IgA and Neutralizing Antibodies to Influenza A Virus in Human Milk: A Randomized Trial of Antenatal Influenza Immunization

Schlaudecker, Elizabeth P.; Steinhoff, Mark C.; Omer, Saad B.; McNeal, Monica; Roy, Eliza; Arifeen, Shams El; Dodd, Caitlin; Raqib, Rubhana; Breiman, Robert F.; Zaman, Khalequ

doi:10.1371/journal.pone.0070867

Cited by 180 publications

(169 citation statements)

References 27 publications

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“…Several potential mechanisms of protection have been proposed, such as maternal immunization against influenza providing indirect protection of the infant by preventing transmission of influenza virus from the mother to the baby, maternal antibody-mediated protection through transplacental transfer, or maternal antibodymediated protection through breast milk. 10,17,18 Our study suggests that the most likely mechanism of protection of the infants is through the transplacental transfer of maternal antibodies. 10,19,20 The concentration of maternally acquired antibodies decreased rapidly in the infants, and by 16 weeks of age, less than 40% of the infants born to IIV3 recipients had HAI titers of 1:40 or more for any of the vaccine strains, mimicking the reduction in vaccine efficacy.…”

Section: Discussionmentioning

confidence: 74%

Duration of Infant Protection Against Influenza Illness Conferred by Maternal Immunization

et al. 2016

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Influenza immunization of women during pregnancy protects the young infants against influenza illness. The duration of this protection remains unclear.OBJECTIVE To evaluate the duration of infant protection conferred by maternal immunization and its association with transplacental antibody transfer. DESIGN, SETTING, AND PARTICIPANTSInfants born to women who participated in a randomized, double-blind, placebo-controlled clinical trial in 2011 and 2012 on the safety, immunogenicity, and efficacy of trivalent inactivated influenza vaccine (IIV3) during pregnancy were followed up during the first 6 months of life for polymerase chain reaction (PCR)-confirmed influenza illness. In a secondary analysis of a subset of infants, hemagglutination inhibition (HAI) antibodies were measured. The study was performed at a single center in South Africa. The secondary analysis was performed in October 2014. EXPOSURE Maternal immunization for influenza.MAIN OUTCOMES AND MEASURES The vaccine's efficacy against PCR-confirmed influenza illness and the percentage of infants with HAI titers of 1:40 or more by age group. RESULTS There were 1026 infants (47.2% female) born to IIV3 recipients and 1023 infants (47.3% female) born to placebo recipients who were included in the analysis of the vaccine's efficacy. The vaccine's efficacy against PCR-confirmed influenza illness was highest among infants 8 weeks of age or younger at 85.6% (95% CI, 38.3%-98.4%) and decreased with increasing age to 25.5% (95% CI, −67.9% to 67.8%) among infants 8 to 16 weeks of age and to 30.3% (95% CI, −154.9% to 82.6%) among infants 16 to 24 weeks of age. Similarly, in the IIV3 group, the percentage of infants with HAI titers of 1:40 or more to the influenza vaccine strains decreased from more than 56% in the first week of life to less than 40% at 16 weeks of age and less than 10.0% at 24 weeks of age.CONCLUSIONS AND RELEVANCE Maternal immunization conferred protection against infection in the infants for a limited period during early life. The lack of protection beyond 8 weeks of age correlated with a decrease in maternally derived antibodies. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01306669

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Section: Discussionmentioning

confidence: 74%

Duration of Infant Protection Against Influenza Illness Conferred by Maternal Immunization

et al. 2016

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“…In a study of 340 pregnant Bangladeshi women who received either IIV3 or pneumococcal polysaccharide vaccine (control group) during the third trimester of pregnancy, influenza-specific IgG A antibody levels in breast milk were significantly higher for at least 6 months postpartum in women who had received influenza vaccine [34]. Moreover, greater exclusivity of breastfeeding in the first 6 months of life was associated with fewer respiratory illnesses in the infants of the influenza-vaccinated mothers, but not the infants of mothers who received the pneumococcal vaccine.…”

Section: Introductionmentioning

confidence: 99%

Optimizing benefits of influenza virus vaccination during pregnancy: Potential behavioral risk factors and interventions

Christian

2014

Vaccine

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Pregnant women and infants are at high risk for complications, hospitalization, and death due to influenza. It is well-established that influenza vaccination during pregnancy reduces rates and severity of illness in women overall. Maternal vaccination also confers antibody protection to infants via both transplacental transfer and breast milk. However, as in the general population, a relatively high proportion of pregnant women and their infants do not achieve protective antibody levels against influenza virus following maternal vaccination. Behavioral factors, particularly maternal weight and stress exposure, may affect initial maternal antibody responses, maintenance of antibody levels over time (i.e., across pregnancy), as well as the efficiency of transplacental antibody transfer to the fetus. Conversely, behavioral interventions including acute exercise and stress reduction can enhance immune protection following vaccination. Such behavioral interventions are particularly appealing in pregnancy because they are safe and non-invasive. The identification of individual risk factors for poor responses to vaccines and the application of appropriate interventions represent important steps towards personalized health care.

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“…Secreted IgA is an important part of host defence at the mucosal level, notably in the gastrointestinal and respiratory tracts [20]. IgA transferred through breast milk help protect infants against enteric infections and, in infants born to influenza-vaccinated mothers, against respiratory illness with fever for at least 6 months after birth [20,22].…”

Section: The Effect Of Maternal Immunization In Infantsmentioning

confidence: 99%

Maternal immunization: where are we now and how to move forward?

et al. 2018

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Pregnancy and the postpartum period are associated with elevated risks to both mother and infant from infectious disease. Vaccination of pregnant women, also called maternal immunization, has the potential to protect pregnant women, foetuses and infants from several vaccinepreventable diseases. Maternal immunoglobulin G antibodies are actively transferred through the placenta to provide passive immunity to new-borns during the first months of life, until the time for infant vaccinations or until the period of greatest susceptibility has passed. Currently, inactivated influenza, tetanus, and pertussis vaccines are recommended during pregnancy in many countries, but other vaccines may also be administered to pregnant women when risk factors are present. Several new vaccines with a specific indication for use during pregnancy are under development (e.g. respiratory syncytial virus and group B streptococcus vaccines). Years of experience suggest that maternal immunization against influenza, tetanus or pertussis has an acceptable safety profile, is well tolerated, effective and confers significant benefits to pregnant women and their infants. This review describes the principles of maternal immunization and provides an update of the recent evidence regarding the use and timing of maternal immunization. Finally, the barriers preventing wider vaccination coverage and the current limitations in addressing these are also described (Supplementary Material). KEY MESSAGESMaternal immunization gives pregnant women greater protection against infectious diseases; induces high levels of maternal antibodies that can be transferred to the foetus; and helps protect new-borns during their first months of life, until they are old enough to be vaccinated. Pregnant women and new-borns are more vulnerable to infectious diseases than the overall population; nevertheless, vaccination rates are often low in pregnant women. This review provides an update of the recent evidence regarding the use and timing of maternal immunization and describes the barriers preventing wider vaccination uptake and the current limitations in addressing these. ARTICLE HISTORY

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IgA and Neutralizing Antibodies to Influenza A Virus in Human Milk: A Randomized Trial of Antenatal Influenza Immunization

Cited by 180 publications

References 27 publications

Duration of Infant Protection Against Influenza Illness Conferred by Maternal Immunization

Duration of Infant Protection Against Influenza Illness Conferred by Maternal Immunization

Optimizing benefits of influenza virus vaccination during pregnancy: Potential behavioral risk factors and interventions

Maternal immunization: where are we now and how to move forward?

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