Abstract
Pertussis containing vaccine is recommended for pregnant women to protect neonates prior to being fully immunized against the disease. The immune response during pregnancy may be impacted by changes in the hormonal status. The aim of this study was to evaluate the immune response to pertussis immunization in pregnancy and to assess the role of sex hormones. In a cross-sectional study, blood samples were drawn from 174 pregnant and 74 non-pregnant women 45–60 days following immunization. Anti-pertussis toxin (Anti-PT) IgG antibody levels, estrogen, and progestogen concentrations were compared between the two groups. Multiple logistic regression analysis was used to examine the association between serum antibody and sex hormone concentrations in each group, controlling for age, body mass index (BMI), and smoking status. The geometric mean concentration (GMC) of anti-PT IgG antibody was significantly higher in non-pregnant women compared with pregnant women (median of 2.09 and 1.86, interquartile range = 2.36–1.8 and 2.11–1.16 respectively, p < 0.0001). Among pregnant women, the anti-PT IgG antibody GMC was negatively associated with both progesterone (odds ratio = 0.300, 95% CI = 0.116, 0.772, p = 0.013) and estrogen (odds ratio = 0.071, 95% CI = 0.017, 0.292, p < 0.0001), after controlling for age, BMI, and smoking. Pregnancy was associated with lower anti-PT IgG antibody levels (odds ratio = 0.413, 95% CI = −0.190, 0.899, p = 0.026). This appears to be at least partially explained by the higher levels of hormones during pregnancy. These findings demonstrate the important role of sex hormones in the response to pertussis vaccine during pregnancy and can help to evaluate the optimum vaccination schedule.
Highlights
Pertussis is a highly contagious, vaccine-preventable disease caused by Bordetella pertussis (B. pertussis)
Our findings revealed that, compared with non-pregnant women, pregnant women who were vaccinated against pertussis during the third trimester in pregnancy developed significantly lower anti-pertussis toxin (anti-PT) IgG antibody levels
Since serum estrogen and progesterone levels remain high until the end of the third trimester of pregnancy [20,21,22,23] and change only after delivery [24,25], the hormone levels measured immediately before delivery should be representative of the hormone levels at the time of immunization
Summary
Pertussis is a highly contagious, vaccine-preventable disease caused by Bordetella pertussis (B. pertussis). The whole cell vaccine against pertussis, combined with diphtheria and tetanus toxoids, has long been part of the routine immunization schedule for infants and young children. The acellular vaccine is highly effective, it is less effective in preventing the spread of the disease [2]. Pertussis vaccination was included in the National Immunization Program in Israel in 1957 and since 2005, has been given together with tetanus and diphtheria toxoids at two, four, six, and 12 months, at 7–8 years, and 13–14 years [3]. Despite a high vaccination infant coverage rate (>93%) in Israel, there is still a considerable circulation of B. pertussis, among 15–19 year-olds as well as in the older age cohort (>60 years) [4]. Following many years of declining incidence rates, over the past few years there has been a resurgence of pertussis [5,6]
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