Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study.
Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study.
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2019年孕妇和哺乳期妇女对冠状病毒病疫苗的反应：一项队列研究。
DOI：
10.1016/j.ajog.2021.03.023
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发表时间：
2021-09
影响因子：
9.8
通讯作者：
Edlow AG
中科院分区：
文献类型：
--
作者：
Gray KJ;Bordt EA;Atyeo C;Deriso E;Akinwunmi B;Young N;Baez AM;Shook LL;Cvrk D;James K;De Guzman R;Brigida S;Diouf K;Goldfarb I;Bebell LM;Yonker LM;Fasano A;Rabi SA;Elovitz MA;Alter G;Edlow AG
孕妇和哺乳期妇女被排除在2019冠状病毒病疫苗试验之外，因此缺乏指导疫苗决策的数据。本研究旨在评估孕妇和哺乳期妇女接种冠状病毒病2019信使RNA疫苗的免疫原性和反应原性，并与以下两种情况进行比较：（1）非妊娠对照组和（2）妊娠期天然冠状病毒病2019感染。共有131名育龄期疫苗接种者（84名孕妇，31名哺乳期妇女和16名非孕妇）参加了在2个学术医学中心进行的前瞻性队列研究。在基线、第二次疫苗接种、第二次疫苗接种后2 - 6周和Luminex分娩时，对参与者血清（n=131）和母乳（n=31）中严重急性呼吸综合征冠状病毒2型刺突和受体结合结构域免疫球蛋白G、免疫球蛋白A和免疫球蛋白M的滴度进行定量。在分娩时评估脐带血清（n=10）滴度。通过酶联免疫吸附试验将滴度与自然感染后4至12周的孕妇（n=37）进行比较。假病毒中和试验用于定量研究期间分娩的妇女亚组的中和抗体滴度。通过问卷调查评估接种后症状。使用Kruskal-Wallis检验和混合效应模型（校正多重比较）评估组间差异。孕妇和哺乳期妇女的疫苗诱导抗体滴度与非孕妇相当（孕妇，中位数，5.59;四分位数范围，4.68-5.89;哺乳期，中位数，5.74;四分位数范围，5.06-6.22;非孕妇，中位数，5.62;四分位数范围，4.77-5.98，P= 0.24）。所有滴度均显著高于妊娠期间严重急性呼吸综合征冠状病毒2型感染诱导的滴度（P<.0001）。疫苗产生的抗体存在于所有脐带血和母乳样本中。脐带中的中和抗体滴度低于母体血清，尽管这一发现没有达到统计学显著性（母体血清，中位数，104.7;四分位数范围，61.2-188.2;脐带血清，中位数，52.3;四分位数范围，11.7-69.6; P= 0.05）。第二剂疫苗（加强剂量）增加了母亲血液和母乳中严重急性呼吸综合征冠状病毒2特异性免疫球蛋白G，但不增加免疫球蛋白A。各组之间的反应原性无差异。2019冠状病毒病信使RNA疫苗在孕妇和哺乳期妇女中产生了强大的体液免疫力，其免疫原性和反应原性与非孕妇中观察到的相似。疫苗诱导的免疫应答在统计学上显著大于对自然感染的应答。新生儿的免疫转移通过胎盘和母乳进行。
Pregnant and lactating women were excluded from initial coronavirus disease 2019 vaccine trials; thus, data to guide vaccine decision making are lacking. This study aimed to evaluate the immunogenicity and reactogenicity of coronavirus disease 2019 messenger RNA vaccination in pregnant and lactating women compared with: (1) nonpregnant controls and (2) natural coronavirus disease 2019 infection in pregnancy. A total of 131 reproductive-age vaccine recipients (84 pregnant, 31 lactating, and 16 nonpregnant women) were enrolled in a prospective cohort study at 2 academic medical centers. Titers of severe acute respiratory syndrome coronavirus 2 spike and receptor-binding domain immunoglobulin G, immunoglobulin A, and immunoglobulin M were quantified in participant sera (n=131) and breastmilk (n=31) at baseline, at the second vaccine dose, at 2 to 6 weeks after the second vaccine, and at delivery by Luminex. Umbilical cord sera (n=10) titers were assessed at delivery. Titers were compared with those of pregnant women 4 to 12 weeks from the natural infection (n=37) by enzyme-linked immunosorbent assay. A pseudovirus neutralization assay was used to quantify neutralizing antibody titers for the subset of women who delivered during the study period. Postvaccination symptoms were assessed via questionnaire. Kruskal-Wallis tests and a mixed-effects model, with correction for multiple comparisons, were used to assess differences among groups. Vaccine-induced antibody titers were equivalent in pregnant and lactating compared with nonpregnant women (pregnant, median, 5.59; interquartile range, 4.68–5.89; lactating, median, 5.74; interquartile range, 5.06–6.22; nonpregnant, median, 5.62; interquartile range, 4.77–5.98, P=.24). All titers were significantly higher than those induced by severe acute respiratory syndrome coronavirus 2 infection during pregnancy (P<.0001). Vaccine-generated antibodies were present in all umbilical cord blood and breastmilk samples. Neutralizing antibody titers were lower in umbilical cord than maternal sera, although this finding did not achieve statistical significance (maternal sera, median, 104.7; interquartile range, 61.2–188.2; cord sera, median, 52.3; interquartile range, 11.7–69.6; P=.05). The second vaccine dose (boost dose) increased severe acute respiratory syndrome coronavirus 2–specific immunoglobulin G, but not immunoglobulin A, in maternal blood and breastmilk. No differences were noted in reactogenicity across the groups. Coronavirus disease 2019 messenger RNA vaccines generated robust humoral immunity in pregnant and lactating women, with immunogenicity and reactogenicity similar to that observed in nonpregnant women. Vaccine-induced immune responses were statistically significantly greater than the response to natural infection. Immune transfer to neonates occurred via placenta and breastmilk.
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影响因子：
3.6
作者：
Demers-Mathieu V;Huston RK;Markell AM;McCulley EA;Martin RL;Dallas DC
通讯作者：
Dallas DC
影响因子：
--
作者：
Palmeira P;Quinello C;Silveira-Lessa AL;Zago CA;Carneiro-Sampaio M
通讯作者：
Carneiro-Sampaio M
影响因子：
13.8
作者：
Edlow AG;Li JZ;Collier AY;Atyeo C;James KE;Boatin AA;Gray KJ;Bordt EA;Shook LL;Yonker LM;Fasano A;Diouf K;Croul N;Devane S;Yockey LJ;Lima R;Shui J;Matute JD;Lerou PH;Akinwunmi BO;Schmidt A;Feldman J;Hauser BM;Caradonna TM;De la Flor D;D'Avino P;Regan J;Corry H;Coxen K;Fajnzylber J;Pepin D;Seaman MS;Barouch DH;Walker BD;Yu XG;Kaimal AJ;Roberts DJ;Alter G
通讯作者：
Alter G
DOI：
10.1016/j.ajogmf.2020.100134
发表时间：
2020-08-01
影响因子：
6.3
作者：
Pierce-Williams, Rebecca A. M.;Burd, Julia;Berghella, Vincenzo
通讯作者：
Berghella, Vincenzo
影响因子：
120.7
作者：
Bianchi, Diana W.;Kaeser, Lisa;Cernich, Alison N.
通讯作者：
Cernich, Alison N.