title: The induction of breast milk pertussis specific antibodies following gestational tetanus-diphtheria-acellular pertussis vaccination.
abstract: BACKGROUND
  Center for Disease Control and Prevention recommends vaccination of pregnant women with tetanus-diphtheria-acellular pertussis (Tdap).
  
  
  OBJECTIVE
  To measure pertussis specific antibodies, total protein and their ratio in breast milk following gestational Tdap vaccination.
  
  
  METHODS
  Women who received Tdap after the 20th week of pregnancy were recruited and unvaccinated women served as controls. Breast milk total protein, immunoglobulin A (IgA) to pertussis toxin (PT), filamentous hemagglutinin (FHA) and immunoglobulin G (IgG) to PT, FHA and pertactin (PRN) were measured. To overcome the dilution that occurs in the transition from colostrum to mature breast milk, we calculated pertussis specific antibody to total protein ratio.
  
  
  RESULTS
  Pertussis specific IgA was the predominant pertussis immunoglobulin in the colostrum of Tdap vaccinated women with the geometric mean concentrations (GMCs) of IgA to FHA higher than for IgA to PT, 24.12 ELISA units/milliliter (EU/mL) vs. 8.18EU/mL, respectively, p<0.004. There were differences between the vaccinated women and controls in the GMCs of IgA to FHA and IgG to PRN in the colostrum, 24.12EU/mL vs. 6.52EU/mL, p=0.01 and 2.46EU/mL vs. <0.6EU/mL, p=0.03, respectively. The GMCs of total protein showed significant decline over 8 weeks in the vaccinated women and controls, p<0.004. Among vaccinated women, there was significant decline in the GMCs of IgA to PT and FHA over 8 weeks, p<0.001. The geometric mean ratio of IgA to FHA to total protein also declined significantly over 8 weeks in the vaccinated women, p<0.01, demonstrating a true decrease, however, pertussis IgA was measurable at 8 weeks.
  
  
  CONCLUSIONS
  Select colostrum pertussis antibody levels were significantly higher among women vaccinated with Tdap during pregnancy compared with unvaccinated women. Among vaccinated women, maximal levels of pertussis specific IgA were in the colostrum but still detected at 8 weeks. Lactation may augment infant's protection against pertussis.
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; Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: Regina
authors.initials: R
authors.lastname: Peri
authors.affiliation: Department of Nursery, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
authors.forename: Nathanealla
authors.initials: N
authors.lastname: Ashtamker
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 / Q000276:immunology*; D001886:Bordetella pertussis; D003126:Colostrum / Q000276:immunology*; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007071:Immunoglobulin A, Secretory / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D008875:Middle Aged; D008895:Milk, Human / Q000276:immunology*; D014917:Whooping Cough / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D007070:Immunoglobulin A; D007071:Immunoglobulin A, Secretory; D007074:Immunoglobulin G
keywords: Breast milk; Pertussis; Secretory IgA; Tetanus–diphtheria–acellular pertussis; Vaccination