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Journal Article Ppublish 10 citations

PubMed: 38332733 DOI: 10.1542/peds.2023-064252

Maternal COVID-19 Vaccination and Prevention of Symptomatic Infection in Infants.

Pediatrics 153(3)

Authors: Cristina V Cardemil, Yi Cao, Christine M Posavad, Martina L Badell, Katherine Bunge, Mark J Mulligan, Lalitha Parameswaran, Courtney Olson-Chen, Richard M Novak, Rebecca C Brady, Emily DeFranco, Jeffrey S Gerber, Marcela Pasetti, Mallory Shriver, Rhea Coler, Bryan Berube, Mehul S Suthar, Alberto Moreno, Fei Gao, Barbra A Richardson, Richard Beigi, Elizabeth Brown, Kathleen M Neuzil, Flor M Munoz

Affiliations

  • National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.
  • Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington.
  • Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Emory University Hospital Midtown Perinatal Center, Atlanta, Georgia.
  • Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital, Pittsburgh, Pennsylvania.
  • New York University Langone Vaccine Center, and Division of Infectious Diseases and Immunology, Department of Medicine, New York University Grossman School of Medicine, New York, New York.
  • Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York.
  • Division of Infectious Diseases, University of Illinois, Chicago, Illinois.
  • Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • Division of Infectious Diseases, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
  • Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
  • Seattle Children's Research Institute, Center for Global Infectious Disease Research, Seattle, Washington.
  • Emory Vaccine Center, Emory School of Medicine, Emory University, Atlanta, Georgia.
  • Departments of Biostatistics and Global Health, University of Washington, Divisions of Vaccine and Infectious Disease and Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington.
  • Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas.

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 = 204) had significantly higher Spike IgG, pseudovirus, and live nAb titers at delivery than infants of nonboosted mothers (n = 271), and were 56% less likely to acquire infection in the first 6 months (P = .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 = .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 SARS-CoV-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.

MeSH

Coronavirus, Sars-Cov-2, Mothers, Vaccines, Vaccination, Covid-19, Viruses, Infections, Infant, Rna

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