Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization

Lipschuetz, Michal; Guedalia, Joshua; Cohen, S. M.; Sompolinsky, Yishai; Shefer, Galit; Melul, Eli; Ergaz‐Shaltiel, Zivanit; Goldman‐Wohl, Debra; Calderon‐Margalit, Ronit; Beharier, Ofer

doi:10.1038/s41591-023-02270-2

Cited by 14 publications

(15 citation statements)

References 40 publications

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“…A recent study from Israel reported that a third dose (booster) during pregnancy was needed for 46% protection against SARS-CoV-2 hospitalization in infants for up to 4 months. Interestingly, they found that infants of mothers who had 2 doses prior to pregnancy were not protected against SARS-CoV-2 hospitalizations (VE, −16% [95% CI, −56% to −14%]) . Our study corroborated this finding as infants of mothers who received vaccination prior to pregnancy remained at a higher risk of infection (VE, 15.4% [95% CI, −17.6% to 39.1%) compared with infants of mothers who received vaccination during pregnancy (VE, 41.5% [95% CI, 22.8% to 55.7%]).…”

Section: Discussioncontrasting

confidence: 63%

“…Hence, mothers who did not receive vaccination during pregnancy are likely to have a lower level of antibodies compared with those who received vaccination during pregnancy. This may be 1 of the reasons for the observed lack of lower risk for Omicron variant infection in our study and the Israeli study . Worryingly, we found that receipt of the third dose (booster) prior to pregnancy did not overcome this lack of lower risk among infants for SARS-CoV-2 infection (VE, −0.4% [95% CI, −67.5% to 39.8%]).…”

Section: Discussionmentioning

confidence: 99%

“…Higher antibody levels against SARS-CoV-2 have been found in infants whose mothers who were vaccinated during pregnancy . While studies have shown maternal vaccination is associated with lower infant SARS-CoV-2 infection and hospitalization, a better understanding of factors associated with lower risk is needed . Data on the optimum timing for maternal vaccination for infant protection and evidence on effectiveness against the Omicron XBB variant are lacking .…”

Section: Introductionmentioning

confidence: 99%

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mRNA SARS-CoV-2 Vaccination Before vs During Pregnancy and Omicron Infection Among Infants

Goh,

Pang,

Tan

et al. 2023

JAMA Netw Open

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ImportanceInfants younger than 6 months are at risk of severe SARS-CoV-2 infection. Data are lacking on the optimum timing for maternal vaccination and estimated effectiveness against Omicron variants, including XBB, for infants.ObjectiveTo investigate maternal vaccination against Omicron variants, including XBB, and the association of vaccination timing during pregnancy vs prior to pregnancy and risks of SARS-CoV-2 infection among infants aged 6 months or younger.Design, Setting, and ParticipantsThis population-based cohort study was conducted between January 1, 2022, and March 31, 2023. Singapore’s national dataset was used to study infants born at greater than 32 weeks’ gestation between January 1, 2022, and September 30, 2022. The study included infants whose parents had a confirmed SARS-CoV-2 infection from the date of birth up to 6 months of age. Of 21 609 infants born during this period, 7292 (33.7%) had at least 1 parent infected with SARS-CoV-2 before the age of 7 months. Statistical analysis was performed from April to July 2023.ExposureInfants’ mothers were unvaccinated, vaccinated prior to pregnancy, or vaccinated with a messenger RNA (mRNA) SARS-CoV-2 vaccine during pregnancy.Main Outcome and MeasureInfants were considered infected if they had a positive polymerase chain reaction test.ResultsAmong 7292 infants included in this study, 4522 (62.0%) had mothers who were Chinese, 527 (7.2%) had mothers who were Indian, 2007 (27.5%) had mothers who were Malay, and 236 (3.2%) had mothers who were other ethnicity; 6809 infants (93.4%) were born at full term, and 1272 infants (17.4%) were infected during the study period. There were 7120 infants (97.6%) born to mothers who had been fully vaccinated or boosted as of 14 days prior to delivery. The crude incidence rate was 174.3 per 100 000 person-days among infants born to mothers who were unvaccinated, 122.2 per 100 000 person-days among infants born to mothers who were vaccinated before pregnancy, and 128.5 per 100 000 person-days among infants born to mothers who were vaccinated during pregnancy. The estimated vaccine effectiveness (VE) was 41.5% (95% CI, 22.8% to 55.7%) among infants born to mothers vaccinated during pregnancy. Infants of mothers who received vaccination prior to pregnancy did not have a lower risk for infection (estimated VE, 15.4% [95% CI, −17.6% to 39.1%]). A lower risk for Omicron XBB infection was only observed among mothers vaccinated with the third (booster) dose antenatally (estimated VE, 76.7% [95% CI, 12.8% to 93.8%]).Conclusions and RelevanceIn this population-based cohort study, maternal mRNA vaccination was associated with a lower risk of Omicron SARS-CoV-2 infection among infants up to 6 months of age only if the vaccine was given during the antenatal period. These findings suggest that mRNA vaccination during pregnancy may be needed for lower risk of SARS-CoV-2 infection among newborns.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

mRNA SARS-CoV-2 Vaccination Before vs During Pregnancy and Omicron Infection Among Infants

