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Geometric mean antibody titer per antigen and per time point, comparing both groups of women and offspring.
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... vaccination, all women responded to all antigens included in the vaccines. Women in the Tdap group had significantly higher concentrations for all pertussis and tetanus IgGs ( p = 0.001). Significantly higher concentrations were observed for all antigens in the cord blood samples in the Tdap group. At month 2, GMCs to all antigens, except for tetanus, were still significantly higher in the Tdap group. At month 5, the antibody concentrations for tetanus was significantly higher and the antibody concentration for Prn and DT were significantly lower in the Tdap group ( p = 0.006), yet the titers of anti-PT ( p = 0.198) and anti- FHA ( p = 0.753) antibodies did not differ significantly between both groups. Fig. 1 displays the log titer distributions for vaccine antigens in infants in both intervention groups before (Prevac) and one month after the three infant hexavalent vaccine doses (Postvac). The responses to Prn, DT and TT are better and higher in the infants in the TT group. Fig. 2 displays the same data for PT antibodies only, but expressed as the individual correlations of pre- and post- vaccination IgG titers for each infant in both groups. Fig. 3 shows the antibody titers in women and children comparing both groups, at several time points and per antigen. Table 3 displays the transplacental transport rates for all of the antigens. A significant difference ( p < 0.001) was observed between both groups for FHA antibodies. Different rates were measured depending on the antigen, from 1 (tetanus) to 8 (diphtheria). At baseline, there was a negative influence of older age of the mother ( p = 0.02) on the anti-Prn IgG concentrations in the Tdap group. There was also a negative influence of higher parity ( p = 0.02) on the anti-Prn IgG concentrations in the TT group. At delivery, there was a negative influence of older age of the mother ( p = 0.04) on both anti-PT and anti-Prn antibody concentrations in the TT group. In the infants, no significant influences of any of the included variables on GMCs were observed. This is a controlled, prospective, randomized clinical trial in a LMIC that provides new and important data to the international community. In addition, we report on the use of vaccines from different brands for maternal (Sanofi Pasteur) and infant (GSK Bio- logicals) vaccination for the first time. No unexpected adverse events were observed following immunization in the women other than the expected side effects based on the product characteristics (SmPC) of both vaccines [25]. There were no significant differences in safety issues between the Tdap and TT groups. Mild to moderate injection site pain and swelling was observed in 45% of all pregnant participants in the Tdap group after vaccination. This proportion was higher than described in the study conducted by Mu noz ̃ et al., in which 36.4% experienced local adverse events [26] but it lies within the expected rate of reactions based on the Adacel ® SmPC (24.7–65.7%). Safety data in the infants did not reveal unexpected patterns of risk, and no congenital dis- orders were detected. One woman in the TT group had a stillbirth, but this had no obvious causal relationship with the vaccine that was administered 5 weeks before. Our results add to the ...
Context 2
... before (Prevac) and one month after the three infant hexavalent vaccine doses (Postvac). The responses to Prn, DT and TT are better and higher in the infants in the TT group. Fig. 2 displays the same data for PT antibodies only, but expressed as the individual correlations of pre-and post- vaccination IgG titers for each infant in both groups. Fig. 3 shows the antibody titers in women and children comparing both groups, at several time points and per antigen. Table 3 displays the transplacental transport rates for all of the antigens. A significant difference (p < 0.001) was observed between ...
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Citations
... The incidence of pertussis was 84.4 per 100,000 in 1984 and decreased to 0.06-0.11 per 100,000, with 95-108 cases reported, of which more than 50% were infants, in 2012-2013 [6,8]. In 2014, 92 of 102 reported pertussis cases were infants aged less than 6 months [8]. ...
... per 100,000, with 95-108 cases reported, of which more than 50% were infants, in 2012-2013 [6,8]. In 2014, 92 of 102 reported pertussis cases were infants aged less than 6 months [8]. The estimated national incidence increased in 2015 to 0.33 per 100,000 from 0.06-0.12 ...
... In 2015, 2016, 2017, 2018, and 2019, 309, 267, 555, 700, and 1013 cases were reported in Vietnam to the WHO repository, respectively, approximately 40% of which were infants aged less than two months who had not received a series of pertussis vaccines [9,10]. Cases are identified and reported based on a clinical or laboratory diagnosis but are likely to be clinically diagnosed at the community level, as laboratory confirmation is not widely available [8]. Such case-reported surveillance is important for assessing disease burden; however, cases are dominated by young children, and the pattern is strongly influenced by age-specific severity and the risk of hospitalization [4]. ...
