The Effect of Tetanus-Diphtheria-Acellular-Pertussis Immunization During Pregnancy on Infant Antibody Responses: Individual-Participant Data Meta-Analysis

Bahaa Abu-Raya; Bahaa Abu-Raya; Kirsten Maertens; Flor M. Munoz; Petra Zimmermann; Petra Zimmermann; Nigel Curtis; Scott A. Halperin; Nynke Rots; Daan Barug; Beth Holder; Beth Holder; Beate Kampmann; Beate Kampmann; Elke Leuridan; Manish Sadarangani; Manish Sadarangani

doi:10.3389/fimmu.2021.689394

Frontiers in Immunology (Jul 2021)

The Effect of Tetanus-Diphtheria-Acellular-Pertussis Immunization During Pregnancy on Infant Antibody Responses: Individual-Participant Data Meta-Analysis

Bahaa Abu-Raya,
Bahaa Abu-Raya,
Kirsten Maertens,
Flor M. Munoz,
Petra Zimmermann,
Petra Zimmermann,
Nigel Curtis,
Scott A. Halperin,
Nynke Rots,
Daan Barug,
Beth Holder,
Beth Holder,
Beate Kampmann,
Beate Kampmann,
Elke Leuridan,
Manish Sadarangani,
Manish Sadarangani

Affiliations

Bahaa Abu-Raya: Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
Bahaa Abu-Raya: Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
Kirsten Maertens: Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
Flor M. Munoz: Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
Petra Zimmermann: Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
Petra Zimmermann: Department of Pediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
Nigel Curtis: Department of Paediatrics, The University of Melbourne and Infectious Diseases Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, VIC, Australia
Scott A. Halperin: Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology and Immunology, Dalhousie University, Izaak Walton Killam Health Centre, and Nova Scotia Health Authority, Halifax, NS, Canada
Nynke Rots: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
Daan Barug: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
Beth Holder: Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom
Beth Holder: 0Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
Beate Kampmann: 1Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
Beate Kampmann: 2The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
Elke Leuridan: Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
Manish Sadarangani: Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
Manish Sadarangani: Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

DOI: https://doi.org/10.3389/fimmu.2021.689394
Journal volume & issue: Vol. 12

Abstract

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BackgroundImmunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in pregnancy is increasingly recommended. We determined the effect of Tdap immunization in pregnancy on infants’ vaccine responses.MethodsIndividual-participant data meta-analysis of ten studies (n=1884) investigating infants’ antibody response to routine immunizations following Tdap immunization in pregnancy was performed. Geometric mean ratios (GMRs) of antigen-specific immunoglobulin G (IgG) levels were calculated using mixed-effects models. Seroprotection rates were compared using chi-squared tests.ResultsInfants of Tdap-immunized women had significantly lower IgG against pertussis toxin (GMR 0.65; 95%CI 0.57-0.74), filamentous haemagglutinin (FHA) (0.68; 0.53-0.87), pertactin (0.65; 0.58-0.72) and fimbria 2/3 (FIM2/3) (0.41; 0.32-0.52) after primary immunization, compared with infants of unimmunized women. These lower levels persisted after booster immunization for FHA (0.72; 0.61-0.84) and FIM2/3 (0.53; 0.29-0.96). After primary immunization, infants of Tdap-immunized women had lower seroprotection rates against diphtheria (90% [843/973] vs 98% [566/579]; p<0.001) and invasive pneumococcal disease (IPD) caused by 5 Streptococcus pneumoniae (SPN) serotypes (SPN5, SPN6B, SPN9V, SPN19A, SPN23F), and higher seroprotection rates against Haemophilus influenzae type b (short-term and long-term seroprotection rates, 86%[471/547] vs 76%[188/247] and 62%[337/547] vs 49%(121/247), respectively, all p=0.001). After booster immunization, seroprotection rates against diphtheria and tetanus were 99% (286/288) and (618/619) in infants of Tdap-immunized women, respectively.ConclusionsInfants of Tdap-immunized women in pregnancy had lower IgG levels against pertussis, diphtheria and some SPN serotypes after their immunization compared with infants of unimmunized women. Enhanced surveillance of pertussis, diphtheria and IPD in infants is needed to determine the clinical significance of these findings.Systematic Review RegistrationCRD42017079171.

Published in Frontiers in Immunology

ISSN: 1664-3224 (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: http://journal.frontiersin.org/journal/immunology

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