Kinetics of the Antibody Response to Tetanus-Diphtheria-Acellular Pertussis Vaccine in Women of Childbearing Age and Postpartum Women
Kinetics of the Antibody Response to Tetanus-Diphtheria-Acellular Pertussis Vaccine in Women of Childbearing Age and Postpartum Women
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DOI：
10.1093/cid/cir538
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发表时间：
2011-11-01
影响因子：
11.8
通讯作者：
Halperin, S. A.
中科院分区：
文献类型：
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作者：
Halperin, B. A.;Morris, A.;Halperin, S. A.
背景资料。由于青少年和成人是婴儿感染百日咳的主要来源，母亲产后立即接种疫苗是减少传播的潜在战略(蚕茧战略)。为了有效，必须在接种疫苗后迅速获得高水平的抗体。我们试图确定破伤风-白喉-无细胞百日咳疫苗(TDAP)的抗体反应是否足够快，以支持蚕茧战略。进行了两项序贯研究。第一项是对育龄妇女接种5种百日咳疫苗(破伤风类毒素、白喉类毒素、百日咳类毒素[PT]、丝状血凝素[FHA]、2型和3型菌毛[FIM]以及Pertactin[PRN])的非随机开放研究；第二项是对产后妇女接种Tdap或不接种疫苗的随机开放研究。免疫后不同时间检测血清抗百日咳免疫球蛋白(Ig)G、抗百日咳免疫球蛋白(IgA)、白喉、破伤风免疫球蛋白(Ig)、母乳抗百日咳免疫球蛋白(IgA)。在这两项研究中，抗体反应相对较快，血清中的免疫球蛋白和免疫球蛋白A水平在第5-7天开始显著升高，到第14天接近峰值。到第14天，分别有超过68%和84.4%的免疫球蛋白和免疫球蛋白A应答者达到最大滴度的90%。白喉和破伤风抗体动力学遵循相似的时间进程。针对PT、FHA和FIM的母乳免疫球蛋白A水平在第7天开始检测到，第10天达到峰值，然后在第28天缓慢下降。抗PRN抗体表现出类似的反应，但高峰出现在第14天。对照组没有显著的抗体反应。尽管健康的非怀孕育龄妇女和产后妇女对一剂Tdap的抗体反应在第14天就开始出现，并提示有记忆免疫反应，但它可能不够快，不足以保护出生后头几周的婴儿。
Background. Because adolescents and adults act as a primary source of pertussis infection for infants, vaccination of mothers immediately postpartum is a potential strategy to reduce transmission (cocoon strategy). For this to be effective, high levels of antibodies must be achieved rapidly after vaccination. We sought to determine whether the antibody response to tetanus-diphtheria-acellular pertussis vaccine (Tdap) is sufficiently rapid to support the cocoon strategy.Methods. Two sequential studies were performed. The first was a nonrandomized, open study of a 5-pertussis-component Tdap vaccine (tetanus toxoid, diphtheria toxoid, pertussis toxoid [PT], filamentous hemagglutinin [FHA], fimbriae types 2 and 3 [FIM], and pertactin [PRN]) given to women of childbearing age; the second was a randomized, open study of Tdap or no vaccine in postpartum women. Serum levels of immunoglobin (Ig) G and IgA against pertussis antigens, serum levels of IgG against diphtheria and tetanus, and breast milk levels of IgA against pertussis antigens were measured at various times after vaccination.Results. In both studies, the antibody response was relatively rapid, with serum IgG and IgA levels beginning to increase noticeably by days 5-7 and approaching peak levels by day 14. Greater than 68% and 84.4% of IgG and IgA responders, respectively, achieved >= 90% of their maximum titer by day 14. The diphtheria and tetanus antibody kinetics followed a similar time course. Breast milk levels of IgA against PT, FHA, and FIM were first detectable at day 7, peaked by day 10, and then slowly decreased through day 28. Antibodies against PRN showed a similar response, although the peak occurred at day 14. There were no significant antibody responses in the control group.Conclusions. Although the antibody response to a dose of Tdap in healthy nonpregnant women of childbearing age and postpartum women occurs by day 14 and is suggestive of an anamnestic immune response, it may not be sufficiently rapid to protect infants in the first weeks of life.