The underestimation of the pertussis burden prompted our study to investigate the prevalence of recent pertussis infection, its associated factors, and antibody titer changes in the same individuals in Vietnam. Two cross-sectional surveys were conducted in Nha Trang in 2017 and Quang Ngai in 2019, representing high- and low-vaccine-coverage areas, respectively. Serum anti-pertussis toxin immunoglobulin-G (anti-PT IgG) ≥ 62.5 IU/mL by ELISA indicated infection in the previous 12 months. In Nha Trang, the participants of the 2017 survey were followed up in 2019. Logistic regression was used to determine the odds ratios for the characteristics associated with anti-PT IgG ≥ 62.5. The age-stratified prevalence in patients aged >2 years ranged from 2.1% (age 26–35) to 9.6% (3–5) in Nha Trang (2017) and from 7.2% (age 26–35) to 11.4% (6–15) in Quang Ngai. The prevalence tended to be higher in Quang Ngai across all age groups. Cough, recent antibiotic use, and smoking in Nha Trang were positively associated with an anti-PT IgG of ≥62.5, and having been diagnosed with pertussis and persistent cough with paroxysms/whoop in Quang Ngai were positively associated with an anti-PT IgG of ≥62.5. No nasopharyngeal swabs were positive for Bordetella pertussis using real-time PCR. The geometric mean of the IgG titer ratio from 2019 to 2017 was 1.45 in the paired samples. This study emphasizes Bordetella pertussis circulation across all age groups in both low- and high-vaccine-coverage settings in Vietnam, underscoring the need for continuous and standardized surveillance for a comprehensive understanding of its epidemiology.
... Of the 49 articles that remained for inclusion in the SLR (Fig. 1), 5 publications [26,27,35,36,37] reported effectiveness (Table 1), 18 publications reported immunogenicity (Table 2) [24, 25,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], 24 publications reported safety of Adacel or Adacel-Polio (Table 3) [24, 25,40,46,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72], and 7 publications reported safety of unspecified Tdap (Table 4) [73][74][75][76][77][78][79]. Five of these publications reported both safety and immunogenicity data [24,25,40,46,53].The characteristics of the selected studies and the USPSTF evidence level and evidence quality for each study are presented in Tables 1, 2, 3, 4, 5. ...
... Of the 49 articles that remained for inclusion in the SLR (Fig. 1), 5 publications [26,27,35,36,37] reported effectiveness (Table 1), 18 publications reported immunogenicity (Table 2) [24, 25,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], 24 publications reported safety of Adacel or Adacel-Polio (Table 3) [24, 25,40,46,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72], and 7 publications reported safety of unspecified Tdap (Table 4) [73][74][75][76][77][78][79]. Five of these publications reported both safety and immunogenicity data [24,25,40,46,53].The characteristics of the selected studies and the USPSTF evidence level and evidence quality for each study are presented in Tables 1, 2, 3, 4, 5. ...
... Of the 49 articles that remained for inclusion in the SLR (Fig. 1), 5 publications [26,27,35,36,37] reported effectiveness (Table 1), 18 publications reported immunogenicity (Table 2) [24, 25,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], 24 publications reported safety of Adacel or Adacel-Polio (Table 3) [24, 25,40,46,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72], and 7 publications reported safety of unspecified Tdap (Table 4) [73][74][75][76][77][78][79]. Five of these publications reported both safety and immunogenicity data [24,25,40,46,53].The characteristics of the selected studies and the USPSTF evidence level and evidence quality for each study are presented in Tables 1, 2, 3, 4, 5. ...
