Abstract
BACKGROUND AND OBJECTIVES: Maternal vaccination may prevent infant coronavirus disease 2019 (COVID-19). We aimed to quantify protection against infection from maternally derived vaccine-induced antibodies in the first 6 months of an infant’s life. METHODS: Infants born to mothers vaccinated during pregnancy with 2 or 3 doses of a messenger RNA COVID-19 vaccine (nonboosted or boosted, respectively) had full-length spike (Spike) immunoglobulin G (IgG), pseudovirus 614D, and live virus D614G, and omicron BA.1 and BA.5 neutralizing antibody (nAb) titers measured at delivery. Infant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was determined by verified maternal-report and laboratory confirmation through prospective follow-up to 6 months of age between December 2021 and July 2022. The risk reduction for infection by dose group and antibody titer level was estimated in separate models. RESULTS: Infants of boosted mothers (n 5 204) had significantly higher Spike IgG, pseudovirus, and live nAb titers at delivery than infants of nonboosted mothers (n 5 271), and were 56% less likely to acquire infection in the first 6 months (P 5 .03). Irrespective of boost, for each 10-fold increase in Spike IgG titer at delivery, the infant’s risk of acquiring infection was reduced by 47% (95% confidence interval 8%–70%; P 5 .02). Similarly, a 10-fold increase in pseudovirus titers against Wuhan Spike, and live virus nAb titers against D614G, and omicron BA.1 and BA.5 at delivery were associated with a 30%, 46%, 56%, and 60% risk reduction, respectively. CONCLUSIONS: Higher transplacental binding and nAb titers substantially reduced the risk of SARSCoV-2 infection in infants, and a booster dose amplified protection during a period of omicron predominance. Until infants are age-eligible for vaccination, maternal vaccination provides passive protection against symptomatic infection during early infancy.
Original language | English |
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Article number | e2023064252 |
Journal | Pediatrics |
Volume | 153 |
Issue number | 3 |
DOIs | |
State | Published - Mar 1 2024 |
Bibliographical note
Publisher Copyright:© 2024 American Academy of Pediatrics. All rights reserved.
Funding
FUNDING: Supported by the Infectious Diseases Clinical Research Consortium through the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, 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 the National Institutes of Health. CONFLICT OF INTEREST DISCLOSURES: Dr Badell conducts laboratory research and clinical trials with contract funding for vaccines or monoclonal antibodies versus severe acute respiratory syndrome coronavirus 2 with Lilly, Pfizer, and Sanofi, and receives personal fees for scientific advisory board service from Merck, Meissa Vaccines, Inc, and Pfizer. Dr Novak is a paid advisor to Gilead and an investigator on National Institutes of Health (NIH)-funded trials of Moderna, Pfizer, and Janssen vaccines. Dr Brady receives research grant support for clinical trials from PATH, Astra Zeneca, and Pfizer, on which she serves as coinvestigator. Dr Berube owns shares in HDT Bio Corp. Dr Suthar served as an advisor for Moderna (ended December 2021) and is currently serving as an advisor for Ocugen, Inc. Dr Richardson currently holds a position on a data and safety monitoring board for clinical trials at Gilead Sciences, Inc. Dr Neuzil is a member of the World Health Organization’s Strategic Advisory Group of Experts on Immunization, serves as coinvestigator on an NIH contract for a Vaccine Treatment and Evaluation Unit, serves as cochair of the NIH Coronavirus Disease 2019 (COVID-19) 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. Dr Neuzil receives grants from Pfizer to conduct clinical trials of COVID-19 vaccines through the Center for Vaccine Development and Global Health at the University of Maryland, Baltimore. She receives grants from NIH to participate in overall organization of COVID-19 vaccine trials and for participation in vaccine trials. Dr Munoz 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 investigator on projects supported by an NIH contract for a Vaccine Treatment and Evaluation Unit; serves as member of the data safety monitoring board 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 is chair of the CEPI-funded Safety Platform for Emergency Vaccines Maternal Immunization Working Group.
Funders | Funder number |
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Immunization Expert Group of the American College of Obstetrics and Gynecology | |
National Institutes of Health (NIH) | UM1AI148689, UM1AI148576, UM1AI148575, UM1AI148685, UM1AI148574, UM1AI148684, UM1AI148452, UM1AI148373, UM1AI148450, UM1AI148372 |
National Institutes of Health (NIH) | |
National Institute of Allergy and Infectious Diseases | |
Pfizer | |
World Health Organization | |
American Academy of Pediatrics | |
University of Maryland, Baltimore |
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health