Pneumococcal Immune Response in Infants Whose Mothers Received Tetanus, Diphtheria and Acellular Pertussis Vaccination During Pregnancy

Abstract

Background: Maternal immunization with a tetanus, diphtheria and acellular pertussis (Tdap) vaccine may blunt infant pneumococcal immune responses after a primary series of vaccines. Methods: As part of a prospective controlled cohort trial of Tdap (Boostrix; GSK Biologicals, Rixensart, Belgium) vaccination in pregnancy, infants born to vaccinated mothers and controls were immunized at 8 and 16 weeks and 12 months of age with 13-valent pneumococcal conjugate vaccine (Prevenar13; Pfizer, Wyeth, United States). Sera were tested for pneumococcal antibody concentrations against vaccine serotypes following primary and booster immunization. Results: Geometric mean concentration of antibodies to serotypes 1, 3, 4, 5, 6A, 7F, 9V, 14 and 19A was significantly lower after 2 doses of Prevenar13 vaccine in the offspring of the mothers vaccinated in pregnancy. This blunting effect disappeared after a booster dose at 12 months of age, except for serotypes 1 and 4. Despite this blunting, the percentage of children achieving the threshold of protection of 0.35 µg/mL was comparable in the vaccine and the control group both after primary and booster vaccination with only a significant lower rate of seroprotection in the vaccine group for serotype 3 after primary vaccination. After booster vaccination, seroprotection rates increased further for serotypes 3, 5, 6B, 9V and 23F. Conclusions: The present results indicate a blunting effect after primary vaccination for some serotypes resolving after booster vaccination. Seroprotection rates were comparable both after primary and booster vaccination, except for serotype 3 with a significant lower seroprotection rate in the vaccine group after primary vaccination.

Antibody responses to Bordetella pertussis and other childhood vaccines in infants born to mothers who received pertussis vaccine in pregnancy – a prospective, observational cohort study from the United Kingdom

“…Pertussis vaccination during pregnancy has been associated with reduced infant responses to other vaccines, such as pneumococcal vaccination . We did not observe any differences in the response to Hib vaccination.…”

“… and Maertens et al . observed blunting of multiple pneumococcal serotypes in infants from Tdap‐vaccinated pregnancies. The blunting of pneumococcal responses was largely removed following a booster vaccination at 12 months of age .…”

“… observed blunting of multiple pneumococcal serotypes in infants from Tdap‐vaccinated pregnancies. The blunting of pneumococcal responses was largely removed following a booster vaccination at 12 months of age . The reason for the differences between our findings and these studies is not clear, but could be due to our small sample size; continued monitoring of the impact of pertussis vaccination during pregnancy on infant responses to other vaccines is required.…”

Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement

“…Data on this respect have been inconsistent, with some studies reporting significantly lower anti-diphtheria toxin antibody levels in infants born to Tdap-vaccinated women when compared to infants born to unvaccinated women, while other studies did not report this effect ( 77 , 80 , 83 , 104 , 175 – 177 ). It is also important to note that Tdap immunization in pregnancy, likely due to anti-DT antibodies, is associated with lower anti-pneumococcal capsular polysaccharide levels after immunization with pneumococcal vaccines (PCVs) conjugated to a non-toxic diphtheria toxin mutant (CRM197), although, this did not result in lower seropotection levels for most serotypes ( 175 , 183 ). Surveillance will be key to assess whether this interference has any impact on pneumococcal disease burden.…”

Persistence of pneumococcal antibodies after primary immunisation with a polysaccharide–protein conjugate vaccine

“…Recent studies show that antenatal immunisation with DTPa vaccine leads to significantly lower infant pneumococcal antibodies at 13 months of age 48–50. Since antenatal immunisation is now routinely recommended, this might further decrease pneumococcal seroprotection rates in young children, leaving them exposed to pneumococcal disease after 12 months of age.…”