Maternal HIV infection and placental malaria reduce transplacental antibody transfer and tetanus antibody levels in newborns in Kenya.
BACKGROUND
In clinical trials, maternal tetanus toxoid (TT) vaccination is effective in protecting newborns against tetanus infection, but inadequate placental transfer of tetanus antibodies may contribute to lower-than-expected rates of protection in routine practice. We studied the effect of placental malaria and maternal human immunodeficiency virus (HIV) infection on placental transfer of antibodies to tetanus.


METHODS
A total of 704 maternal-cord paired serum samples were tested by ELISA for antibodies to tetanus. The HIV status of all women was determined by an immunoglobulin G antibody-capture particle-adherence test, and placental malaria was determined by placental biopsy. Maternal history of TT vaccination was recorded.


RESULTS
Tetanus antibody levels were reduced by 52% (95% confidence interval [CI], 30%-67%) in newborns of HIV-infected women and by 48% (95% CI, 26%-62%) in newborns whose mothers had active-chronic or past placental malaria. Thirty-seven mothers (5.3%) and 55 newborns (7.8%) had tetanus antibody levels <0.1 IU/mL (i.e., were seronegative). Mothers' self-reported history of lack of tetanus immunization was the strongest predictor of seronegativity and of tetanus antibody levels in maternal and cord serum.


CONCLUSIONS
Malarial and HIV infections may hinder efforts to eliminate maternal and neonatal tetanus, making implementation of the current policy for mass vaccination of women of childbearing age an urgent priority.
Cumberland
Phillippa
P
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK.
Shulman
Caroline E
CE
Maple
P A Chris
PA
Bulmer
Judith N
JN
Dorman
Edgar K
EK
Kawuondo
Ken
K
Marsh
Kevin
K
Cutts
Felicity T
FT
D000293:Adolescent; D000328:Adult; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood* / Q000378:metabolism; D001706:Biopsy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005312:Fetal Blood; D006678:HIV; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007231:Infant, Newborn; D007630:Kenya; D016778:Malaria, Falciparum / Q000150:complications* / Q000469:parasitology / Q000473:pathology; D010920:Placenta / Q000378:metabolism / Q000469:parasitology* / Q000473:pathology; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000276:immunology; D013742:Tetanus / Q000097:blood / Q000150:complications / Q000276:immunology; D013743:Tetanus Antitoxin / Q000097:blood* / Q000378:metabolism; D013745:Tetanus Toxoid / Q000008:administration & dosage; D014611:Vaccination
D000907:Antibodies, Bacterial; D013743:Tetanus Antitoxin; D013745:Tetanus Toxoid