Antibody responses after primary immunization in infants born to women receiving a Pertussis-containing vaccine during pregnancy: Single arm observational study with a historical comparator

Ladhani, Shamez N., Andrews, Nick J., Southern, Jo, Jones, Christine E. and Waight, Pauline A. , et al. (2015) Antibody responses after primary immunization in infants born to women receiving a Pertussis-containing vaccine during pregnancy: Single arm observational study with a historical comparator. Clinical Infectious Diseases, 61 (11), 1637-1644. (doi:10.1093/cid/civ695).

Abstract

Introduction: In England, antenatal pertussis immunization using a tetanus/low-dose diphtheria/5-component acellular-pertussis/inactivated-polio (TdaP5/IPV) vaccine was introduced in October 2012. We assessed infant responses to antigens in the maternal vaccine and to those conjugated to tetanus (TT) or the diphtheria toxin variant, CRM.
Methods: Infants of 141 TdaP5/IPV-vaccinated mothers in Southern England immunized with DTaP5/IPV/Haemophilus influenzae b (Hib-TT) vaccine at 2-3-4 months, 13-valent pneumococcal vaccine (PCV13, CRM-conjugated) at 2-4 months and 1 or 2 meningococcal C vaccine (MCC-CRM- or MCC-TT) doses at 3-4 months had blood samples taken at 2 and/or 5 months of age. Results. Antibody responses to pertussis toxin (PT), filamentous hemagglutinin (FHA), fimbriae 2 + 3 (FIMs), diphtheria, tetanus, Hib, MCC and PCV13 serotypes were compared to responses in a historical cohort of 246 infants born to mothers not vaccinated in pregnancy. Infants had high pertussis antibody concentrations pre-immunization but only PT antibodies increased post-immunization (fold-change, 2.64; 95% confidence interval [CI], 2.12-3.30; P <. 001), whereas FHA antibodies fell (fold-change, 0.56; 95% CI,. 48-.65; P <. 001). Compared with infants of unvaccinated mothers, PT, FHA, and FIMs antibodies were lower post-vaccination, with fold-differences of 0.67 (0.58-0.77; P <. 001), 0.62 (0.54-0.71; P <. 001) and 0.51 (0.42-0.62; P <. 001), respectively. Antibodies to diphtheria and some CRM-conjugated antigens were also lower, although most infants achieved protective thresholds; antibodies to tetanus and Hib were higher. Conclusions. Antenatal pertussis immunization results in high infant pre-immunization antibody concentrations, but blunts subsequent responses to pertussis vaccine and some CRM-conjugated antigens. In countries with no pertussis booster until school age, continued monitoring of protection against pertussis is essential.

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Contributors

Author: Christine E. Jones

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