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Zimmermann P, Perrett KP, Messina NL, Donath S, Ritz N, van der Klis FR, Curtis N. The Effect of Maternal Immunisation During Pregnancy on Infant Vaccine Responses. EClinicalMedicine 2019; 13:21-30. [PMID: 31517260 PMCID: PMC6733996 DOI: 10.1016/j.eclinm.2019.06.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/01/2019] [Accepted: 06/18/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Immunisation during pregnancy to protect infants against tetanus, pertussis and influenza is recommended in many countries. However, maternal antibodies can interfere with infant vaccine responses. We investigated the effect of antenatal diphtheria-tetanus-acellular pertussis (dTpa) and trivalent inactivated influenza (TIV) immunisation on specific and heterologous antibody responses to routine immunisations given in the first year of life. METHODS In total, 471 healthy infants were included. At 7 and 13 months of age, antibodies to the primary course of routine vaccines given at 6 weeks, 4 and 6 months of age (pertussis (pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN)), polio (type 1, 2, 3), Haemophilus influenzae type b (Hib), pneumococcus (serotype 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F)) were measured, and at 13 months of age, antibodies to the 12-month routine vaccines (Hib, meningococcus C, measles, mumps and rubella). The seroprotection rates for each vaccine and the geometric mean concentrations (GMC) of antibodies were compared between infants whose mothers did or did not receive dTpa or TIV immunisation during pregnancy. RESULTS A total of 369 infants were included in the final analysis. Maternal dTpa immunisation was associated with reduced antibody responses to both specific (diphtheria and pertussis) and heterologous (polio and pneumococcus) vaccine antigens. This effect was stronger for persistence of antibodies at 13 months of age than it was at 7 months of age. At 7 months of age, adjusted average antibody concentrations were significantly lower for diphtheria, pertussis (PT, FHA, PRN) and polio type 2, and at 13 months of age, for diphtheria, pertussis (PT, FHA, PRN), polio type 1-3 and pneumococcal serotypes 1, 4, 5, 6A, 6B, 7F, 18C and 23F. Additionally, at 13 months of age, seroprotection rates for diphtheria, PT, pneumococcal serotype 1, 6A and 6B were significantly lower in infants after maternal dTpa immunisation. In contrast, for Hib, in infants with maternal dTpa immunisation, the adjusted average antibody concentration and the seroprotection rate were higher, particularly at 7 months of age. Maternal TIV immunisation had minimal effect on infant vaccine responses. CONCLUSION Whilst maternal immunisation protects infants in the first few months of life, it might interfere with both specific and heterologous (unrelated) vaccines responses in infants. RESEARCH IN CONTEXT Evidence before this study: Maternal immunisation during pregnancy helps to protect infants during the period before they complete their primary immunisations. It has been proven to be safe and beneficial. However, pre-existing maternal antibodies can influence antibody responses following infant immunisation, an effect called 'blunting'. Previous studies have investigated the influence of dTpa but not influenza immunisation during pregnancy on infant vaccine responses. The majority of studies investigated antibody concentrations only to the specific vaccine antigens included in the maternal immunisation, and there is scarce data available on heterologous vaccine responses, particularly pneumococcal responses.Added value of this study: In this study, we have shown that maternal dTpa immunisation during pregnancy is associated with reduced antibody responses to both specific (diphtheria and pertussis) and heterologous (polio and pneumococcus) vaccine antigens. This effect is stronger for persistence of antibodies at 13 months of age than after primary immunisation at 7 months of age. In contrast, for Hib, in infants with maternal dTpa immunisation, antibody concentrations are higher, particularly at 7 months of age. Maternal TIV immunisation has minimal effect on infant vaccine responses.Implications of all the available evidence: Whilst maternal immunisation protects infants in the first few months of life, it might interfere with both specific and heterologous (unrelated) vaccines responses in infants. As most vaccines induce very high antibody responses, small differences in antibody concentrations may not be of clinical significance. However, since maternal immunisation during pregnancy also influences seroprotection rates, strategies, such as additional booster doses in the second year of life, particularly for pertussis and pneumococcus, might need to be considered to address this.
