Munoz Flor M, Beigi Richard, Posavad Christine M, Kelly Clifton, Badell Martina L, Bunge Katherine, Mulligan Mark J, Parameswaran Lalitha, Richardson Barbra A, Olsen-Chen Courtney, Novak Richard M, Brady Rebecca C, DeFranco Emily, Gerber Jeffrey S, Shriver Mallory, Suthar Mehul S, Coler Rhea, Berube Bryan J, Kim So Hee, Piper Jeanna M, Miedema Joy, Pasetti Marcela, Neuzil Kathleen M, Cardemil Cristina V
From the Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital, Pittsburgh, PA.
Pediatr Infect Dis J. 2024 Nov 1;43(11):1065-1073. doi: 10.1097/INF.0000000000004510. Epub 2024 Aug 13.
Following maternal COVID-19 vaccination, the persistence of antibodies in sera and breast milk for mothers and infants is not well characterized. We sought to describe the persistence of antibodies through 2 months after delivery in maternal and infant serum and breast milk following maternal COVID-19 mRNA vaccination and to examine differences by receipt of booster dose during pregnancy or postpartum.
This is a prospective cohort study with enrollment from July 2021 to January 2022 at 9 US academic sites. Pregnant or postpartum participants and their infants were enrolled after COVID-19 mRNA monovalent vaccination during pregnancy (primary 2-dose series) with booster (third dose) vaccination during pregnancy or within 2 months post-partum. SARS-CoV-2-binding and functional antibody responses at delivery and 2 months after delivery in mothers and infants were measured by spike and receptor-binding domain immunoglobulin (Ig) G, pseudovirus and live neutralizing antibody (nAb) titers to ancestral and Omicron BA.1 and BA.5 strains. Breast milk spike and receptor-binding domain IgG and IgA titers were also measured.
A total of 237 maternal/infant dyads were included (110 primary series during pregnancy, 99 pregnancy booster and 28 postpartum booster). A pregnancy booster resulted in 2.2-4.7-fold higher IgG and nAb at delivery and 2 months for both mothers and infants compared to the primary series alone (P < 0.001 for all comparisons). While infant IgG and nAb titers decreased by 2 months of age, the proportion of infants with detectable nAb at 2 months was greater in infants of mothers boosted during pregnancy compared with primary series for all variants (D614G: 99% vs. 56%; BA.1: 56% vs. 4% and BA.5: 57% vs. 9%; P < 0.001 for all comparisons). Breast milk spike IgA and IgG were present in 64%-100% and 100% of participants, respectively, and those boosted during pregnancy or postpartum had 3.1-4.6-fold higher levels of breast milk antibodies at 2 months compared to primary series during pregnancy (P < 0.001).
mRNA COVID-19 monovalent booster vaccination during pregnancy results in significantly higher maternal and infant serum-binding IgG and nAb titers compared to a primary 2-dose series, including against Omicron variants, through 2 months of age. Breast milk antibodies following maternal vaccination during pregnancy or postpartum may provide additional protection during early infancy.
在母亲接种新冠病毒疫苗后，母亲和婴儿血清及母乳中抗体的持久性尚未得到充分描述。我们试图描述母亲接种新冠病毒mRNA疫苗后，母婴血清和母乳中抗体在产后2个月内的持久性，并研究孕期或产后接种加强针后的差异。
这是一项前瞻性队列研究，于2021年7月至2022年1月在美国9个学术地点招募研究对象。怀孕或产后参与者及其婴儿在孕期接种新冠病毒mRNA单价疫苗（初始2剂系列）后，于孕期或产后2个月内接种加强针（第3剂）。通过针对原始毒株和奥密克戎BA.1及BA.5毒株的刺突蛋白和受体结合域免疫球蛋白（Ig）G、假病毒和活病毒中和抗体（nAb）滴度，测量母亲和婴儿在分娩时及分娩后2个月的新冠病毒结合和功能性抗体反应。还测量了母乳中的刺突蛋白和受体结合域IgG及IgA滴度。
共纳入237对母婴（孕期接种初始系列110对，孕期接种加强针99对，产后接种加强针28对）。与仅接种初始系列相比，孕期接种加强针使母亲和婴儿在分娩时及2个月时的IgG和nAb水平提高了2.2至4.7倍（所有比较P<0.001）。虽然婴儿的IgG和nAb滴度在2月龄时下降，但与接种初始系列的母亲所生婴儿相比，孕期接种加强针的母亲所生婴儿在2个月时可检测到nAb的比例在所有变异株中都更高（D614G：99%对56%；BA.1：56%对4%；BA.5：57%对9%；所有比较P<0.001）。64%-100%的参与者母乳中存在刺突蛋白IgA，100%的参与者母乳中存在刺突蛋白IgG，与孕期接种初始系列相比，孕期或产后接种加强针的参与者在2个月时母乳抗体水平高3.1至4.6倍（P<0.001）。
与初始2剂系列相比，孕期接种新冠病毒mRNA单价加强针可使母亲和婴儿血清结合IgG和nAb滴度显著升高，包括针对奥密克戎变异株，直至婴儿2月龄。孕期或产后母亲接种疫苗后母乳中的抗体可能在婴儿早期提供额外保护。
