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Cardemil CV, Cao Y, Posavad CM, Badell ML, Bunge K, Mulligan MJ, Parameswaran L, Olson-Chen C, Novak RM, Brady RC, DeFranco E, Gerber JS, Pasetti M, Shriver M, Coler R, Berube B, Suthar MS, Moreno A, Gao F, Richardson BA, Beigi R, Brown E, Neuzil KM, Munoz FM. Maternal COVID-19 Vaccination and Prevention of Symptomatic Infection in Infants. Pediatrics 2024; 153:e2023064252. [PMID: 38332733 PMCID: PMC10904887 DOI: 10.1542/peds.2023-064252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Maternal vaccination may prevent infant coronavirus disease 2019 (COVID-19). We aimed to quantify protection against infection from maternally derived vaccine-induced antibodies in the first 6 months of an infant's life. METHODS Infants born to mothers vaccinated during pregnancy with 2 or 3 doses of a messenger RNA COVID-19 vaccine (nonboosted or boosted, respectively) had full-length spike (Spike) immunoglobulin G (IgG), pseudovirus 614D, and live virus D614G, and omicron BA.1 and BA.5 neutralizing antibody (nAb) titers measured at delivery. Infant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was determined by verified maternal-report and laboratory confirmation through prospective follow-up to 6 months of age between December 2021 and July 2022. The risk reduction for infection by dose group and antibody titer level was estimated in separate models. RESULTS Infants of boosted mothers (n = 204) had significantly higher Spike IgG, pseudovirus, and live nAb titers at delivery than infants of nonboosted mothers (n = 271), and were 56% less likely to acquire infection in the first 6 months (P = .03). Irrespective of boost, for each 10-fold increase in Spike IgG titer at delivery, the infant's risk of acquiring infection was reduced by 47% (95% confidence interval 8%-70%; P = .02). Similarly, a 10-fold increase in pseudovirus titers against Wuhan Spike, and live virus nAb titers against D614G, and omicron BA.1 and BA.5 at delivery were associated with a 30%, 46%, 56%, and 60% risk reduction, respectively. CONCLUSIONS Higher transplacental binding and nAb titers substantially reduced the risk of SARS-CoV-2 infection in infants, and a booster dose amplified protection during a period of omicron predominance. Until infants are age-eligible for vaccination, maternal vaccination provides passive protection against symptomatic infection during early infancy.
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Affiliation(s)
- Cristina V. Cardemil
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Yi Cao
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Christine M. Posavad
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Martina L. Badell
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Emory University Hospital Midtown Perinatal Center, Atlanta, Georgia
| | - Katherine Bunge
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women’s Hospital, Pittsburgh, Pennsylvania
| | - Mark J. Mulligan
- New York University Langone Vaccine Center, and Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Lalitha Parameswaran
- New York University Langone Vaccine Center, and Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
| | - Richard M. Novak
- Division of Infectious Diseases, University of Illinois, Chicago, Illinois
| | - Rebecca C. Brady
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily DeFranco
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey S. Gerber
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marcela Pasetti
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mallory Shriver
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rhea Coler
- Seattle Children’s Research Institute, Center for Global Infectious Disease Research, Seattle, Washington
| | - Bryan Berube
- Seattle Children’s Research Institute, Center for Global Infectious Disease Research, Seattle, Washington
| | - Mehul S. Suthar
- Emory Vaccine Center, Emory School of Medicine, Emory University, Atlanta, Georgia
| | - Alberto Moreno
- Emory Vaccine Center, Emory School of Medicine, Emory University, Atlanta, Georgia
| | - Fei Gao
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Barbra A. Richardson
- Departments of Biostatistics and Global Health, University of Washington, Divisions of Vaccine and Infectious Disease and Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Richard Beigi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women’s Hospital, Pittsburgh, Pennsylvania
| | - Elizabeth Brown
- Departments of Biostatistics and Global Health, University of Washington, Divisions of Vaccine and Infectious Disease and Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Kathleen M. Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Flor M. Munoz
- Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, and Texas Children’s Hospital, Houston, Texas
