Seroprevalence of Bordetella pertussis Antibodies in Mothers and their Newborn Infants

Abstract

BACKGROUND: Pertussis is a highly communicable, vaccine-preventable respiratory disease. Although the largest number of reported cases is among young infants, the most rapidly increasing incidence in the USA is in adolescents and young adults. Importantly, adult family members are the likely major reservoir, infecting susceptible infants before completion of childhood vaccination. We studied maternal-neonatal paired blood samples for the presence of pertussis-related antibodies to assess level of immunity and passive transplacental antibody passage. METHODS. Unselected maternal-neonatal cord blood samples were collected from 101 term deliveries in a single urban uninsured/underinsured hospital setting. Sera were analyzed for anti-pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) IgG antibodies by enzyme-linked immunosorbent assay (ELISA). Antibody titers were calculated using reference line methodology. Antibody values were log-transformed to establish geometric mean titers (GMT) for analysis. Student's t-test, Mann-Whitney, Pearson correlation and chi square were used for statistical comparisons as appropriate. RESULTS. Mean (SD) maternal age, gestational age and birth weight were 26.8 (6.8) years, 38.9 (1.4) weeks and 3239 (501) g, respectively. Detectable maternal levels of anti-PT, FHA and PRN were found in 34.7%, 95.0% and 80.2%, respectively. Maternal GMT (SD) for PT, FHA and PRN were 4.4 (2.6), 26.6 (3.1) and 12.3 (2.9), respectively. There was no significant relationship between PT, FHA or PRN detection or antibody GMT and maternal age. Maternal anti-PT, FHA and PRN were highly correlated with neonatal cord blood values. CONCLUSION: Despite previous childhood immunization, a large number of parous women have low or undetectable pertussis-related antibody levels, suggesting susceptibility to infection. Even with efficient transplacental passage of these antibodies, neonates similarly have limited measurable protection as detected by cord blood sampling. These data support the need for adolescent or adult vaccination against Bordetella pertussis. Healthcare providers and their clients should be aware of the risk for infant infection via family member transmission.

Seroprevalence of Pertussis Antibodies in Maternal and Cord Blood Sample of Their Newborns

“…This significant relationship between maternal anti-PT with neonatal cord blood was confirmed by Gonik et al (17). Moreover, it has been shown that in spite of the highly efficient placental antibodies transportation, IgG concentrations are not high enough to passively protect neonates in the first months of life (1).…”

Maternal Immunity Provides Protection against Pertussis in Newborn Piglets

“…In particular, CD4 ϩ T cells and the presence of gamma interferon seem to be important for the clearance of bacteria from the lung (31). Furthermore, B cells can also represent a source of cytokines and chemokines, which in turn can exert a critical regulatory effect on APCs and CD4 ϩ -T-cell-mediated immunity (5,17,32). Although we have not directly addressed the role of cell-mediated immunity in the present study, we believe that a combination of both humoral and cell-mediated immunity is required for optimal disease protection.…”

Pertussis vaccination in pregnancy

“…63 Further studies since 2000 demonstrated that both naturally and vaccine-induced pertussis-specific IgG in mothers was efficiently transported across the placenta, resulting in higher infant than maternal antibody levels for tested pertussis antigens. [64][65][66][67][68] Van Savage et al had calculated the half-life (t 1/2 ) of naturally-induced maternal antibody to PT and FHA to be 36 and 40 days, respectively. 69 Serological correlates of protection from pertussis are not known.…”