Impact of maternally derived pertussis antibody titers on infant whole-cell pertussis vaccine response in a low income setting

Romesa Ibrahim; S Asad Ali; A Momin Kazi; Arjumand Rizvi; L Beryl Guterman; Robert A Bednarczyk; Ellie Kim; SoHee Park; Simon Paulos; Amilia Jeyachandran; Divya Patel; Yamini Gorantla; Emily Wong; Gowrisankar Rajam; Jarad Schiffer; Saad B Omer

doi:10.1016/j.vaccine.2018.09.045

Impact of maternally derived pertussis antibody titers on infant whole-cell pertussis vaccine response in a low income setting

Vaccine. 2018 Nov 12;36(46):7048-7053. doi: 10.1016/j.vaccine.2018.09.045. Epub 2018 Oct 5.

Authors

Affiliations

¹ Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
² Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan. Electronic address: asad.ali@aku.edu.
³ Department of Global Health, Emory University, Atlanta, Georgia.
⁴ Department of Global Health, Emory University, Atlanta, Georgia; Department of Epidemiology, Emory University, Atlanta, Georgia; Department of Emory Vaccine Center, Emory University, Atlanta, Georgia.
⁵ MPIR Laboratory, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁶ Department of Global Health, Emory University, Atlanta, Georgia; Department of Epidemiology, Emory University, Atlanta, Georgia; Department of Pediatrics, Emory University, Atlanta, Georgia; Department of Emory Vaccine Center, Emory University, Atlanta, Georgia.

Abstract

Background: Maternal vaccines against pertussis are not yet recommended in the developing world. Besides unclear burden estimates, another concern is that transplacental transfer of maternal pertussis antibodies could result in attenuation of the immune response to whole cell pertussis (DTwP) primary vaccination series in infants. This study was taken up to determine whether higher levels of maternal pertussis antibodies attenuate immune response of infants to DTwP vaccination series given at 6-10-14 weeks of age.

Methodology: A total of 261 pregnant women and their infants from four low-income settlements in Karachi, Pakistan were enrolled in this study. The study endpoints were infant antibody titers for Pertussis toxin (PTx), Filamentous hemagglutinin antigen (FHA), Pertactin (PRN) and Fimbriae type 2/3 (FIM) - from birth through 18 weeks of age. Cord blood or pre-vaccine pertussis antibody titers indicate the concentration of maternal antibodies transferred to infants. Linear regression models were used to determine the association between higher maternal antibody titers and infant immune response to DTwP vaccine. Geometric Mean Ratio (GMR) was calculated as the ratio of infant antibody titers at specified time points against the maternal antibody titers at the time of delivery.

Results: At eighteen weeks of age, the adjusted β regression coefficient for PTx was 0.06 (95% CI: -0.49-0.61), FHA 0.02 (95% CI: -0.26 -0.29), PRN 0.02 (95%CI -0.38- 0.43), and FIM 0.17 (95%CI: -0.21-0.54). Among infants who received at least two doses of DTwP vaccine, higher maternal antibody titers did not have any attenuating effect on infant post-immunization antibody titers against all four pertussis antigens.

Conclusion: Maternal pertussis antibodies did not attenuate infant's immune response to pertussis antigens in DTwP primary vaccine given at 6-10-14 weeks of age.

Keywords: DTwP; Immune blunting; Immunogenicity; Maternal vaccination; Pertussis vaccine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Antibodies, Bacterial / blood*
Cohort Studies
Developing Countries
Diphtheria-Tetanus-Pertussis Vaccine / administration & dosage*
Diphtheria-Tetanus-Pertussis Vaccine / immunology*
Female
Humans
Immunity, Maternally-Acquired*
Immunization Schedule
Infant
Infant, Newborn
Male
Pakistan
Pregnancy
Treatment Outcome
Young Adult

Substances

Antibodies, Bacterial
Diphtheria-Tetanus-Pertussis Vaccine