An observational, cohort, multi-centre, open label phase IV extension study comparing preschool DTAP-IPV booster vaccine responses in children whose mothers were randomised to one of two pertussis-containing vaccines or received no pertussis-containing vaccine in pregnancy in England

Sapuan, Shari; Andrews, Nick; Hallis, Bassam; Hole, Laura; Jones, Christine E; Matheson, Mary; Miller, Elizabeth; Snape, Matthew D; Heath, Paul T.

doi:10.1016/j.vaccine.2022.10.005

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Data from a meta-analysis of 10 studies has recently shown that anti- B. pertussis IgG concentrations in infants/children after primary and booster vaccination were lower for the pertussis antigens included in aP vaccines [ 118 ]. Other data from a study carried out in England to evaluate the impact of aP (dTaP3-IPV (diphtheria toxoid, tetanus toxoid, three-antigen acellular pertussis, and inactivated polio), compared with dTaP5-IPV (diphtheria toxoid, tetanus toxoid, five-antigen acellular pertussis, and inactivated polio)), administered during pregnancy on the immunity induced after infant immunization with acellular vaccines, showed no difference in the levels of IgGs against pertussis-specific antigens in children prior to receiving the preschool booster at around 3.3 years of age [ 119 ]. The levels of IgGs against the pertussis toxin, however, were significantly lower in vaccinated 3.5-year-olds born to women vaccinated with dTaP3-IPV, as compared to children born to unvaccinated women receiving their vaccination at the same age.…”

Section: Boosters and The Relevance Of Immunization During Pregnancymentioning

confidence: 99%

Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity

et al. 2022

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After the pertussis vaccine had been introduced in the 1940s and was shown to be very successful in reducing the morbidity and mortality associated with the disease, the possibility of improving both vaccine composition and vaccination schedules has become the subject of continuous interest. As a result, we are witnessing a considerable heterogeneity in pertussis vaccination policies, which remains beyond universal consensus. Many pertussis-related deaths still occur in low- and middle-income countries; however, these deaths are attributable to gaps in vaccination coverage and limited access to healthcare in these countries, rather than to the poor efficacy of the first generation of pertussis vaccine consisting in inactivated and detoxified whole cell pathogen (wP). In many, particularly high-income countries, a switch was made in the 1990s to the use of acellular pertussis (aP) vaccine, to reduce the rate of post-vaccination adverse events and thereby achieve a higher percentage of children vaccinated. However the epidemiological data collected over the past few decades, even in those high-income countries, show an increase in pertussis prevalence and morbidity rates, triggering a wide-ranging debate on the causes of pertussis resurgence and the effectiveness of current pertussis prevention strategies, as well as on the efficacy of available pertussis vaccines and immunization schedules. The current article presents a systematic review of scientific reports on the evaluation of the use of whole-cell and acellular pertussis vaccines, in the context of long-term immunity and vaccines efficacy.

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Section: Boosters and The Relevance Of Immunization During Pregnancymentioning

confidence: 99%

Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity

et al. 2022

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“…Specifically, there has been long-standing concern regarding potential immunological blunting, i.e., the interference of maternally transferred antibodies with the infant immune response 18 – 20 . Indeed, several studies and meta-analyses have shown that, after infants received their primary immunization, the antibody concentrations against several pertussis antigens were reduced by 30–60% in infants from vaccinated mothers relative to infants from unvaccinated mothers 21 – 24 . Similarly, the avidity of pertussis antibodies is reduced in infants from vaccinated mothers 25 .…”

Section: Introductionmentioning

confidence: 99%

Maternal pertussis immunization and the blunting of routine vaccine effectiveness: a meta-analysis and modeling study

Briga,

Goult,

Brett

et al. 2024

Nat Commun

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A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38–1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization’s short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.

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“…Specifically, there has been longstanding concern regarding potential immunological blunting, i.e., the interference of maternally transferred antibodies with the infant immune response [18][19][20] . Indeed, several studies and meta-analyses have shown that, after infants received their primary immunization, the antibody concentrations against several pertussis antigens were reduced by 30% to 60% in infants from vaccinated mothers relative to infants from unvaccinated mothers [21][22][23][24] . Similarly, the avidity of pertussis antibodies is reduced in infants from vaccinated mothers 25 .…”

Section: Introductionmentioning

confidence: 99%

Maternal pertussis immunization and the blunting of routine vaccine effectiveness: A meta-analysis and modeling study

Briga¹,

Goult²,

Brett³

et al. 2023

Preprint

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Pertussis, a highly contagious respiratory infection primarily caused by the bacterium Bordetella pertussis, remains a public health priority largely because of the persistently high disease burden in infants too young to be vaccinated. To protect this vulnerable demographic, maternal immunization during pregnancy has been adopted in an increasing number of countries over the last decade. Although this strategy is effective at protecting unvaccinated newborns, it has been demonstrated to cause immunological blunting, whereby maternal antibodies reduce the infant's immune response to pertussis vaccines. However, the clinical and epidemiological consequences of immunological blunting remain unclear. To illuminate these consequences, we first reviewed the epidemiological evidence for the blunting of vaccine effectiveness after primary immunization of infants. Of the four studies identified, all had short-time monitoring (range: 2-6 years), and their results were heterogeneous, with some estimates consistent with blunting. Next, to better interpret this epidemiological evidence, we extended a previously validated model of pertussis transmission by incorporating maternal immunization with varying degrees of blunting, assumed to reduce the vaccine effectiveness in infants born to vaccinated mothers. Our simulations show three results. First, we find evidence for a transient phase lasting at least a decade after the start of maternal immunization, during which the long-term epidemiological impact of blunting is masked. Hence, ignoring these transient dynamics results in an overestimation of the effectiveness of maternal immunization. Second, because of this transient effect, we show that current empirical estimates may be consistent with a modest level of blunting, amounting to a 10-20% reduction in vaccine effectiveness. However, the large between-study heterogeneity and within-study statistical uncertainty preclude a definitive conclusion, urging for more research to infer the degree of blunting, if any. Ultimately, we predict that, regardless of the degree of blunting, maternal immunization remains effective at reducing pertussis in unvaccinated newborns, supporting the continued use of this strategy to protect this vulnerable population. More generally, our results suggest that maternal immunization can result in an infection-control trade-off between age groups, of practical relevance to many other vaccine-preventable diseases.

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An observational, cohort, multi-centre, open label phase IV extension study comparing preschool DTAP-IPV booster vaccine responses in children whose mothers were randomised to one of two pertussis-containing vaccines or received no pertussis-containing vaccine in pregnancy in England

Cited by 5 publications

References 14 publications

Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity

Evaluation of Whole-Cell and Acellular Pertussis Vaccines in the Context of Long-Term Herd Immunity

Maternal pertussis immunization and the blunting of routine vaccine effectiveness: a meta-analysis and modeling study

Maternal pertussis immunization and the blunting of routine vaccine effectiveness: A meta-analysis and modeling study

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