Goh,

Pang,

Tan

et al. 2023

JAMA Netw Open

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“…Patients living with HIV, specifically with low CD4 þ T-cell count or detectable viral load, have higher risk of poor COVID-19 outcomes [40]. Both primary maternal immunization schemes and booster doses with mRNA-based COVID-19 vaccines decrease the risk of severe maternal and neonatal diseases [16,41].…”

Section: Maternal Covid-19 Vaccinationmentioning

confidence: 99%

“…Maternal immunization represents an important and well tolerated strategy for the prevention of both maternal and infant morbidity [14]. Transplacental transfer of vaccinespecific maternal antibodies provide pathogen-specific passive immunity for several months and has already demonstrated its efficacy in the prevention of postnatal severe influenza [15], COVID-19 [16], Bordetella pertussis [17] and RSV infections [18] while results of trials of maternal GBS vaccine trials are currently awaited [19,20].…”

Section: Introductionmentioning

confidence: 99%

Maternal immunization in women living with HIV

Dauby,

Gagneux-Brunon,

Martin

et al. 2023

Aids

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Thanks to widespread use of antiretroviral therapy worldwide, women living with HIV (WLWH) are becoming pregnant and giving birth to HIV-exposed but uninfected (HEU) newborns. Both pregnancy and HIV infection-related factors such as low CD4+ T-cell count or uncontrolled viral load increase the risk of severe infections such as influenza, COVID-19, and others, making maternal immunization a valuable tool to decrease maternal morbidity among WLWH. Vaccines administered during pregnancy may also benefit the health of HEU infants. Indeed, HEU infants suffer from higher risk of morbidity of infectious origin, including respiratory syncytial virus (RSV), group B streptococcus (GBS), pneumococcus and pertussis infections. Maternal pertussis immunization is recommended in various high-income countries but not in many low-middle income countries where HIV prevalence is higher. GBS and RSV vaccines to be administered during pregnancy are currently in late-phase clinical trials in HIV-uninfected women and could represent a valuable tool to decrease morbidity during infancy. Decreased transfer of vaccine-specific IgG, accelerated waning of vaccine-induced antibody responses, linked to persistent maternal immune activation, and blunting of infant immune response to vaccines could hamper vaccine effectiveness among WLWH and HEU infants. Vaccine hesitancy could limit benefits of maternal immunization and strategies to tackle vaccine hesitancy should be part of HIV routine care. The aim of this review is to summarize the current knowledge regarding the immunogenicity and efficacy of available and upcoming vaccines recommended during pregnancy of WLWH.

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New variants of COVID‐19 (XBB.1.5 and XBB.1.16, the “Arcturus”): A review of highly questioned concerns, a brief comparison between different peaks in the COVID‐19 pandemic, with a focused systematic review on expert recommendations for prevention, vaccination, and treatment measures in the general population and at‐risk groups

Pourriyahi,

Hajizadeh,

Khosravi

et al. 2024

Immunity Inflam & Disease

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IntroductionThe COVID‐19 pandemic has taken many forms and continues to evolve, now around the Omicron wave, raising concerns over the globe. With COVID‐19 being declared no longer a “public health emergency of international concern (PHEIC),” the COVID pandemic is still far from over, as new Omicron subvariants of interest and concern have risen since January of 2023. Mainly with the XBB.1.5 and XBB.1.16 subvariants, the pandemic is still very much “alive” and “breathing.”MethodsThis review consists of five highly concerning questions about the current state of the COVID Omicron peak. We searched four main online databases to answer the first four questions. For the last one, we performed a systematic review of the literature, with keywords “Omicron,” “Guidelines,” and “Recommendations.”ResultsA total of 31 articles were included. The main symptoms of the current Omicron wave include a characteristically high fever, coughing, conjunctivitis (with itching eyes), sore throat, runny nose, congestion, fatigue, body ache, and headache. The median incubation period of the symptoms is shorter than the previous peaks. Vaccination against COVID can still be considered effective for the new subvariants.ConclusionGuidelines recommend continuation of personal protective measures, third and fourth dose boosters, along with administration of bivalent messenger RNA vaccine boosters. The consensus antiviral treatment is combination therapy using Nirmatrelvir and Ritonavir, and the consensus for pre‐exposure prophylaxis is Tixagevimab and Cilgavimab combination. We hope the present paper raises awareness for the continuing presence of COVID and ways to lower the risks, especially for at‐risk groups.

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Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization

Cited by 14 publications

References 40 publications

mRNA SARS-CoV-2 Vaccination Before vs During Pregnancy and Omicron Infection Among Infants

mRNA SARS-CoV-2 Vaccination Before vs During Pregnancy and Omicron Infection Among Infants

Maternal immunization in women living with HIV

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