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Munoz FM, Posavad CM, Richardson BA, Badell ML, Bunge KE, Mulligan MJ, Parameswaran L, Kelly CW, Olson-Chen C, Novak RM, Brady RC, Pasetti MF, Defranco EA, Gerber JS, Shriver MC, Suthar MS, Coler RN, Berube BJ, Kim SH, Piper JM, Miller AM, Cardemil CV, Neuzil KM, Beigi RH. COVID-19 booster vaccination during pregnancy enhances maternal binding and neutralizing antibody responses and transplacental antibody transfer to the newborn. Vaccine 2023; 41:5296-5303. [PMID: 37451878 PMCID: PMC10261713 DOI: 10.1016/j.vaccine.2023.06.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/13/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
The immune response to COVID-19 booster vaccinations during pregnancy for mothers and their newborns and the functional response of vaccine-induced antibodies against Omicron variants are not well characterized. We conducted a prospective, multicenter cohort study of participants vaccinated during pregnancy with primary or booster mRNA COVID-19 vaccines from July 2021 to January 2022 at 9 academic sites. We determined SARS-CoV-2 binding and live virus and pseudovirus neutralizing antibody (nAb) titers pre- and post-vaccination, and at delivery for both maternal and infant participants. Immune responses to ancestral and Omicron BA.1 SARS-CoV-2 strains were compared between primary and booster vaccine recipients in maternal sera at delivery and in cord blood, after adjusting for days since last vaccination. A total of 240 participants received either Pfizer or Moderna mRNA vaccine during pregnancy (primary 2-dose series: 167; booster dose: 73). Booster vaccination resulted in significantly higher binding and nAb titers, including to the Omicron BA.1 variant, in maternal serum at delivery and in cord blood compared to a primary 2-dose series (range 0.44-0.88 log10 higher, p < 0.0001 for all comparisons). Live virus nAb to Omicron BA.1 were present at delivery in 9 % (GMT ID50 12.7) of Pfizer and 22 % (GMT ID50 14.7) of Moderna primary series recipients, and in 73 % (GMT ID50 60.2) of mRNA boosted participants (p < 0.0001), although titers were significantly lower than to the D614G strain. Transplacental antibody transfer was efficient for all regimens with median transfer ratio range: 1.55-1.77 for IgG, 1.00-1.78 for live virus nAb and 1.79-2.36 for pseudovirus nAb. COVID-19 mRNA vaccination during pregnancy elicited robust immune responses in mothers and efficient transplacental antibody transfer to the newborn. A booster dose during pregnancy significantly increased maternal and cord blood binding and neutralizing antibody levels, including against Omicron BA.1. Findings support the use of a booster dose of COVID-19 vaccine during pregnancy.
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Affiliation(s)
- Flor M Munoz
- Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, and Texas Children's Hospital, Houston, TX 77030, United States.
| | - Christine M Posavad
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98109, United States.
| | - Barbra A Richardson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98109, United States; Departments of Biostatistics and Global Health, University of Washington, Vaccine and Infectious Disease and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, WA 98109, United States.
| | - Martina L Badell
- Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Emory University Hospital Midtown Perinatal Center, Atlanta, GA 30308, United States.
| | - Katherine E Bunge
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, United States.
| | - Mark J Mulligan
- NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, United States.
| | - Lalitha Parameswaran
- NYU Langone Vaccine Center and Division of Infectious Diseases and Immunology, Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, United States.
| | - Clifton W Kelly
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Center, Seattle, WA 98109, United States.
| | - Courtney Olson-Chen
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY 14642, United States.
| | - Richard M Novak
- Division of Infectious Diseases, University of Illinois, Chicago, IL 60612, United States.
| | - Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States.
| | - Marcela F Pasetti
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Emily A Defranco
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States.
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19146, United States.
| | - Mallory C Shriver
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Mehul S Suthar
- Emory Vaccine Center, Yerkes National Primate Research Center, Department of Microbiology and Immunology, Emory School of Medicine, Emory University, Atlanta, GA 30322, United States.
| | - Rhea N Coler
- Seattle Children's Research Institute, Center for Global Infectious Disease Research, Seattle, WA 98109, United States.
| | - Bryan J Berube
- Seattle Children's Research Institute, Center for Global Infectious Disease Research, Seattle, WA 98109, United States.
| | - So Hee Kim
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Center, Seattle, WA 98109, United States.
| | - Jeanna M Piper
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20850, United States.
| | | | - Cristina V Cardemil
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20850, United States.
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Richard H Beigi
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA 15213, United States.