Vaccination in pregnancy using a tetanus toxoid, reduced dose diphtheria toxoid, and reduced dose acellular pertussis (Tdap) vaccine is important for prevention of severe pertussis disease in young infants. The objectives of this systematic literature review were to search for original research studies evaluating the vaccine effectiveness, immunogenicity, and safety of Adacel®/Adacel-Polio® used during pregnancy to prevent pertussis disease in young infants. Medical databases used included EMBASE, BIOSIS Previews, and Chemical Abstracts, with search terms related to pregnancy, vaccines/immunization, safety, pertussis, effectiveness/efficacy, and immune response; other potentially eligible reports were included where applicable. Search results were restricted to literature published from 1 January 1995 to 26 July 2021. A total of 2021 articles and 4 other reports were identified for primary review. A total of 49 publications qualified for inclusion after primary and secondary reviews. Effectiveness studies of Adacel or Adacel-Polio given in pregnancy consistently showed high levels of protection from pertussis disease in the newborn (vaccine effectiveness: 91-93%). In immunogenicity studies, the response in pregnant women was consistent with that of non-pregnant women. Infants of mothers vaccinated with Adacel or Adacel-Polio in pregnancy had higher anti-pertussis antibody levels at birth and at 2 months of age compared to infants born to women vaccinated with comparator vaccines, placebo, or those not vaccinated during pregnancy. There was evidence of a slightly decreased response to primary pertussis vaccination in infants of mothers vaccinated with Adacel or Adacel-Polio, but this was not thought to be clinically significant. In safety studies, Adacel or Adacel-Polio vaccination was well tolerated by pregnant woman and not associated with pregnancy, postpartum, or neonatal complications. In conclusion, Adacel or Adacel-Polio vaccination in pregnancy is highly effective in protecting young infants from pertussis disease, with a favorable safety profile for both pregnant women and their infants.
... At the population level, maternal vaccination had significant protective effects both on infants too young to be vaccinated ( ≤ 2 months) and on infants eligible for their 1 st dose of pertussis-containing vaccination ( ≤ 3 months), with higher protective effects in the former group. This notion is also supported by the results of previous clinical trials [62][63][64]. Barug et al. reported a higher geometric mean concentration of pertussis toxin antibodies in 3-monthold infants whose mothers received maternal Tdap compared to that in those whose mothers declined [63]. Even when maternal vaccination failed to prevent infants from contracting pertussis, infants whose mothers received the maternal vaccine had a significantly lower risk of hospitalization. ...
... Maternal VE was high in infants, regardless of the vaccine administered timing. Previous studies reported no increased risks of adverse events among women who received maternal pertussis-containing vaccines and their infants [62][63][64][65]. Together, maximizing pertussis-containing vaccine uptake during pregnancy should be promoted worldwide, particularly in countries with re-emerging pertussis outbreaks. ...
Background
Robust routine immunization schedules for pertussis-containing vaccines have been applied for years, but pertussis outbreaks remain a worldwide problem. This study aimed to investigate the association between vaccine hesitancy and pertussis in infants and children.
Methods
We searched PubMed, Cochrane, Web of Science, Embase, and China National Knowledge Internet for studies published between January 2012 and June 2022. This study included case–control and cohort studies that assessed the association between childhood/maternal vaccine hesitancy and odds ratios (ORs), risk ratios (RRs), and vaccine effectiveness (VE) related to pertussis in infants and children $$\le$$ ≤ 9 years old. ORs/VEs with a 95% confidence interval (CI) were calculated. Random-effects meta-analysis models were used for appropriate pooled estimates, and heterogeneity was assessed using $${I}^{2}$$ I 2 . Cumulative meta-analysis and subgroup analyses stratified by study characteristics were performed.
Results
Twenty-two studies were included, with a mean quality score of 7.0 (range 6.0–9.0). Infants and children with pertussis were associated with higher vaccine hesitancy to all doses (OR = 4.12 [95% CI: 3.09–5.50]). The highest OR was between children who were unvaccinated over four doses and children who were fully vaccinated (OR = 14.26 [95%CI: 7.62–26.70]); childhood vaccine delay was not statistically significantly associated with pertussis risk (OR = 1.18 [95% CI: 0.74–1.89]). Maternal vaccine hesitancy was associated with significantly higher pertussis risk in infants aged 2 and 3 months old, with higher pertussis ORs in infants $$\le$$ ≤ 2 months old (OR = 6.02 [95%CI: 4.31–8.50], OR = 5.14 [95%CI: 1.95–13.52] for infants $$\le$$ ≤ 2 and $$\le$$ ≤ 3 months old, respectively). Maternal and childhood VEs were high in reducing pertussis infection in infants and children. The administration time of maternal vaccination had little effect on VE.
Conclusion
Vaccine hesitancy increased pertussis risks in infants and children. Ensuring that children receive up-to-date pertussis vaccines is essential; short delays in receiving childhood vaccinations may be unimportant. Maternal vaccinations for pertussis should be encouraged.
