Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, Texas.
Clin Infect Dis. 2013 Feb;56(4):539-44. doi: 10.1093/cid/cis923. Epub 2012 Oct 24.
Pertussis booster vaccine (Tdap) recommendations assume that pertussis-specific antibodies in women immunized preconception, during, or after previous pregnancies persist at sufficient levels to protect newborn infants.
Pertussis-specific immunoglobulin G (IgG) was measured by IgG-specific enzyme-linked immunosorbent assay (ELISA) in maternal-umbilical cord serum pairs where mothers received Tdap during the prior 2 years. Geometric mean concentrations (GMCs) of pertussis antibodies and cord-maternal GMC ratios were calculated.
One hundred five mothers (mean age, 25.3 years [range, 15.3-38.4 years]; mean gestation, 39 weeks [range, 37-43 weeks]) immunized with Tdap vaccine a mean of 13.7 months (range, 2.3-23.9 months) previously were included; 72 (69%) had received Tdap postpartum, 31 at a routine healthcare visit and 2 as contacts of another newborn. There was no difference in GMCs for pertussis-specific IgG in maternal delivery or infant cord sera for women immunized before (n = 86) or during (n = 19) early pregnancy. Placental transport of antibodies was 121%-186% from mothers immunized before and during pregnancy, respectively. Estimated GMC of IgG to pertussis toxin was <5 ELISA units (EU)/mL at infant age 2 months (start of infant immunization series). More infants of mothers immunized during pregnancy had pertussis toxin levels estimated to be higher than the lower limit of quantitation of the assay (4 EU/mL) through age 2 months (52% vs 38%; P = .34).
Infants of mothers immunized preconception or in early pregnancy have insufficient pertussis-specific antibodies to protect against infection. Maternal immunization during the third trimester, immunization of other infant contacts, and reimmunization during subsequent pregnancies may be necessary.
百白破疫苗（Tdap）的接种建议假设，在先前妊娠期间或妊娠后进行过 Tdap 接种的女性体内的百日咳特异性抗体仍保持在足够的水平，从而可以保护新生儿。
通过 IgG 特异性酶联免疫吸附试验（ELISA）测量了母亲-脐血血清对中 Tdap 接种前 2 年内接受 Tdap 接种的母亲的百日咳特异性免疫球蛋白 G（IgG）。计算了百日咳抗体的几何平均浓度（GMC）和脐带-母体 GMC 比值。
共纳入 105 名母亲（平均年龄为 25.3 岁[范围为 15.3-38.4 岁]；平均妊娠 39 周[范围为 37-43 周]），平均在 Tdap 疫苗接种前 13.7 个月（范围为 2.3-23.9 个月）前接受了 Tdap 免疫接种；72 名（69%）母亲在产后接种了 Tdap，31 名是在常规医疗保健就诊时接种的，2 名是因接触另一名新生儿而接种的。对于在妊娠前（n=86）或妊娠期间（n=19）接受 Tdap 免疫接种的母亲的分娩时和婴儿脐带血清中的百日咳特异性 IgG GMC 无差异。分别从妊娠前和妊娠期间接受免疫接种的母亲向胎盘转运的抗体为 121%-186%。在婴儿 2 个月龄时（婴儿免疫接种系列开始时），估计 IgG 对百日咳毒素的平均浓度<5 ELISA 单位（EU）/mL。在 2 个月龄时，更多妊娠期间接受免疫接种的母亲的婴儿的百日咳毒素水平估计高于检测的定量下限（4 EU/mL）（52% vs 38%；P=.34）。
在妊娠前或妊娠早期接受免疫接种的母亲的婴儿体内没有足够的百日咳特异性抗体来预防感染。在妊娠晚期进行母体免疫接种、对其他婴儿接触者进行免疫接种以及在随后的妊娠中进行再次免疫接种可能是必要的。