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Juliá-Burchés C, Martínez-Varea A. An Update on COVID-19 Vaccination and Pregnancy. J Pers Med 2023; 13:jpm13050797. [PMID: 37240967 DOI: 10.3390/jpm13050797] [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: 03/27/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Pregnant women are more prone to experience severe COVID-19 disease, including intensive care unit (ICU) admission, use of invasive ventilation, extracorporeal membrane oxygenation (ECMO), and mortality compared to non-pregnant individuals. Additionally, research suggests that SARS-CoV-2 infection during pregnancy is linked to adverse pregnancy outcomes, such as preterm birth, preeclampsia, and stillbirth, as well as adverse neonatal outcomes, including hospitalization and admission to the neonatal intensive care unit. This review assessed the available literature from November 2021 to 19 March 2023, concerning the safety and effectiveness of COVID-19 vaccination during pregnancy. COVID-19 vaccination administered during pregnancy is not linked to significant adverse events related to the vaccine or negative obstetric, fetal, or neonatal outcomes. Moreover, the vaccine has the same effectiveness in preventing severe COVID-19 disease in pregnant individuals as in the general population. Additionally, COVID-19 vaccination is the safest and most effective method for pregnant women to protect themselves and their newborns from severe COVID-19 disease, hospitalization, and ICU admission. Thus, vaccination should be recommended for pregnant patients. While the immunogenicity of vaccination in pregnancy appears to be similar to that in the general population, more research is needed to determine the optimal timing of vaccination during pregnancy for the benefit of the neonate.
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Affiliation(s)
- Cristina Juliá-Burchés
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
| | - Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
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Munoz FM, Posavad CM, Richardson BA, Badell ML, Bunge K, Mulligan MJ, Parameswaran L, Kelly C, Olsen-Chen C, Novak RM, Brady RC, Pasetti M, DeFranco E, Gerber JS, Shriver M, Suthar MS, Moore K, Coler R, Berube B, Kim SH, Piper JM, Miller A, Cardemil C, Neuzil KM, Beigi R. COVID-19 booster vaccination during pregnancy enhances maternal binding and neutralizing antibody responses and transplacental antibody transfer to the newborn (DMID 21-0004). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.06.13.22276354. [PMID: 35734087 PMCID: PMC9216723 DOI: 10.1101/2022.06.13.22276354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
IMPORTANCE COVID-19 vaccination is recommended during pregnancy for the protection of the mother. Little is known about the immune response to booster vaccinations during pregnancy. OBJECTIVE To measure immune responses to COVID-19 primary and booster mRNA vaccination during pregnancy and transplacental antibody transfer to the newborn. DESIGN Prospective cohort study of pregnant participants enrolled from July 2021 to January 2022, with follow up through and up to 12 months after delivery. SETTING Multicenter study conducted at 9 academic sites. PARTICIPANTS Pregnant participants who received COVID-19 vaccination during pregnancy and their newborns. EXPOSURES Primary or booster COVID-19 mRNA vaccination during pregnancy. MAIN OUTCOMES AND MEASURES SARS-CoV-2 binding and neutralizing antibody (nAb) titers after primary or booster COVID-19 mRNA vaccination during pregnancy and antibody transfer to the newborn. Immune responses were compared between primary and booster vaccine recipients in maternal sera at delivery and in cord blood, after adjusting for days since last vaccination. RESULTS In this interim analysis, 167 participants received a primary 2-dose series and 73 received a booster dose of mRNA vaccine during pregnancy. Booster vaccination resulted in significantly higher binding and nAb titers, including to the Omicron BA.1 variant, in maternal serum at delivery and cord blood compared to a primary 2-dose series (range 0.55 to 0.88 log 10 higher, p<0.0001 for all comparisons). Although levels were significantly lower than to the prototypical D614G variant, nAb to Omicron were present at delivery in 9% (GMT ID50 12.7) of Pfizer and 22% (GMT ID50 14.7) of Moderna recipients, and in 73% (GMT ID50 60.2) of boosted participants (p<0.0001). Transplacental antibody transfer was efficient regardless of vaccination regimen (median transfer ratio range: 1.55-1.77 for binding IgG and 1.00-1.78 for nAb). CONCLUSIONS AND RELEVANCE COVID-19 mRNA vaccination during pregnancy elicited robust immune responses in mothers and efficient transplacental antibody transfer to the newborn. A booster dose during pregnancy significantly increased maternal and cord blood antibody levels, including against Omicron.Findings support continued use of COVID-19 vaccines during pregnancy, including booster doses. TRIAL REGISTRATION clinical trials.gov; Registration Number: NCT05031468 ; https://clinicaltrials.gov/ct2/show/NCT05031468. KEY POINTS Question: What is the immune response after COVID-19 booster vaccination during pregnancy and how does receipt of a booster dose impact transplacental antibody transfer to the newborn?Findings: Receipt of COVID-19 mRNA vaccines during pregnancy elicited robust binding and neutralizing antibody responses in the mother and in the newborn. Booster vaccination during pregnancy elicited significantly higher antibody levels in mothers at delivery and cord blood than 2-dose vaccination, including against the Omicron BA.1 variant.Meaning: COVID-19 vaccines, especially booster doses, should continue to be strongly recommended during pregnancy.
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