title: The effect of timing of maternal tetanus, diphtheria, and acellular pertussis (Tdap) immunization during pregnancy on newborn pertussis antibody levels - a prospective study.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention recommend Tdap immunization during pregnancy, preferably at 27-36 weeks.
  
  
  OBJECTIVE
  To ascertain whether there is a preferential period of maternal Tdap immunization during pregnancy that provides the highest concentration of pertussis-specific antibodies to the newborn.
  
  
  METHODS
  This prospective study measured pertussis-specific antibodies in paired maternal-cord sera of women immunized with Tdap after the 20th week of their pregnancy (n=61).
  
  
  RESULTS
  The geometric mean concentrations (GMCs) of Immunoglobulin G (IgG) to pertussis toxin (PT) were higher in the newborns' cord sera when women were immunized at 27-30(+6) weeks (n=21) compared with 31-36 weeks (n=30) and >36 weeks (n=7), 46.04 international units/milliliter (IU/mL) (95% CI, 24.29-87.30) vs. 8.69IU/mL (95% CI, 3.66-20.63) and 21.12IU/mL (95% CI, 7.93-56.22), p<0.02, respectively. The umbilical cord GMCs of IgG to filamentous hemagglutinin (FHA) were higher in the newborns' cord sera when women were immunized at 27-30(+6) weeks compared with 31-36 weeks and >36 weeks, 225.86IU/mL (95% CI, 182.34-279.76) vs. 178.31IU/mL (95% CI, 134.59-237.03) and 138.03IU/mL (95% CI, 97.61-195.16), p<0.02, respectively.
  
  
  CONCLUSIONS
  Immunization of pregnant women with Tdap between 27-30(+6) weeks was associated with the highest umbilical cord GMCs of IgG to PT and FHA compared with immunization beyond 31 weeks gestation. Further research should be conducted to reaffirm these finding in order to promote an optimal pertussis controlling policy.
authors.affiliation: Department of Pediatrics, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel. Electronic address: baha_aboraya@yahoo.com.
authors.forename: Bahaa
authors.initials: B
authors.lastname: Abu Raya
authors.affiliation: Department of Pediatrics, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Clinical Microbiology Laboratory, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: Isaac
authors.initials: I
authors.lastname: Srugo
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: Aharon
authors.initials: A
authors.lastname: Kessel
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Clinical Microbiology Laboratory, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Peterman
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Department of Neonatology, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Bader
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Gonen
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Efron St. 1, Haifa 31096, Israel; Clinical Microbiology Laboratory, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: Ellen
authors.initials: E
authors.lastname: Bamberger
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007115:Immunization Schedule; D007074:Immunoglobulin G / Q000097:blood; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D014611:Vaccination; D014917:Whooping Cough / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D007074:Immunoglobulin G
keywords: Immunoglobulin G transfer; Maternal immunization; Pertussis; Tetanus-diphtheria-acellular pertussis