COVID-19 mRNA Vaccination in Lactation: Assessment of adverse events and vaccine related antibodies in mother-infant dyads

Golan, Yarden; Prahl, Mary; Cassidy, Arianna G.; Wu, Alan H.B.; Jigmeddagva, Unurzul; Lin, Christine Y.; González, Verónica; Basilio, Emilia; Warrier, Lakshmi; Buarpung, Sirirak; Li, Lin; Murtha, Amy P.; Asiodu, Ifeyinwa V.; Ahituv, Nadav; Flaherman, Valerie J.; Gaw, Stephanie L.

doi:10.1101/2021.03.09.21253241

Cited by 17 publications

(26 citation statements)

References 35 publications

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“…Our detected milk SIgA prevalence is on the lower-end of the interval of milk IgA prevalence (61.8% to >80%) detected by others [16][17][18][19][20] . This discrepancy can probably be ascribed to different experimental procedures.…”

Section: Discussionsupporting

confidence: 51%

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Non-neutralizing secretory IgA and T cells targeting SARS-CoV-2 spike protein are transferred to the breastmilk upon BNT162b2 vaccination

Gonçalves

Charepe

et al. 2021

Preprint

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In view of data scarcity to guide decision-making in breastfeeding women, we evaluated how mRNA vaccines impact immune response of lactating health care workers (HCW) and the effector profile of breast milk transferred immune protection. We show that upon BNT162b2 vaccination, immune transfer via milk to suckling infants occurs through secretory IgA (SIgA) and T cells. Functionally, spike-SIgA was non-neutralizing and its titers were unaffected by vaccine boosting, indicating that spike-SIgA is produced in a T-cell independent manner by mammary gland. Even though their milk was devoid of neutralizing antibodies, we found that lactating women had higher frequencies of RBD-reactive circulating memory B cells and more RBD-IgG antibodies, when compared to controls. Nonetheless, blood neutralization titers in lactating and non-lactating HCW were similar. Further studies are required to determine transferred antibodies and spike-T cells complete functional profile and whether they can mediate protection in the suckling infant.HighlightsMilk and blood responses to BNT162b2 vaccine are initially isotype discordantImmune transfer via milk to suckling infants occurs by spike-reactive SIgA and T cellsSpike-reactive SIgA in the breastmilk is non-neutralizing and T-cell independentLactating vs non-lactating HCW had distinct cellular responses, despite similar NT50

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Section: Discussionsupporting

confidence: 51%

“…Importantly, neutralizing SIgA antibodies elicited through maternal vaccination protect suckling infants from respiratory disease upon transfer via breastmilk 15 . Few recent reports have documented IgA presence in the breastmilk in response to COVID-19 mRNA vaccines [16][17][18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Non-neutralizing secretory IgA and T cells targeting SARS-CoV-2 spike protein are transferred to the breastmilk upon BNT162b2 vaccination

Gonçalves

Charepe

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…This limitation is present not only in studies of mothers who have passed the infection, but also in those in which the breast milk of mothers vaccinated against SARS-CoV-2 has been analysed, and it is also mentioned that additional studies are needed to evaluate the effect of these vaccines on lactation outcomes and infant health because the protection they may provide to the child has not been studied [ 82 , 86 , 87 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19: Relationship and Impact on Breastfeeding—A Systematic Review

2021

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COVID-19 is an infectious disease caused by the SARS-CoV-2 virus that was declared a Public Health Emergency of International Concern by the World Health Organization (WHO). One major problem faced is whether breastfeeding by mothers infected with the virus is safe. The objective of this work is to study the impact that the SARS-CoV-2 virus can have on breastfeeding, and whether the virus or antibodies can be transmitted from mother to child through milk. We carried out a systematic review of studies focusing on the impact of SARS-CoV-2 on breastfeeding by mothers infected with the virus. The bibliographic search was done through Medline (Pubmed), MedlinePlus and Google Scholar. From 292 records, the title and summary of each were examined according to the criteria, and whether they meet the selection criteria was also analysed. A total of 30 articles are included, of which 26 deal with the study of RNA virus in breastmilk and its involvement in breastfeeding and four on the study of SARS-CoV-2 antibodies in milk. Most studies have been conducted in China. Breastfeeding by mothers infected with SARS-CoV-2 is highly recommended for infants, if the health of the mother and the infant allow for it. Direct breastfeeding and maintaining appropriate protective measures should be encouraged. Should the mother’s health condition not permit direct breastfeeding, infants should be fed with pumped breastmilk or donor milk.

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“…The same has been shown for mothers vaccinated with the mRNA vaccine technology, where SARS-CoV-2-specific IgG and IgA antibodies seem to appear in breastmilk soon after the first dose and reach maximum levels about 2 weeks after the second dose (Kelly et al, 2021; Pace et al, 2021; Perl et al, 2021). A number of pre-prints have also shown that even though both IgA and IgG antibodies appear in milk after vaccination, IgG seems to be the prominent isotype reported in the majority of studies but results are still inconclusive (Baird et al, 2021; Bertrand et al, 2021; Esteve-Palau et al, 2021; Fox et al, 2021; Friedman et al, 2021; Golan et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Survival of vaccine-induced human milk SARS-CoV-2 IgG and IgA immunoglobulins across simulated human infant gastrointestinal digestion

Pieri

Nicolaidou

Paphiti

et al. 2021

Preprint

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Four vaccines have been approved to date by the European Medicines Agency for the management of the COVID-19 pandemic in Europe, with all four being targeted to adults over 18 years of age. One way to protect the younger population such as infants or younger children until pediatric vaccines are licensed is through passive immunity via breastfeeding. Recent evidence points to the fact that human milk contains immunoglobulins (Ig) against the SARS-CoV-2 virus, both after natural infection or vaccination, but it is not known whether these antibodies can resist enzymatic degradation during digestion in the infant gastrointestinal (GI) tract or indeed protect the consumers. Here, we describe our preliminary experiments where we validated commercially available ELISA kits to detect IgA and IgG antibodies in human milk from two lactating mothers vaccinated with either the Pfizer/BioNTech or the Astra Zeneca vaccine, and the effect of a static in vitro digestion protocol on the IgA and IgG concentrations. Our data, even preliminary, provide an indication that the IgA antibodies produced after vaccination with the Pfizer/BioNTech vaccine resist the gastric phase but are degraded during the intestinal phase of infant digestion, whereas the IgGs are more prone to degradation in both phases of digestion. We are in the process of recruiting more individuals to further evaluate the vaccine-induced immunoglobulin profile of breastmilk, and the extent to which these antibodies can resist digestion in the infant GI tract.

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COVID-19 mRNA Vaccination in Lactation: Assessment of adverse events and vaccine related antibodies in mother-infant dyads

Cited by 17 publications

References 35 publications

Non-neutralizing secretory IgA and T cells targeting SARS-CoV-2 spike protein are transferred to the breastmilk upon BNT162b2 vaccination

Non-neutralizing secretory IgA and T cells targeting SARS-CoV-2 spike protein are transferred to the breastmilk upon BNT162b2 vaccination

COVID-19: Relationship and Impact on Breastfeeding—A Systematic Review

Survival of vaccine-induced human milk SARS-CoV-2 IgG and IgA immunoglobulins across simulated human infant gastrointestinal digestion

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