Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum

doi:10.1097/INF.0000000000004510

Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original language	English
Pages (from-to)	1065-1073
Number of pages	9
Journal	Pediatric Infectious Disease Journal
Volume	43
Issue number	11
DOIs	https://doi.org/10.1097/INF.0000000000004510
State	Published - Nov 1 2024

Bibliographical note

Publisher Copyright:
© 2024 Wolters Kluwer Health, Inc. All rights reserved.

Funding

F.M.M. is an investigator of pediatric studies of COVID-19 vaccines for Pfizer and for a pediatric Remdesivir study conducted by Gilead Sciences, Inc; serves as an investigator on projects supported by a National Institutes of Health (NIH) contract for a Vaccine Treatment and Evaluation Unit (VTEU), serves as a member of the Data Safety Monitoring Board (DSMB) for clinical trials conducted by Pfizer, Moderna, Meissa Vaccines, Virometix and the NIH; is a member of the American Academy of Pediatrics Section of Infectious Diseases and the Immunization Expert Group of the American College of Obstetrics and Gynecology; and Chair of the Coalition for Epidemic Preparedness and Innovation-Safety Platform for Emergency Vaccines (CEPI-SPEAC) Maternal Immunization Working Group. K.M.N. is a member of the World Health Organization Strategic Advisory Group of Experts on Immunization, serves as co-investigator on an NIH contract for a VTEU and the Co-Chair of the NIH COVID Prevention Network and served as an investigator for Phase I/II Pfizer COVID-19 vaccine grant, with a grant to the institution, but no salary support. K.M.N. receives grants from Pfizer to conduct clinical trials of COVID vaccines through the Center for Vaccine Development and Global Health at the University of Maryland, Baltimore. K.M.N. receives grants from NIH to participate in the overall organization of COVID-19 vaccine trials and for participation in vaccine trials. M.J.M. conducts laboratory research and clinical trials with contract funding for vaccines or monoclonal antibodies versus SARS-CoV-2 with Lilly, Pfizer and Sanofi and receives personal fees for the Scientific Advisory Board service from Merck, Meissa Vaccines, Inc, and Pfizer. M.S.S. served as an advisor for Moderna (ended December 2021) and is currently serving as an advisor for Ocugen, Inc. B.A.R. currently holds a position on a DSMB for clinical trials at Gilead Sciences, Inc. R.C.B. at Cincinnati Children’s Hospital receives research grant support for clinical trials from PATH, Astra Zeneca and Pfizer in which she serves as a co-investigator. B.B. owns shares in HDT Bio Corp. J.S.G. receives research funds from NIH for the Moderna KidCOVE study. R.M.N. is a paid advisor to Gilead and an investigator on NIH-funded trials of Moderna, Pfizer and Janssen vaccines. All authors have completed relevant conflicts of interest in the Disclosure of Potential Conflicts of Interest Section of the Authorship Form. This work was supported by the Infectious Diseases Clinical Research Consortium through the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH), under awards UM1AI148684, UM1AI148575, UM1AI148372, UM1AI148452, UM1AI148576, UM1AI148574, UM1AI148450, UM1AI148685, UM1AI148689 and UM1AI148373. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

Funders	Funder number
COVAX Maternal Immunization Working Group
University of Maryland, Baltimore County
American Academy of Pediatrics
Vaccine Treatment and Evaluation Unit
National Institute of Allergy and Infectious F32-AI286447 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R01AI168214 Jason W. Rosch Diseases National Institute of Allergy and Infectious P30 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R00-AI166116 Christopher D. Radka Diseases National Institute of Allergy and Infectious T32-AI106700 Cydney N. Johnson Diseases National Institute of Allergy and Infectious R01AI192221 Jason W. Rosch Diseases National Inst...
Immunization Expert Group of the American College of Obstetrics and Gynecology
Coalition for Epidemic Preparedness and Innovation-Safety Platform for Emergency Vaccines
Pfizer
National Institutes of Health (NIH)	UM1AI148689, UM1AI148576, UM1AI148685, UM1AI148575, UM1AI148684, UM1AI148574, UM1AI148452, UM1AI148450, UM1AI148373, UM1AI148372

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

COVID-19
antibodies
booster
breast milk
durability
infant
pregnancy
vaccination

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Microbiology (medical)
Infectious Diseases

Access to Document

10.1097/INF.0000000000004510

Cite this

@article{1abf073f7c0b4d4e9b99457be80d69a0,

title = "Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum",

abstract = "Background: 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. Methods: 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. Results: 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). Conclusions: 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.",

keywords = "COVID-19, antibodies, booster, breast milk, durability, infant, pregnancy, vaccination",

author = "Munoz, \{Flor M.\} and Richard Beigi and Posavad, \{Christine M.\} and Clifton Kelly and Badell, \{Martina L.\} and Katherine Bunge and Mulligan, \{Mark J.\} and Lalitha Parameswaran and Richardson, \{Barbra A.\} and Courtney Olsen-Chen and Novak, \{Richard M.\} and Brady, \{Rebecca C.\} and Emily DeFranco and Gerber, \{Jeffrey S.\} and Mallory Shriver and Suthar, \{Mehul S.\} and Rhea Coler and Berube, \{Bryan J.\} and Kim, \{So Hee\} and Piper, \{Jeanna M.\} and Joy Miedema and Marcela Pasetti and Neuzil, \{Kathleen M.\} and Cardemil, \{Cristina V.\}",

year = "2024",

month = nov,

day = "1",

doi = "10.1097/INF.0000000000004510",

language = "English",

volume = "43",

pages = "1065--1073",

number = "11",

}

TY - JOUR

T1 - Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum

AU - Munoz, Flor M.

AU - Beigi, Richard

AU - Posavad, Christine M.

AU - Kelly, Clifton

AU - Badell, Martina L.

AU - Bunge, Katherine

AU - Mulligan, Mark J.

AU - Parameswaran, Lalitha

AU - Richardson, Barbra A.

AU - Olsen-Chen, Courtney

AU - Novak, Richard M.

AU - Brady, Rebecca C.

AU - DeFranco, Emily

AU - Gerber, Jeffrey S.

AU - Shriver, Mallory

AU - Suthar, Mehul S.

AU - Coler, Rhea

AU - Berube, Bryan J.

AU - Kim, So Hee

AU - Piper, Jeanna M.

AU - Miedema, Joy

AU - Pasetti, Marcela

AU - Neuzil, Kathleen M.

AU - Cardemil, Cristina V.

PY - 2024/11/1

Y1 - 2024/11/1

N2 - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

AB - Background: 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. Methods: 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. Results: 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). Conclusions: 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.

KW - COVID-19

KW - antibodies

KW - booster

KW - breast milk

KW - durability

KW - infant

KW - pregnancy

KW - vaccination

UR - https://www.scopus.com/pages/publications/85201758884

UR - https://www.scopus.com/pages/publications/85201758884#tab=citedBy

U2 - 10.1097/INF.0000000000004510

DO - 10.1097/INF.0000000000004510

M3 - Article

C2 - 39774938

AN - SCOPUS:85201758884

SN - 0891-3668

VL - 43

SP - 1065

EP - 1073

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

IS - 11

ER -

Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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