Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus.
Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus.
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DOI：
10.1097/00006254-198908000-00008
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发表时间：
1989-08
期刊：
影响因子：
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通讯作者：
C. Baker;M. Rench;M. Edwards;R. Carpenter;B. Hays;D. Kasper
中科院分区：
文献类型：
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作者：
C. Baker;M. Rench;M. Edwards;R. Carpenter;B. Hays;D. Kasper
孕妇接种B群链球菌多糖疫苗是预防B群链球菌围产期感染的一种有前景的策略。为了探索这一策略的可行性，我们给40名平均孕周为31周的孕妇接种了单剂50微克剂量的B群链球菌III型荚膜多糖。检测到的唯一不良反应是9名女性(22%)出现轻微的局部反应。在免疫前抗体水平低或无保护性的35名妇女中(每毫升低于2微克)，20名(57%)对疫苗有反应。几何平均抗体水平在接种四周后从1.3微克/毫升上升到7.1微克/毫升(P<0.02)，并在分娩时和产后3个月持续存在。在母亲中，疫苗诱导的免疫球蛋白中有62%是免疫球蛋白，它很容易通过胎盘。新生儿脐带血抗体水平与分娩时母体抗体水平呈正相关(r=0.913，P<0.001)。在25名对疫苗有反应的母亲所生的婴儿中，80%的婴儿在一个月大时仍有保护性抗体水平，的婴儿在三个月大时仍有保护性抗体水平。每毫升B型链球菌抗体大于或等于2微克的婴儿的血清样本均匀地促进了III型菌株的有效调理、吞噬和体外细菌杀灭。这种作用可以完全通过替代的补体途径来实现。尽管这种总应答率为63%的疫苗并不具有最佳的免疫原性，但我们得出结论，母体免疫是可行的，可以为大多数新生儿提供对系统性感染III型B组链球菌的被动免疫。将需要用更好的疫苗进行更大规模的试验，以评估这一策略的安全性和临床有效性。
Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus is a promising strategy for the prevention of perinatal infections caused by group B streptococci. To explore the feasibility of this strategy, we vaccinated 40 pregnant women at a mean gestation of 31 weeks with a single 50-microgram dose of the Type III capsular polysaccharide of group B streptococcus. The only adverse effect detected was a mild local reaction in nine women (22 percent). Of the 35 women with low or unprotective antibody levels before immunization (less than 2 micrograms per milliliter), 20 (57 percent) responded to the vaccine. The geometric mean antibody level rose from 1.3 to 7.1 micrograms per milliliter four weeks after vaccination (P less than 0.02), and these levels persisted at delivery and three months post partum. Sixty-two percent of the vaccine-induced immunoglobulin in the mothers was IgG, which readily crosses the placenta. Infant antibody levels in cord serum correlated directly with maternal antibody levels at delivery (r = 0.913, P less than 0.001). Of the 25 infants born to women who responded to the vaccine, 80 percent continued to have protective levels of antibody at one month of age and 64 percent had protective levels at three months. Serum samples from infants with greater than or equal to 2 micrograms of antibody to Type III group B streptococcus per milliliter uniformly promoted efficient opsonization, phagocytosis, and bacterial killing in vitro of Type III strains. This effect could be mediated exclusively by the alternative complement pathway. Although this vaccine with an overall response rate of 63 percent is not optimally immunogenic, we conclude that maternal immunization is feasible and can provide passive immunity against systemic infection with Type III group B streptococcus in the majority of newborns. Larger trials with better vaccines will be required to evaluate the safety and clinical effectiveness of this strategy.