Bahaa Abu Raya1, Isaac Srugo2, Aharon Kessel3, Michael Peterman4, David Bader5, Regina Peri3, Nathanealla Ashtamker6, Ron Gonen7, Ellen Bamberger4. 1. Department of Pediatrics, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel. Electronic address: baha_aboraya@yahoo.com. 2. Department of Pediatrics, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Clinical Microbiology Laboratory, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel. 3. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel. 4. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Clinical Microbiology Laboratory, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel. 5. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Department of Neonatology, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel. 6. Department of Nursery, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel. 7. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
Abstract
BACKGROUND: Center for Disease Control and Prevention recommends vaccination of pregnant women with tetanus-diphtheria-acellular pertussis (Tdap). AIM: To measure pertussis specific antibodies, total protein and their ratio in breast milk following gestational Tdap vaccination. METHODS: Women who received Tdap after the 20th week of pregnancy were recruited and unvaccinated women served as controls. Breast milk total protein, immunoglobulin A (IgA) to pertussis toxin (PT), filamentous hemagglutinin (FHA) and immunoglobulin G (IgG) to PT, FHA and pertactin (PRN) were measured. To overcome the dilution that occurs in the transition from colostrum to mature breast milk, we calculated pertussis specific antibody to total protein ratio. RESULTS: Pertussis specific IgA was the predominant pertussis immunoglobulin in the colostrum of Tdap vaccinated women with the geometric mean concentrations (GMCs) of IgA to FHA higher than for IgA to PT, 24.12 ELISA units/milliliter (EU/mL) vs. 8.18EU/mL, respectively, p<0.004. There were differences between the vaccinated women and controls in the GMCs of IgA to FHA and IgG to PRN in the colostrum, 24.12EU/mL vs. 6.52EU/mL, p=0.01 and 2.46EU/mL vs. <0.6EU/mL, p=0.03, respectively. The GMCs of total protein showed significant decline over 8 weeks in the vaccinated women and controls, p<0.004. Among vaccinated women, there was significant decline in the GMCs of IgA to PT and FHA over 8 weeks, p<0.001. The geometric mean ratio of IgA to FHA to total protein also declined significantly over 8 weeks in the vaccinated women, p<0.01, demonstrating a true decrease, however, pertussis IgA was measurable at 8 weeks. CONCLUSIONS: Select colostrum pertussis antibody levels were significantly higher among women vaccinated with Tdap during pregnancy compared with unvaccinated women. Among vaccinated women, maximal levels of pertussis specific IgA were in the colostrum but still detected at 8 weeks. Lactation may augment infant's protection against pertussis.
BACKGROUND: Center for Disease Control and Prevention recommends vaccination of pregnant women with tetanus-diphtheria-acellular pertussis (Tdap). AIM: To measure pertussis specific antibodies, total protein and their ratio in breast milk following gestational Tdap vaccination. METHODS:Women who received Tdap after the 20th week of pregnancy were recruited and unvaccinated women served as controls. Breast milk total protein, immunoglobulin A (IgA) to pertussis toxin (PT), filamentous hemagglutinin (FHA) and immunoglobulin G (IgG) to PT, FHA and pertactin (PRN) were measured. To overcome the dilution that occurs in the transition from colostrum to mature breast milk, we calculated pertussis specific antibody to total protein ratio. RESULTS: Pertussis specific IgA was the predominant pertussis immunoglobulin in the colostrum of Tdap vaccinated women with the geometric mean concentrations (GMCs) of IgA to FHA higher than for IgA to PT, 24.12 ELISA units/milliliter (EU/mL) vs. 8.18EU/mL, respectively, p<0.004. There were differences between the vaccinated women and controls in the GMCs of IgA to FHA and IgG to PRN in the colostrum, 24.12EU/mL vs. 6.52EU/mL, p=0.01 and 2.46EU/mL vs. <0.6EU/mL, p=0.03, respectively. The GMCs of total protein showed significant decline over 8 weeks in the vaccinated women and controls, p<0.004. Among vaccinated women, there was significant decline in the GMCs of IgA to PT and FHA over 8 weeks, p<0.001. The geometric mean ratio of IgA to FHA to total protein also declined significantly over 8 weeks in the vaccinated women, p<0.01, demonstrating a true decrease, however, pertussis IgA was measurable at 8 weeks. CONCLUSIONS: Select colostrum pertussis antibody levels were significantly higher among women vaccinated with Tdap during pregnancy compared with unvaccinated women. Among vaccinated women, maximal levels of pertussis specific IgA were in the colostrum but still detected at 8 weeks. Lactation may augment infant's protection against pertussis.
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Authors: Bahaa Abu-Raya; Kirsten Maertens; Kathryn M Edwards; Saad B Omer; Janet A Englund; Katie L Flanagan; Matthew D Snape; Gayatri Amirthalingam; Elke Leuridan; Pierre Van Damme; Vana Papaevangelou; Odile Launay; Ron Dagan; Magda Campins; Anna Franca Cavaliere; Tiziana Frusca; Sofia Guidi; Miguel O'Ryan; Ulrich Heininger; Tina Tan; Ahmed R Alsuwaidi; Marco A Safadi; Luz M Vilca; Nasamon Wanlapakorn; Shabir A Madhi; Michelle L Giles; Roman Prymula; Shamez Ladhani; Federico Martinón-Torres; Litjen Tan; Lessandra Michelin; Giovanni Scambia; Nicola Principi; Susanna Esposito Journal: Front Immunol Date: 2020-06-24 Impact factor: 7.561