Bridget E Young1, Antti E Seppo1, Nichole Diaz1, Casey Rosen-Carole2, Anna Nowak-Wegrzyn3,4, Joseline M Cruz Vasquez3, Rita Ferri-Huerta1,5, Phuong Nguyen-Contant6, Theresa Fitzgerald6, Mark Y Sangster6, David J Topham6, Kirsi M Järvinen1. 1. Division of Allergy and Immunology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. 2. Division of General Pediatrics and Neonatology, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. 3. Division of Pediatric Allergy and Immunology, Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, New York. 4. Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland. 5. Now with Family Medicine Residency Program, University of Minnesota Medical Center, Minneapolis. 6. David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York.
Abstract
Importance: Long-term effect of parental COVID-19 infection vs vaccination on human milk antibody composition and functional activity remains unclear. Objective: To compare temporal IgA and IgG response in human milk and microneutralization activity against SARS-CoV-2 between lactating parents with infection and vaccinated lactating parents out to 90 days after infection or vaccination. Design, Setting, and Participants: Convenience sampling observational cohort (recruited July to December 2020) of lactating parents with infection with human milk samples collected at days 0 (within 14 days of diagnosis), 3, 7, 10, 28, and 90. The observational cohort included vaccinated lactating parents with human milk collected prevaccination, 18 days after the first dose, and 18 and 90 days after the second dose. Exposures: COVID-19 infection diagnosed by polymerase chain reaction within 14 days of consent or receipt of messenger RNA (mRNA) COVID-19 vaccine (BNT162b2 or mRNA-1273). Main Outcomes and Measures: Human milk anti-SARS-CoV-2 receptor-binding domain IgA and IgG and microneutralization activity against live SARS-CoV-2 virus. Results: Of 77 individuals, 47 (61.0%) were in the infection group (mean [SD] age, 29.9 [4.4] years), and 30 (39.0%) were in the vaccinated group (mean [SD] age, 33.0 [3.4] years; P = .002). The mean (SD) age of infants in the infection and vaccinated group were 3.1 (2.2) months and 7.5 (5.2) months, respectively (P < .001). Infection was associated with a variable human milk IgA and IgG receptor-binding domain-specific antibody response over time that was classified into different temporal patterns: upward trend and level trend (33 of 45 participants [73%]) and low/no response (12 of 45 participants [27%]). Infection was associated with a robust and quick IgA response in human milk that was stable out to 90 days after diagnosis. Vaccination was associated with a more uniform IgG-dominant response with concentrations increasing after each vaccine dose and beginning to decline by 90 days after the second dose. Vaccination was associated with increased human milk IgA after the first dose only (mean [SD] increase, 31.5 [32.6] antibody units). Human milk collected after infection and vaccination exhibited microneutralization activity. Microneutralization activity increased throughout time in the vaccine group only (median [IQR], 2.2 [0] before vaccine vs 10 [4.0] after the first dose; P = .003) but was higher in the infection group (median [IQR], 20 [67] at day 28) vs the vaccination group after the first-dose human milk samples (P = .002). Both IgA and non-IgA (IgG-containing) fractions of human milk from both participants with infection and those who were vaccinated exhibited microneutralization activity against SARS-CoV-2. Conclusions and Relevance: In this cohort study of a convenience sample of lactating parents, the pattern of IgA and IgG antibodies in human milk differed between COVID-19 infection vs mRNA vaccination out to 90 days. While infection was associated with a highly variable IgA-dominant response and vaccination was associated with an IgG-dominant response, both were associated with having human milk that exhibited neutralization activity against live SARS-CoV-2 virus.
