Kinetics of the Antibody Response to Tetanus-Diphtheria-Acellular Pertussis Vaccine in Women of Childbearing Age and Postpartum Women

Halperin, Donna; Morris, Anne; MacKinnon‐Cameron, Donna; Mutch, Jill; Langley, Joanne M.; McNeil, Shelly; MacDougall, Donna; Halperin, SA

doi:10.1093/cid/cir538

Cited by 144 publications

(89 citation statements)

References 32 publications

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“…In the US, the Advisory Committee on Immunization Practices first recommended in 2011 that unvaccinated pregnant women receive a dose of Tdap [36]. However, a rapid decline of pertussis antibody levels was observed in adults and postpartum women immunized with Tdap [42,43]. This recommendation was thus updated in October 2012 to extend vaccination to all women during each pregnancy regardless of previous immunization status [44].…”

Section: Pertussismentioning

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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Section: Pertussismentioning

confidence: 99%

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

et al. 2018

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“…Cocooning is rational from an immunologic perspective, as the kinetics of the humoral response after Tdap immunization is rapid, with 88% to 94% of vaccinated individuals developing maximal antibody titers within 2 weeks. 40,41 However, because immunity is not immediate, if vaccination occurs solely during the postpartum period, there will be a short time (#2 weeks postvaccination) when the infant could be at risk for transmission. 40,41 …”

Section: The Cocoon Vaccination Strategymentioning

confidence: 99%

“…40,41 However, because immunity is not immediate, if vaccination occurs solely during the postpartum period, there will be a short time (#2 weeks postvaccination) when the infant could be at risk for transmission. 40,41 …”

Section: The Cocoon Vaccination Strategymentioning

confidence: 99%

Strategies to Decrease Pertussis Transmission to Infants

et al. 2015

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The Global Pertussis Initiative (GPI) is an expert scientific forum addressing the worldwide burden of pertussis, which remains a serious health issue, especially in infants. This age cohort is at risk for developing pertussis by transmission from those in close proximity. Risk is increased in infants aged 0 to 6 weeks, as they are too young to be vaccinated. Older infants are at risk when their vaccination schedules are incomplete. Infants also bear the greatest disease burden owing to their high risk for pertussis-related complications and death; therefore, protecting them is a high priority. Two vaccine strategies have been proposed to protect infants. The first involves vaccinating pregnant women, which directly protects through the passive transfer of pertussis antibodies. The second strategy, cocooning, involves vaccinating parents, caregivers, and other close contacts, which indirectly protects infants from transmission by preventing disease in those in close proximity. The goal of this review was to present and discuss evidence on these 2 strategies. Based on available data, the GPI recommends vaccination during pregnancy as the primary strategy, given its efficacy, safety, and logistic advantages over a cocoon approach. If vaccination during pregnancy is not feasible, then all individuals having close contact with infants ,6 months old should be immunized consistent with local health authority guidelines. These efforts are anticipated to minimize pertussis transmission to vulnerable infants, although real-world effectiveness data are limited. Countries should educate lay and medical communities on pertussis and introduce robust surveillance practices while implementing these protective strategies.

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“…98 Moreover, maximal response to immunization in terms of antibody levels does not occur until 14 days after administration of a booster dose, thus leaving a potentially uncovered time window. 99 Finally, besides mothers, several other family members are also potential sources of infection. 91 In fact, post-partum immunization alone does not seem to be sufficient to reduce pertussis incidence in newborns.…”

Section: Strategies For the Prevention Of Pertussismentioning

confidence: 99%