Antibody responses to Bordetella pertussis and other childhood vaccines in infants born to mothers who received pertussis vaccine in pregnancy-a prospective, observational cohort study from the United Kingdom.

T F Rice,M Bouqueau,F R Van Der Klis,G Vamvakas,G P Smits,B Kampmann,G A M Berbers,P G M Van Gageldonk,B Holder,D A Diavatopoulos,B Donaldson

doi:10.1111/cei.13275

Abstract

SummaryThe maternal Tdap (tetanus, diphtheria and acellular pertussis) vaccination programme in the United Kingdom has successfully reduced cases of pertussis in young infants. In addition to prevention of pertussis cases, it is also important to investigate the persistence of maternal antibodies during infancy and the possible interference of maternal antibodies with infant responses to vaccines. We recruited mother–infant pairs from vaccinated and unvaccinated pregnancies and measured concentrations of immunoglobulin (Ig)G against pertussis toxin (PTx), filamentous haemagglutinin (FHA), pertactin (Prn), diphtheria toxin (DTx), tetanus toxoid (TTx) Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae in mothers and infants at birth, and in infants at 7 weeks and at 5 months. Thirty‐one mother–infant pairs were tested. Tdap‐vaccinated women had significantly higher antibody against Tdap antigens, compared to unvaccinated women (DTx, P = 0·01; PTx, FHA, Prn and TTx, P < 0·001). All antibodies were actively transferred to the infants (transfer ratio > 1) with higher transfer of DTx (P = 0·04) and TTx (P = 0·02) antibody in Tdap‐vaccinated pregnancies compared to unvaccinated pregnancies. Infants from Tdap‐vaccinated pregnancies had significantly elevated antibodies to all antigens at birth (P < 0.001) and at 7 weeks (FHA, Prn, TTx, P < 0·001; DTx, P = 0.01; PTx, P = 0·004) compared to infants from unvaccinated pregnancies. Infants from Tdap‐vaccinated and ‐unvaccinated pregnancies had comparable antibody concentrations following primary pertussis immunization (PTx, P = 0·77; FHA, P = 0·58; Prn, P = 0·60; DTx, P = 0·09; TTx, P = 0·88). These results support maternal immunization as a method of protecting vulnerable infants during their first weeks of life.

Highlights

Pertussis is a highly contagious infection of the upper respiratory tract caused by the bacterium Bordetella pertussis [1]
All antibodies were actively transferred to the infants with higher transfer of diphtheria toxin (DTx) (P = 0·04) and tetanus toxoid (TTx) (P = 0·02) antibody in Tdap-vaccinated pregnancies compared to unvaccinated pregnancies
Antibody responses to Bordetella pertussis not be obtained in the unvaccinated group, as mothers withdrew consent for further sampling

Summary

Introduction

Pertussis is a highly contagious infection of the upper respiratory tract caused by the bacterium Bordetella pertussis [1]. Pertussis affects all age groups, complications and mortality from infection are highest in infants too young to be fully immunized. Following 14 infant deaths in the United Kingdom in 2012, a nationwide pertussis vaccination programme for pregnant women was introduced [3]. The rationale of maternal vaccination is to boost the observed low pertussis antibody levels in the pregnant population [4], thereby increasing levels of antibodies transferred to the fetus in utero. The programme in the United Kingdom is safe [5] and highly effective [6], with the highest proportional reduction in cases and hospital admissions in infants less than 3 months of age [7]. Maternal pertussis vaccination has been introduced by the United States, Australia, South American and other European countries [8,9,10]

Methods

Results

Discussion

Conclusion