Pregnant women unvaccinated against pertussis had infants with higher anti-PT IgG levels at six months
Photo by Spencer Davis / Unsplash
Key Takeaway
Note higher anti-PT IgG in infants of unvaccinated mothers at six months in this trial.
This prospective open-label controlled clinical trial examined the impact of immunization during pregnancy against pertussis on antibody responses in infants and their mothers. The study included 47 pregnant women who received a DTaP vaccine booster and 22 pregnant women who were not vaccinated. Their infants received hexavalent DTaP vaccine. The primary outcome assessed the effect of immunization during pregnancy on the epitopes and avidity of anti-pertussis toxin immunoglobulin G antibodies.
At six months of age, infants in the control group demonstrated higher anti-PT IgG concentrations compared to the vaccinated group. Additionally, higher epitope-specific inhibition targeting 1B7 and 11E6 was noted in the control group infants. The increase in avidity after vaccination was highest in those mothers and infants with lower baseline avidity.
No difference in avidity of anti-PT IgG was observed between the two study groups. The study did not report adverse events, discontinuations, or specific tolerability data. The authors did not provide p-values or confidence intervals for the avidity comparison or the baseline avidity increase finding. This trial suggests that infants of unvaccinated mothers may have higher antibody levels at six months than those exposed to maternal immunization.
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View Original Abstract ↓
BACKGROUND: Immunization during pregnancy (IP) against pertussis protects young infants, but the maternally derived antibodies blunt the quantity of infants' antibody responses to their primary vaccination. While the blunting effect has been well studied for antibody quantity, potential blunting that would affect functional characteristics of these antibodies is less studied. This study evaluated the effect of IP on the epitopes and avidity of anti-pertussis toxin (PT) immunoglobulin G (IgG) antibodies in infants and their mothers.
METHODS: In this prospective open-label controlled clinical trial, 47 pregnant women received diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine booster, and 22 pregnant women who were not vaccinated served as controls. Sixty-nine infants received hexavalent DTaP vaccine at 3 and 5 months of age. The binding strength of anti-PT IgG antibodies and their ability to inhibit epitope-specific binding of mouse monoclonal antibodies were measured with enzyme-linked immunosorbent assays in both maternal and infant samples.
RESULTS: In both study groups, antibodies in cord blood showed higher epitope-specific inhibition and avidity than what was induced in infants after 2 primary vaccine doses, at age 6 months. Higher anti-PT IgG concentrations (P < .001) and epitope-specific inhibition targeting 1B7 (P = .049) and 11E6 (P = .02) were noted at age 6 months in control group infants, suggesting epitope-specific blunting in the IP group. No difference was observed in the avidity of anti-PT IgG at age 6 months between 2 study groups. The increase in avidity after vaccination was the highest in those mothers and infants with lower baseline avidity.
CONCLUSIONS: IP decreased primary vaccination-induced antibody responses disproportionately against different PT epitopes in infants.
CLINICAL TRIALS REGISTRATION: European Union Clinical Trial database (EudraCT no. 2019-001986-34; https://www.clinicaltrialsregister.eu).
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