... Altogether, 6 randomized controlled trials were included in our fnal quantitative analysis [26][27][28][29][30][31]. Healthy pregnant women 18-45 years old who were not at known risk of pregnancy-related complications and had a normal singleton pregnancy were included in all these six studies. ...
... GMCs against pertussis were assessed by performing an ln transformation, Journal of Tropical Medicine to get a more intuitional understanding of the immunogenicity of vaccines. For immunogenicity, our results from the analysis of 6 RCTs suggested that GMCs of anti-PT, anti-FHA, and anti-PRN were higher in the Tdap group than the control group at delivery and before primary vaccination of infants, which is consistent with the included studies [26][27][28][29][30][31]. However, after primary vaccination, anti-PT and anti-PRN did not show statistical diferences between the Tdap group and the control group, and GMCs of anti-FHA were statistically less in the Tdap group than the control group, suggesting that maternal immunization with Tdap resulted in high concentrations of pertussis antibodies in infants during the frst 2 months of life until they get primary vaccinated. ...
... According to the included studies, none of the SAEs in women and their infants were judged to be attributable to the Tdap vaccine, except that four of these pregnancy-related SAEs were assessed as possible vaccine- Journal of Tropical Medicine related (preeclampsia, premature delivery, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) in 1 Td recipient and gestational hypertension in 1 Tdap recipient) [31]. Hoang et al.'s study [28] reported 7 SAEs but did not reveal the distribution of the incidences, so we did not include this in the meta-analysis. Other included studies also reported the incidence of non-SAEs [26,28,30], mainly redness and mild local pain, but they were either without signifcant diferences between the Tdap group and control group or without eligible data for pooled analysis; therefore, we did not perform a meta-analysis about non-SAEs. ...
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.
... However, some reports have shown that Tdap immunization in pregnancy is associated with decreases in humoral immune responses to the subsequent immunization of infants using acellular pertussis antigen-containing vaccines. In particular, lower anti-PT IgG levels were detected in infants born to Tdap-vaccinated pregnant women after the completion of primary immunization, while less consistent results were obtained following booster immunization [114][115][116][117]. Data from a meta-analysis of 10 studies has recently shown that anti-B. ...
After the pertussis vaccine had been introduced in the 1940s and was shown to be very successful in reducing the morbidity and mortality associated with the disease, the possibility of improving both vaccine composition and vaccination schedules has become the subject of continuous interest. As a result, we are witnessing a considerable heterogeneity in pertussis vaccination policies, which remains beyond universal consensus. Many pertussis-related deaths still occur in low- and middle-income countries; however, these deaths are attributable to gaps in vaccination coverage and limited access to healthcare in these countries, rather than to the poor efficacy of the first generation of pertussis vaccine consisting in inactivated and detoxified whole cell pathogen (wP). In many, particularly high-income countries, a switch was made in the 1990s to the use of acellular pertussis (aP) vaccine, to reduce the rate of post-vaccination adverse events and thereby achieve a higher percentage of children vaccinated. However the epidemiological data collected over the past few decades, even in those high-income countries, show an increase in pertussis prevalence and morbidity rates, triggering a wide-ranging debate on the causes of pertussis resurgence and the effectiveness of current pertussis prevention strategies, as well as on the efficacy of available pertussis vaccines and immunization schedules. The current article presents a systematic review of scientific reports on the evaluation of the use of whole-cell and acellular pertussis vaccines, in the context of long-term immunity and vaccines efficacy.
... Vaccination against pertussis in pregnancy is associated with significantly lower anti-B. pertussis IgG concentrations in infants born to vaccinated compared with unvaccinated women after their primary and booster vaccination [17,82,[85][86][87][88][89][90]. Individual participant data meta-analysis of 10 studies (9 performed in high-income countries, 1 performed in a middle-income country) has recently shown lower anti-B. ...
... While some individual studies reported significantly lower anti-DT antibody concentrations in infants born to women vaccinated against pertussis in pregnancy when compared to infants born to unvaccinated women, other studies did not report this effect, which could be due to lack of power to detect such differences [17,82,[85][86][87][88][89]. However, a recent meta-analysis reported significantly lower anti-DT IgG concentrations in infants born to women vaccinated in pregnancy compared with unvaccinated women after the primary vaccine series, before and after booster vaccination with DT-containing vaccines in infancy [91]. ...
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 1st 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.