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Key Words
- Adacel
- Antibodies
- BCG, Bacillus Calmette-Guérin vaccine
- Boostrix
- CI, confidence interval
- FHA, filamentous haemagglutinin
- FIM, fimbriae
- Flu
- GMC, geometric mean antibody concentration
- GMR, geometric mean antibody ratio
- HepB, hepatitis B
- Heterologous
- Hib, Haemophilus influenzae type b
- Humoral
- IPV, inactivated polio vaccine
- IgG, immunoglobulin G
- Immunisation
- Immunoglobulin
- Influenza
- MIS BAIR, Melbourne Infant Study: BCG for Allergy and Infection Reduction
- MMR, measles-mumps-rubella vaccine
- MenC, meningococcus type C
- Non-specific
- PCV13, 13-valent conjugate pneumococcal vaccine
- PRN, pertactin
- PT, pertussis toxin
- TCV, tetanus-containing vaccine
- TIV, trivalent inactivated influenza vaccine
- Titre
- Vaccination
- dTpa
- dTpa, diphtheria-tetanus-acellular pertussis vaccine
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Affiliation(s)
- Petra Zimmermann
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Switzerland
| | - Kirsten P. Perrett
- Food Allergy Research Group and Melbourne Children's Trial Centre, Murdoch Children's Research Institute, Parkville, Australia
- Departments of Allergy and Immunology and General Medicine, Royal Children's Hospital Melbourne, Parkville, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Nicole L. Messina
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Susan Donath
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Nicole Ritz
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
- Infectious Diseases Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Fiona R.M. van der Klis
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia
- Corresponding author at: Department of Paediatrics, The University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia.
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Abstract
Whole-cell pertussis vaccines (WPVs) have been completely replaced by the co-purified acellular vaccines (APVs) in China. To date few laboratory studies were reported for co-purified APVs in terms of their antigenic composition and protective immune responses. To further understand the antigenic composition in co-purified APVs, in the present study 2-dimensional gel electrophoresis-based proteomic technology was used to analyze the composition of co-purified APVs. The results showed that besides the main antigens pertussis toxin (PT) and filamentous hemagglutinin (FHA), co-purified APVs also contained pertactin (PRN), fimbriae (FIM) 2and3 and other minor protein antigens. Of the 9 proteins identified, 3 were differentially presented in products from manufacturer 1 and manufacturer 2. Compared with WPVs and purified APVs, co-purified APVs induced a mixed Th1/Th2 immune response with more toward to a Th1 response than the purified APVs in this study. These results hint that different immune mechanisms might be involved in protection induced by co-purified and purified APVs.
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Key Words
- 2-DE, 2-dimensional gel electrophoresis
- APVs, acellular pertussis vaccines
- BipA, putative outer membrane ligand binding protein
- Co-purified acellular pertussis vaccines
- FHA, filamentous hemagglutinin
- FIM, fimbriae
- PRN, pertactin
- PT, pertussis toxin
- SHD, single human dose
- Sbp, sulfate-binding protein precursor
- WPVs, whole-cell pertussis vaccines
- bvg, Bordetella virulence regulon
- immune responses
- protection
- proteomic analysis
- sphB1, autotransporter subtilisin-like protease
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Affiliation(s)
- Yinghua Xu
- a Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products ; National Institutes for Food and Drug Control ; Beijing , PR China
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Silfverdal SA, Assudani D, Kuriyakose S, Van Der Meeren O. Immunological persistence in 5 y olds previously vaccinated with hexavalent DTPa-HBV-IPV/Hib at 3, 5, and 11 months of age. Hum Vaccin Immunother 2015; 10:2795-8. [PMID: 25483640 PMCID: PMC5443106 DOI: 10.4161/21645515.2014.970494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The combined diphtheria-tetanus-acellular pertussis-hepatitis B-poliomyelitis/Haemophilus influenza vaccine (DTPa-HBV-IPV/Hib: Infanrix™ hexa, GlaxoSmithKline Vaccines) is used for primary vaccination of infants in a range of schedules world-wide. Antibody persistence after 4 DTPa-HBV-IPV/Hib doses in the first 2 y of life has been documented, but long-term persistence data following the 3, 5, 11–12 months (3–5–11) infant vaccination schedule, employed for example in Nordic countries, are limited. We assessed antibody persistence in 57 5-year-old children who had received either DTPa-HBV-IPV/Hib or DTPa-IPV/Hib (Infanrix™-IPV/Hib, GlaxoSmithKline Vaccines) in the 3–5–11 schedule. Among DTPa-HBV-IPV/Hib recipients, 7/12 retained seroprotective antibody concentrations for diphtheria, 10/12 for tetanus, 5/12 for hepatitis and 10/12 for Hib. Detectable antibodies were observed for 0/12 children for pertussis toxin (PT), 12/12 for filamentous haemagglutinin (FHA) and 8/12 for pertactin (PRN). Among DTPa-IPV/Hib recipients, 28/45 retained seroprotective anti-diphtheria concentrations, 34/44 for tetanus and 40/45 for Hib. Detectable antibodies were observed for 9/45 children for PT, 41/45 for FHA and 34/45 for PRN. Antibody persistence in DTPa-HBV-IPV/Hib and DTPa-IPV/Hib-vaccinees appeared similar in 5 y olds to that previously observed in children of a similar age who had received 4 prior doses of DTPa-HBV-IPV/Hib (or DTPa-IPV/Hib). As in subjects primed with 4 prior doses, we observed that antibodies markedly declined by 5 y of age, calling for the administration of a pre-school booster dose in order to ensure continued protection against pertussis.
