Abstract
* Abbreviations: aP — : acellular pertussis DTaP — : diphtheria-tetanus-acellular pertussis DTwP — : diphtheria, tetanus, and whole-cell pertussis HIC — : high-income country LMICs — : low- and middle-income countries WHO — : World Health Organization Pertussis is a major public health concern. In 2014, 24 million cases and 160 000 deaths from pertussis in children <5 years were estimated worldwide, with nearly one-third of the cases occurring in Africa.1 Vaccination with an acellular pertussis (aP)–containing vaccine in pregnancy prevents severe pertussis in young infants and has been recommended in an increasing number of high-income countries (HICs). We have recently discussed optimal strategies for vaccination in pregnancy to maximize protection against infections in infancy.2 However, pertussis vaccination in pregnancy reduces infants’ primary immune responses to diphtheria-tetanus-acellular pertussis (DTaP) vaccines, leading to lower antibody levels to some pertussis antigens, when compared with infants of unvaccinated mothers.3 This is termed “interference” and has been shown primarily in studies from HICs that used DTaP formulations for infant immunization, but its clinical implications are unknown. Fewer data are available on the potential interference with diphtheria, tetanus, and whole-cell pertussis (DTwP) vaccines for infant immunization, the vaccines used almost exclusively in low- and middle-income countries (LMICs). An earlier study that we conducted in the United States revealed interference with DTwP vaccines, but not with DTaP vaccines, in infants with higher maternally derived antibody levels before primary vaccination.4 In a recent study conducted in Pakistan, the authors found no correlation between preexisting anti-pertussis antibody levels at delivery and infants’ anti-pertussis antibody levels after primary vaccination with DTwP vaccines.5 However, women in these 2 studies did … Address correspondence to Bahaa Abu-Raya, MD, British Columbia Children’s Hospital Research Institute, The University of British Columbia, 950 W 28th Ave, Vancouver, BC V5Z 4H4, Canada. E-mail: baburaya{at}bcchr.ubc.ca
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