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- Title
Maternal Pertussis Immunization and Immunoglobulin G Levels in Early- to Late-Term and Preterm Infants.
- Authors
Immink, Maarten M.; Bekker, Mireille N.; de Melker, Hester E.; den Hartog, Gerco; Rots, Nynke Y.; van Gageldonk, Pieter G. M.; Groenendaal, Floris; Sanders, Elisabeth A. M.; van der Maas, Nicoline A. T.
- Abstract
This cohort study compares maternal-derived anti–pertussis toxin immunoglobulin G (IgG) antibody levels in 2-month-old early- to late-term and preterm infants whose mothers received tetanus, diphtheria, and acellular pertussis vaccination between 20 and 24 weeks' vs 30 and 33 weeks' gestation. Key Points: Question: Is maternal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination between 20 and 24 weeks' gestation noninferior to vaccination between 30 and 33 weeks gestation with respect to maternal-derived anti–pertussis toxin (anti-PT) antibody levels in early- to late-term (≥37 weeks) and preterm (<35 weeks) infants at age 2 months? Findings: In this cohort study of 221 women and 239 offspring, anti-PT antibody levels following maternal Tdap vaccination between 20 and 24 weeks' gestation in 66 early- to late-term infants were significantly lower compared with levels in 55 early- to late-term infants (reference) after maternal vaccination from 30 to 33 weeks' gestation. The anti-PT geometric mean concentration in 73 preterm infants was substantially lower than in the reference group despite a similar median time from maternal vaccination to delivery. Meaning: The findings suggest that maternal Tdap immunization before 24 weeks' gestation is associated with less protection against pertussis among early- to late-term and preterm infants. 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.
- Subjects
NETHERLANDS; MATERNALLY acquired immunity; RESEARCH funding; IMMUNOGLOBULINS; DPT vaccines; LONGITUDINAL method; DURATION of pregnancy; GESTATIONAL age; RESEARCH; CONFIDENCE intervals; CHILDREN; PREGNANCY
- Publication
JAMA Network Open, 2024, Vol 7, Issue 7, pe2424608
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.24608