... Previous studies have shown that the immune response induced post primary series of pertussis vaccination among infants of vaccinated pregnant women is lower compared to infants of unvaccinated mothers and varies among different pertussis antibodies (PT, FHA, and PRN); however, this effect seems to diminish following the booster dose in the second year of age [13,[111][112][113][114]. Remarkably, surveillance data from the United Kingdom did not report any resurgence of pertussis cases in the last months on infancy [115]. ...
Pregnancy is characterized by immunological alterations in pregnant women that permit the growth of a semi-allogenic fetus, resulting in greater susceptibility of childbearing women to infections. Furthermore, due to the immaturity of the immune system of neonates, a protection gap is present in early life, leaving neonates and infants vulnerable to infectious diseases with increased morbidity and mortality. Maternal immunization against influenza, pertussis, and, in the context of the COVID-19 pandemic, SARS-CoV-2 has been implemented in several countries, with beneficial effects on both the mother and the offspring. The main protective mechanism of vaccination during pregnancy is transplacental transfer of maternal antibodies. However, recent evidence has implied that the fetal immune system may be influenced beyond passive immunity. This review sheds light on the current status of the routinely administered vaccinations during pregnancy, focusing on the impact of maternal immunization on the priming of the fetal immune system and suggesting future perspectives for the optimization of vaccination strategies.
... One of the key questions regarding maternal vaccination however, is the clinical significance of the interference of maternally derived antibodies on the infant's own immune response to vaccination, a phenomenon known as blunting [5]. Blunting has been widely observed [5,[7][8][9][10][11]. In a preceding study to this, known as immunising Mums Against Pertussis 2 (iMAP2), which compared the IgG response to pertussis antigens following primary immunisation in infants born to mothers who received pertussis-containing vaccines (BOOSTRIX-IPV Ò or REPE-VAX Ò ), or no pertussis-containing vaccine in pregnancy [12]. ...
... Several studies have looked at the influence of antenatal pertussis vaccination on children's antibody response in the first two years of life, including some that have shown blunting postprimary and post-booster immunisation [5,[7][8][9][10][11]15,16]. We identified one study performed in Belgium that looked beyond the first year of life at age 15 months, which is the age when a pertussiscontaining booster vaccine (Infanrix-hexa Ò ) is given according to the country's routine immunisation programme [17]. ...
An antenatal pertussis vaccination programme was introduced in 2012 in the UK in the context of a national outbreak of pertussis. It has been shown that a lower antibody response to primary immunisation can be seen for certain pertussis antigens in infants born to women who received pertussis-containing antenatal vaccines, a phenomenon known as blunting. The longer-term impact of this has not been documented previously, and accordingly was evaluated in this study.
Children were predominantly recruited from a previous study in which their mothers had received acellular pertussis-containing antenatal vaccines (dTaP3-IPV [diphtheria toxoid, tetanus toxoid, three antigen acellular pertussis and inactivated polio] or dTaP5-IPV [diphtheria toxoid, tetanus toxoid, five antigen acellular pertussis and inactivated polio]), or no pertussis-containing vaccine. Blood samples were obtained prior to and one month after the acellular pertussis-containing preschool booster (dTaP5-IPV) was given at around age 3 years 4 months. Pre- and post-booster immunoglobulin G (IgG) geometric mean concentrations (GMCs) against pertussis toxin, filamentous haemagglutinin, fimbriae 2 & 3, and pertactin, were compared.
Prior to the receipt of the preschool booster, there was no difference in the IgG GMCs against pertussis-specific antigens between children born to women vaccinated with dTaP3-IPV and dTaP5-IPV; however, IgG GMCs against pertussis toxin were significantly lower in children born to women vaccinated with dTaP3-IPV compared with children born to unvaccinated women (geometric mean ratio 0.42 [95 % CI 0.22–0.78], p = 0.03). One month after the receipt of the preschool booster there was no differences between the groups.
The blunting effect of antenatal pertussis vaccine on pertussis responses in children can persist until preschool age, although it is overcome by the administration of a booster dose.
ClinicalTrials.gov registration number: NCT03578120
... This multi-country analysis utilises data from four parent studies conducted in either Belgium, Vietnam or Thailand (9,(12)(13)(14)(15). All parent studies were prospective cohort studies looking at the effect of Tdap vaccination during pregnancy on maternal and infant immune responses. ...
