Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Division of Hematology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Breastfeed Med. 2023 Aug;18(8):612-620. doi: 10.1089/bfm.2023.0106.
Pregnant and lactating women were not included in the initial large vaccine clinical trials for SARS-CoV-2 (COVID) infection. Delineating the antibody titers in serum and breast milk of lactating women is important to determine the safety and benefits of vaccination in this special population. To investigate COVID vaccinations in breastfeeding dyads and effects on lactation, the Antibody Detection of Vaccine-Induced Secretory Effects trial (ADVISE) prospectively evaluated anti-COVID antibodies in serum and breast milk after initial paired and booster vaccines. This is a prospective longitudinal surveillance cohort study of lactating women. Eligibility criteria included ≥18 years of age, currently lactating, and at enrollment either received COVID vaccination within the past 60 days or planning vaccination within 60 days. Among 63 lactating mothers, COVID vaccination led to breast milk secretory IgA (sIgA) and IgG antibodies with consistent viral neutralizing activity. Milk sIgA titers increased further after second vaccination and were prolonged after a third booster dose, including women with extended breastfeeding beyond 12 months. Milk IgG antibody titers were higher and more sustained than sIgA. Antibody titers were not associated with individual dyad characteristics or vaccine manufacturer. Vaccine-induced antibodies from milk were not detected in infant circulation. Maternal COVID vaccination during lactation is well tolerated and generates sustained and boosted antibody responses in breast milk. COVID-specific sIgA and IgG antibodies with neutralizing activity are found in breast milk, including boosted mothers who continue breastfeeding beyond 12 months. These data support universal COVID vaccinations for all lactating mothers, including booster immunizations during extended breastfeeding (NCT04895475).
孕妇和哺乳期妇女未被纳入最初针对严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2，即新冠病毒）感染的大规模疫苗临床试验。明确哺乳期妇女血清和母乳中的抗体滴度对于确定该特殊人群接种疫苗的安全性和获益至关重要。为了研究哺乳期母婴对新冠疫苗的接种情况及其对母乳喂养的影响，“疫苗诱导的分泌效应抗体检测（Antibody Detection of Vaccine-Induced Secretory Effects，ADVISE）”前瞻性评估了初始配对和加强疫苗接种后血清和母乳中的抗新冠抗体。这是一项前瞻性纵向监测队列研究，纳入了哺乳期女性。入选标准包括年龄≥18 岁、正在哺乳期、在入组时要么在过去 60 天内接种了新冠疫苗，要么计划在 60 天内接种疫苗。在 63 名哺乳期母亲中，新冠疫苗接种导致母乳分泌型免疫球蛋白 A（secretory IgA，sIgA）和 IgG 抗体具有一致的病毒中和活性。第二次接种后，母乳 sIgA 滴度进一步增加，第三次加强接种后持续时间更长，包括母乳喂养时间超过 12 个月的女性。母乳 IgG 抗体滴度高于 sIgA，且更持久。抗体滴度与母婴个体特征或疫苗制造商无关。婴儿循环中未检测到来自母乳的疫苗诱导抗体。哺乳期母亲接种新冠疫苗耐受性良好，可在母乳中产生持续且增强的抗体反应。母乳中存在具有中和活性的新冠特异性 sIgA 和 IgG 抗体，包括持续母乳喂养超过 12 个月的增强型母亲。这些数据支持所有哺乳期母亲普遍接种新冠疫苗，包括在延长母乳喂养期间进行加强免疫接种（NCT04895475）。