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Key Words
- CI, confidence interval
- DTPa-HBV-IPV/Hib, - diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus and Haemophilus influenzae type b vaccine
- DTPa-IPV/Hib, diphtheria-tetanus-acellular pertussis-inactivated poliovirus and Haemophilus influenzae type b vaccine
- FHA, filamentous haemagglutinin
- GMC, geometric mean antibody concentration
- HBs, anti-hepatitis B surface antigen
- Hib, Haemophilus influenzae type b
- NA, not applicable
- PRN, pertactin
- PRP, polyribosylribitol phosphate
- PT, pertussis toxin
- antibody persistence
- booster
- vaccination schedule
- vaccine
- μg/ml, micrograms per milliliter
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Affiliation(s)
- Sven A Silfverdal
- a Department of Clinical Sciences; Pediatrics ; Umeå University ; Umeå , Sweden
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Pavia-Ruz N, Abarca K, Lepetic A, Cervantes-Apolinar MY, Hardt K, Jayadeva G, Kuriyakose S, Han HH, de la O M. Evaluation of a new syringe presentation of reduced-antigen content diphtheria, tetanus, and acellular pertussis vaccine in healthy adolescents--A single blind randomized trial. Hum Vaccin Immunother 2015; 11:1770-4. [PMID: 26075317 PMCID: PMC4514261 DOI: 10.1080/21645515.2015.1041697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Reduced-antigen-content diphtheria-tetanus-acellular pertussis (dTpa) vaccine, Boostrix™, is indicated for booster vaccination of children, adolescents and adults. The original prefilled disposable dTpa syringe presentation was recently replaced by another prefilled-syringe presentation with latex-free tip-caps and plunger-stoppers. 671 healthy adolescents aged 10–15 years who had previously received 5 or 6 previous DT(P)/dT(pa) vaccine doses, were randomized (1:1) to receive dTpa booster, injected using the new (dTpa-new) or previous syringe (dTpa-previous) presentations. Immunogenicity was assessed before and 1-month post-booster vaccination; safety/reactogenicity were assessed during 31-days post-vaccination. Non-inferiority of dTpa-new versus dTpa-previous was demonstrated for all antigens (ULs 95% CIs for GMC ratios ranged between 1.03-1.13). 1-month post-booster, immune responses were in similar ranges for all antigens with both syringe presentations. dTpa delivered using either syringe presentation was well-tolerated. These clinical results complement the technical data and support the use of the new syringe presentation to deliver the dTpa vaccine.
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Key Words
- ANCOVA, analysis of co-variance
- ATP, according to protocol
- CI, confidence interval
- El.U, Elisa units
- FHA, filamentous hemagglutinin
- GI, gastrointestinal
- GMC, geometric mean concentration
- IU, international units
- LL, lower limit
- PRN, pertactin
- PT, pertussis toxin
- SAE, serious adverse event
- TVC, total vaccinated cohort
- UL, upper limit
- booster
- dTpa, reduced-antigen-content diphtheria tetanus and acellular pertussis vaccine
- diphtheria
- pertussis
- syringe presentation
- tetanus
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Affiliation(s)
- Noris Pavia-Ruz
- a Universidad Nacional Autónoma de México; , México City , Mexico
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