... Pertussis-specific antibody concentrations (Pertussis Toxin (PT), Filamentous Hemagglutinin (FHA), Pertactin (PRN)) in blood taken from infants at birth (cord) were used in this analysis. Full details on recruitment, data collection, inclusion/ exclusion criteria and laboratory testing can be found in the articles published on the parent studies (9,(12)(13)(14)(15). Written informed consent was obtained from all participants in the parent studies. ...
Background
Pertussis vaccination during pregnancy is an effective strategy at reducing pertussis-related morbidity and mortality in infancy and is recommended across several countries. However, the optimal timepoint for vaccination in pregnancy to afford maximal protection to newborns is yet to be elucidated. This multi-country analysis aimed to model the impact of timing of vaccination during pregnancy on infant antibody titers at birth.MethodsA multi-country analysis on a cohort of mother-infant pairs (n=698) vaccinated between 19.6-37.1 weeks gestation was conducted. Data taken from four parent studies on pertussis vaccination during pregnancy were modelled using natural cubic splines and linear mixed models to study the association of both gestational age at vaccination and the interval between vaccination and delivery with pertussis-specific cord blood antibody levels after pertussis vaccination during pregnancy.ResultsTerm born infants on average achieve the highest antibody levels at birth if women are vaccinated before 31 weeks’ gestation. When considering both term and preterm deliveries, an interval of at least 7.5 weeks between vaccination and delivery is required to achieve the highest cord blood antibody levels. The models show that vaccinating earlier than these timeframes will also provide the infant with equally high antibody levels at birth.Conclusions
Vaccinating in the second and early third trimester results in the highest antibody levels at birth. Vaccinating earlier within this window is needed to provide equal benefits to both term and preterm born infants.
... Tdap administration during pregnancy boosts maternal preexisting antibody levels against B. pertussis and increases transplacental transfer to the newborn [3][4][5]. In the context of COVID-19 mitigation measures, countries have seen a profound decrease in clinical detection of B. pertussis infections in populations [6][7][8][9]. ...
Background
Immunization against Bordetella pertussis during pregnancy reduces morbidity from severe pertussis in young infants via trans-placental transfer of anti-B. pertussis Immunoglobulin G (IgG). Studies have reported a near disappearance of respiratory pathogens including B. pertussis following implementation of mitigation strategies to control Coronavirus disease 2019 (COVID-19). We explored how immunity against B. pertussis changed in women of childbearing-age through the COVID-19 pandemic.
Methods
Paired blood samples from females of childbearing-age collected at the beginning (May-June 2020) and nearly one year into the COVID-19 pandemic (February-May 2021) in British Columbia (BC), Canada were tested for anti-B. pertussis IgG levels. To ascertain whether early-pandemic IgG levels in 2020 reflected levels in pregnant women early in gestation, 1st trimester sera collected from age-matched healthy pregnant women in 2018 and 2019 were tested for anti-B. pertussis IgG. Levels were compared by t tests. P-value of 0.05 was assigned and statistical significance was set as p<0.016 using Bonferroni correction.
Results
Annual provincial B. pertussis incidences per 100,000 in BC in 2020 (3/100,000) and 2021 (<1/100,000) approximated the lowest levels since 1990. In 2021 vs. 2020, anti-pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) IgG levels declined in women of childbearing-age: 6.8 IU/ml (95%CI, 4.2-10.9) vs. 8.4 IU/ml (5.1-13.9; p=0.004); 18.8 IU/ml (10.9-32.2) vs. 23.6 IU/ml (13.2-42.1; p<0.001); and 37.1 IU/ml (18.1-75.9) vs. 47.2 IU/ml (24.8-89.9; p=0.092), respectively. Although all values were slightly higher, anti-PT, FHA and PRN IgG levels in women of childbearing age did not significantly differ in 2020 compared with early-gestation pregnant women in 2018-2019, 8.4 IU/ml (95% CI, 5.1-13.9) vs. 5.4 IU/ml (95% CI, 3.8-7.7; p=0.166), 23.6 IU/ml (95% CI, 13.2-42.1) vs. 20.1 IU/ml (95% CI, 13.4-30.2; p=0.656), and 47.2 IU/ml (24.8-89.9) vs. 17.3 IU/ml (95% CI, 10.5-28.7; p=0.021), respectively.
Discussion
B. pertussis infections should be closely monitored during the relaxing of mitigation measures for COVID-19.
