Maternal Pertussis Immunization and Immunoglobulin G Levels in Early- to Late-Term and Preterm Infants.

Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE

Original Publication: Chicago, IL : American Medical Association, [2018]-

Infant, Premature*/immunology ; Immunoglobulin G*/blood ; Immunoglobulin G*/immunology ; Whooping Cough*/prevention & control ; Whooping Cough*/immunology ; Diphtheria-Tetanus-acellular Pertussis Vaccines*/immunology ; Diphtheria-Tetanus-acellular Pertussis Vaccines*/administration & dosage; Humans ; Female ; Pregnancy ; Adult ; Prospective Studies ; Infant, Newborn ; Netherlands ; Infant ; Gestational Age ; Male ; Immunity, Maternally-Acquired/immunology ; Vaccination

Importance: Maternal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination protects newborns against severe pertussis. Data on transplacental antibody transfer on Tdap vaccination before 24 weeks' gestation remain scarce and are particularly relevant for preterm infants to increase the time interval for maternal antibody transfer.
Objective: To assess noninferiority of anti-pertussis toxin (anti-PT) immunoglobulin G (IgG) antibody levels at age 2 months in early- to late-term infants following Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 30 0/7 and 33 0/7 weeks' gestation and compared with preterm infants.
Design, Setting, and Participants: This prospective, multicenter cohort study included pregnant women aged 18 years or older in birthing centers and hospitals in the Netherlands between August 2019 and November 2021 who received Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation. Women with imminent premature birth were recruited if they had received maternal Tdap vaccination between 20 and 24 weeks' gestation. Blood samples were collected from mothers at delivery, from the umbilical cord, and from infants at age 2 months. Data from infants' blood samples at age 2 months were compared with a reference cohort (recruited between January 2014 and February 2016) of early- to late-term infants of the same age whose mothers had received Tdap vaccination between 30 0/7 and 33 0/7 weeks' gestation.
Exposure: Maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation or 30 0/7 and 33 0/7 weeks' gestation.
Main Outcomes and Measures: The primary outcome was the geometric mean concentration (GMC) of anti-PT IgG antibodies in early- to late-term infants (≥37 0/7 weeks' gestation) at age 2 months, comparing maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' vs 30 0/7 and 33 0/7 weeks' gestation (reference cohort). Anti-PT GMC in 2-month-old infants born preterm (<35 0/7 weeks' gestation) compared with early- to late-term infants after maternal Tdap vaccination between 20 and 24 weeks' gestation was a secondary outcome.
Results: In total, 221 women who delivered 239 offspring were enrolled in the study; 66 early- to late-term infants (median gestational age [GA], 40.6 weeks [IQR, 39.8-41.0 weeks]; 38 [57.6%] male) and 73 preterm infants (median GA, 32.1 weeks [IQR, 29.5-33.0 weeks]; 42 [54.5%] female) had blood samples collected at 2 months of age. Anti-PT GMC was 14.7 IU/mL (95% CI, 10.6-20.4 IU/mL) in early- to late-term infants following maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 27.3 IU/mL (95% CI, 20.1-37.1 IU/mL) in 55 infants in the reference group (median GA, 40.3 [IQR, 39.1-41.0]; 33 [60.0%] female). The mean anti-PT GMC in preterm infants in the study group was 11.2 IU/mL (95% CI, 8.1-15.3 IU/mL) (P = .23 compared with early- to late-term infants).
Conclusions and Relevance: In this cohort study, 2-month-old preterm and early- to late-term infants showed significantly lower anti-PT antibody levels following maternal Tdap vaccination between 20 0/7 and 24 0/7 weeks' gestation compared with 30 0/7 and 33 0/7 weeks' gestation; preterm and early- to late-term infants had similar anti-PT antibody levels, but both groups showed significantly lower antibody levels compared with the reference group. Epidemiological research should investigate whether maternal Tdap vaccination before 24 weeks' gestation provides sufficient protection against clinical pertussis, particularly in preterm infants, as long as no correlate of protection is available.

Front Immunol. 2019 Oct 11;10:2423. (PMID: 31681310)
Front Immunol. 2023 Jul 12;14:1210580. (PMID: 37520565)
Vaccine. 2015 Oct 13;33(42):5490-5491. (PMID: 26071193)
Clin Infect Dis. 2022 Jan 29;74(2):189-198. (PMID: 33971009)
Vaccine. 2021 Feb 12;39(7):1039-1043. (PMID: 33478793)
Vaccine. 2015 Apr 15;33(16):1948-52. (PMID: 25744227)
Clin Infect Dis. 2007 May 15;44(10):1278-9. (PMID: 17443463)
J Infect Dis. 2003 Sep 1;188(5):738-42. (PMID: 12934190)
Vaccine. 2022 Jun 15;40(27):3746-3751. (PMID: 35599039)
Pediatrics. 2017 May;139(5):. (PMID: 28557752)
Vaccines (Basel). 2022 Nov 23;10(12):. (PMID: 36560400)
JAMA. 2018 Oct 9;320(14):1464-1470. (PMID: 30304426)
Clin Infect Dis. 2021 Nov 2;73(9):e2502-e2508. (PMID: 32569365)
Arch Dis Child. 2018 Mar;103(3):224-229. (PMID: 28814424)
Lancet Infect Dis. 2019 Apr;19(4):392-401. (PMID: 30938299)
Front Immunol. 2022 Jun 28;13:913922. (PMID: 35837400)
BMC Infect Dis. 2021 Sep 3;21(1):897. (PMID: 34479491)
Clin Infect Dis. 2023 Feb 8;76(3):e1087-e1093. (PMID: 35642525)
JAMA. 2013 Nov 27;310(20):2191-4. (PMID: 24141714)
Lancet Microbe. 2023 May;4(5):e300-e308. (PMID: 37080224)
Am J Reprod Immunol. 1996 Nov;36(5):248-55. (PMID: 8955500)
Clin Infect Dis. 2016 Apr 1;62(7):829-836. (PMID: 26797213)
BMC Med. 2015 Jun 24;13:146. (PMID: 26103968)
Expert Rev Vaccines. 2020 Jul;19(7):621-638. (PMID: 32772755)
J Immunol Methods. 2008 Jun 1;335(1-2):79-89. (PMID: 18407287)
Vaccine. 2014 Oct 7;32(44):5787-93. (PMID: 25173476)
Am J Obstet Gynecol. 2016 Aug;215(2):237.e1-6. (PMID: 26968625)
Clin Infect Dis. 2017 Apr 15;64(8):1129-1132. (PMID: 28329335)
Vaccine. 1998 Dec;16(20):1901-6. (PMID: 9796041)
Front Immunol. 2017 Sep 15;8:1158. (PMID: 28966622)

Investigator: A Huisjes; K Hollander; J Terwisscha; J Persoons; R Scholten; K Deurloo; S Galjaard; I Schiering

0 (Immunoglobulin G)
0 (Diphtheria-Tetanus-acellular Pertussis Vaccines)

Date Created: 20240730 Date Completed: 20240730 Latest Revision: 20240916

20240916

PMC11289700

10.1001/jamanetworkopen.2024.24608

39078627