, USA
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50
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Sompagdee N, Anuwutnavin S, Phongsamart W, Senawong S, Umrod P, Robkhonburi A. Seroprevalence of Bordetella pertussis antibodies and anti-pertussis antibody response after a single dose of reduced-antigen combined diphtheria, tetanus, and acellular pertussis vaccine (Tdap) in pregnant Thai women. Vaccine 2020; 38:2725-2733. [PMID: 32070680 DOI: 10.1016/j.vaccine.2020.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal immunization with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) has recently been implemented to prevent infant pertussis. Tdap is still not routinely recommended in Thailand, and there are limited data to support or challenge this strategy. OBJECTIVES The primary aim was to determine the seroprevalence of anti-pertussis toxin antibodies (anti-PT IgG) among pregnant Thai women. The secondary aims were to evaluate antibodies response after Tdap vaccination between seronegative and seropositive mothers and to compare the different antibody titers at delivery among seropositive mothers who received Tdap to those who received tetanus-diphtheria vaccine (Td). METHODS This randomized clinical trial was conducted during April 2018 to April 2019 at Siriraj Hospital, Bangkok, Thailand. A total of 129 pregnant women were included. Paired blood samples for anti-PT IgG levels were obtained during the first antenatal visit and at delivery. A baseline cut-off value of <5 IU/ml indicated seronegativity. There were 29 exclusions from the original 129 enrollment. All seronegative participants (n = 69) received Tdap, while the seropositive group were randomized 1:1 to receive either Tdap (n = 18) or Td (n = 13) during 27-36 weeks' gestation. The antibody levels from both sera were compared between groups. RESULTS The seroprevalence of maternal anti-PT IgG was 33.3% (43/129). There was no significant difference in the increment of antibody levels after Tdap vaccination between the seronegative and seropositive groups (30.2 vs. 42 IU/ml; p = 0.183). Among seropositive groups, all Tdap recipients had increased antibody titers at delivery, while all Td recipients showed waning of immunity throughout gestation. (42 IU/ml vs. -7.4 IU/ml; p < 0.001). CONCLUSION Most pregnant Thai women have seronegative against pertussis. Most seropositive mothers had initial low antibody titers and their immunity significantly decreased before delivery. Our findings highlight the need for universal pertussis immunization in pregnancy regardless of individual baseline immunity.
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Affiliation(s)
- Nalat Sompagdee
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanitra Anuwutnavin
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Wanatpreeya Phongsamart
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sansnee Senawong
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pinklow Umrod
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amporn Robkhonburi
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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