PEDIATRICS Vol. 96 No. 3 September 1995, pp. 580-584
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The Effect of Maternal Antibody on the Serologic Response and the Incidence of Adverse Reactions After Primary Immunization With Acellular and Whole-Cell Pertussis Vaccines Combined with Diphtheria and Tetanus Toxoids

Janet A. Englund MD1, Edwin L. Anderson MD2, George F. Reed PhD3, Michael D. Decker MD, MPH4, Kathryn M. Edwards MD5, Michael E. Pichichero MD6, Mark C. Steinhoff MD7, Margaret B. Rennels MD8, Adamadia Deforest PhD9, and Bruce D. Meade PhD10

1 Departments of Microbiology and Immunology and Pediatrics, Baylor College of Medicine, Houston, TX
2 Department of Medicine, St Louis University School of Medicine, Bethesda, MD
3 Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD
4 Departments of Preventive Medicine, Medicine (Infectious Diseases), Vanderbilt University School of Medicine, Nashville, TN
5 Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
6 Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY
7 Departments of International Health and Pediatrics, Johns Hopkins University School of Medicine and School of Public Health, Baltimore, MD
8 Department of Pediatrics, University of Maryland, Baltimore
9 Departments of Microbiology and Pediatrics, Temple University School of Medicine, and St Christopher's Hospital for Children, Philadelphia, PA
10 Division of Bacterial Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD

Objective. To evaluate the effect of maternally derived antibody on the immunogenicity and reactogenicity of acellular (DTaP) or whole-cell (DTP) pertussis vaccine with diphtheria and tetanus toxoids combined.

Methods. A total of 2342 infants were randomized to receive one of 13 DTaP or 2 DTP vaccines at 2, 4, and 6 months of age. The correlation between preimmunization and postimmunization antibody after three doses of vaccine and the relation between preimmunization antibody and adverse reactions after the first immunization were modeled by linear regression.

Results. After DTP but not DTaP, higher levels of preexisting antibody were associated with substantial (28% to 56%) reductions in the subsequent antibody response to pertussis toxin (PT). For other pertussis antibodies, modest inverse correlations were seen between preexisting antibody concentrations and most postimmunization antibody responses (resulting in 8% to 18% reductions in postimmunization antibody) for both DTP and DTaP. There was no consistent association in any DTP or DTaP group between adverse reactions and preimmunization antibody levels.

Conclusion. The PT antibody response to DTaP, unlike DTP, is not adversely affected by preexisting antibody to PT. Inhibitory effects with respect to other antibodies, seen with both DTP and DTaP, were relatively modest. Our data suggest that the use of acellular pertussis vaccines in adults, which could confer higher levels of antibody in women before pregnancy, would be unlikely to adversely affect pertussis antibody responses after DTaP among infants born to mothers with high antibody levels.




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