Importance: Long-term effect of parental COVID-19 infection vs vaccination on human milk antibody composition and functional activity remains unclear. Objective: To compare temporal IgA and IgG response in human milk and microneutralization activity against SARS-CoV-2 between lactating parents with infection and vaccinated lactating parents out to 90 days after infection or vaccination. Design, Setting, and Participants: Convenience sampling observational cohort (recruited July to December 2020) of lactating parents with infection with human milk samples collected at days 0 (within 14 days of diagnosis), 3, 7, 10, 28, and 90. The observational cohort included vaccinated lactating parents with human milk collected prevaccination, 18 days after the first dose, and 18 and 90 days after the second dose. Exposures: COVID-19 infection diagnosed by polymerase chain reaction within 14 days of consent or receipt of messenger RNA (mRNA) COVID-19 vaccine (BNT162b2 or mRNA-1273). Main Outcomes and Measures: Human milk anti-SARS-CoV-2 receptor-binding domain IgA and IgG and microneutralization activity against live SARS-CoV-2 virus. Results: Of 77 individuals, 47 (61.0%) were in the infection group (mean [SD] age, 29.9 [4.4] years), and 30 (39.0%) were in the vaccinated group (mean [SD] age, 33.0 [3.4] years; P = .002). The mean (SD) age of infants in the infection and vaccinated group were 3.1 (2.2) months and 7.5 (5.2) months, respectively (P < .001). Infection was associated with a variable human milk IgA and IgG receptor-binding domain-specific antibody response over time that was classified into different temporal patterns: upward trend and level trend (33 of 45 participants [73%]) and low/no response (12 of 45 participants [27%]). Infection was associated with a robust and quick IgA response in human milk that was stable out to 90 days after diagnosis. Vaccination was associated with a more uniform IgG-dominant response with concentrations increasing after each vaccine dose and beginning to decline by 90 days after the second dose. Vaccination was associated with increased human milk IgA after the first dose only (mean [SD] increase, 31.5 [32.6] antibody units). Human milk collected after infection and vaccination exhibited microneutralization activity. Microneutralization activity increased throughout time in the vaccine group only (median [IQR], 2.2 [0] before vaccine vs 10 [4.0] after the first dose; P = .003) but was higher in the infection group (median [IQR], 20 [67] at day 28) vs the vaccination group after the first-dose human milk samples (P = .002). Both IgA and non-IgA (IgG-containing) fractions of human milk from both participants with infection and those who were vaccinated exhibited microneutralization activity against SARS-CoV-2. Conclusions and Relevance: In this cohort study of a convenience sample of lactating parents, the pattern of IgA and IgG antibodies in human milk differed between COVID-19 infection vs mRNA vaccination out to 90 days. While infection was associated with a highly variable IgA-dominant response and vaccination was associated with an IgG-dominant response, both were associated with having human milk that exhibited neutralization activity against live SARS-CoV-2 virus.
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Lancet Date: 2007-10-20 Impact factor: 79.321
Authors: Kirsten Maertens; Sara De Schutter; Tessa Braeckman; Lesley Baerts; Pierre Van Damme; Ingrid De Meester; Elke Leuridan Journal: Vaccine Date: 2014-02-13 Impact factor: 3.641
Authors: Ryan M Pace; Janet E Williams; Kirsi M Järvinen; Mandy B Belfort; Christina D W Pace; Kimberly A Lackey; Alexandra C Gogel; Phuong Nguyen-Contant; Preshetha Kanagaiah; Theresa Fitzgerald; Rita Ferri; Bridget Young; Casey Rosen-Carole; Nichole Diaz; Courtney L Meehan; Beatrice Caffé; Mark Y Sangster; David Topham; Mark A McGuire; Antti Seppo; Michelle K McGuire Journal: mBio Date: 2021-02-09 Impact factor: 7.867
Authors: Jeannie C Kelly; Ebony B Carter; Nandini Raghuraman; Lila S Nolan; Qingqing Gong; Angela N Lewis; Misty Good Journal: Am J Obstet Gynecol Date: 2021-03-31 Impact factor: 8.661
Authors: Kathryn J Gray; Evan A Bordt; Caroline Atyeo; Elizabeth Deriso; Babatunde Akinwunmi; Nicola Young; Aranxta Medina Baez; Lydia L Shook; Dana Cvrk; Kaitlyn James; Rose De Guzman; Sara Brigida; Khady Diouf; Ilona Goldfarb; Lisa M Bebell; Lael M Yonker; Alessio Fasano; S Alireza Rabi; Michal A Elovitz; Galit Alter; Andrea G Edlow Journal: Am J Obstet Gynecol Date: 2021-03-26 Impact factor: 8.661
Authors: Elizabeth P Schlaudecker; Mark C Steinhoff; Saad B Omer; Monica M McNeal; Eliza Roy; Shams E Arifeen; Caitlin N Dodd; Rubhana Raqib; Robert F Breiman; K Zaman Journal: PLoS One Date: 2013-08-14 Impact factor: 3.240
Authors: Hannah G Juncker; Sien J Mulleners; Marit J van Gils; Christianne J M de Groot; Dasja Pajkrt; Aniko Korosi; Johannes B van Goudoever; Britt J van Keulen Journal: J Hum Lact Date: 2021-06-27 Impact factor: 2.219
Authors: Erin C Davis; Vanessa P Castagna; David A Sela; Margaret A Hillard; Samantha Lindberg; Nicholas J Mantis; Antti E Seppo; Kirsi M Järvinen Journal: J Allergy Clin Immunol Date: 2022-09 Impact factor: 14.290
Authors: Jiong Wang; Bridget E Young; Dongmei Li; Antti Seppo; Qian Zhou; Alexander Wiltse; Anna Nowak-Wegrzyn; Katherine Murphy; Kaili Widrick; Nicole Diaz; Joseline Cruz-Vasquez; Kirsi M Järvinen; Martin S Zand Journal: Vaccines (Basel) Date: 2022-06-20
Authors: Erika Esteve-Palau; Araceli Gonzalez-Cuevas; M Eugenia Guerrero; Clara Garcia-Terol; M Carmen Alvarez; Geneva Garcia; Encarna Moreno; Francisco Medina; David Casadevall; Vicens Diaz-Brito Journal: Open Forum Infect Dis Date: 2022-05-11 Impact factor: 4.423