Continued longitudinal assessment of vaccine-induced titers in cohorts of people vaccinated during pregnancy and lactation are critical to answering these questions

Continued longitudinal assessment of vaccine-induced titers in cohorts of people vaccinated during pregnancy and lactation are critical to answering these questions. vaccination in pregnancy and lactation and highlight opportunities for investigation that may inform future maternal vaccine development and implementation strategies. Keywords: COVID-19, pregnancy, lactation, maternal immunization, vaccination, SARS-CoV-2, mRNA vaccine Introduction Vaccination against infectious pathogens is one of the most impactful public health interventions, reducing global morbidity and mortality related to infection (Woodworth et al., 2020; CDC, a, 2021). In the US alone, nearly 99,000 pregnant people have been infected with COVID-19, resulting in 109 maternal deaths to date (CDC, a, 2021). The COVID-19 pandemic has demonstrated the urgent need to develop vaccine strategies optimized for pregnant people and their newborns, as both populations are at risk of developing severe disease (Woodworth et al., 2020; Zambrano Danusertib (PHA-739358) et?al., 2020). To date, two COVID-19 mRNA vaccines C BNT162b2 (Pfizer/BioNTech) and mRNA-1273 (Moderna) C and one monovalent Ad26-vector vaccine (Janssen/Johnson & Johnson) have been granted Emergency Use Authorization (EUA) by the FDA for administration to prevent COVID-19 in the US. Although not included in COVID-19 vaccine development trials, pregnant people have had access to these vaccines since their initial release in the US, and more recent data supporting the safety of COVID-19 vaccines in pregnancy (Shimabukuro et?al., 2021) have led to broadening support for vaccinating pregnant and lactating individuals (ACOG, 2021 Immunization, Infectious Disease and Public Health Preparedness ExpertWorking Group; CDC, b, 2021). With increasing numbers of pregnant people receiving the vaccine during all trimesters of pregnancy and during lactation, several key questions have arisen, including: what is the safety profile of mRNA vaccines in pregnancy and lactation? Which vaccines induce the most robust maternal immune response? Does the efficiency of transplacental and breastmilk antibody transfer differ by timing of administration or vaccine platform? What factors govern efficiency of placental and Danusertib (PHA-739358) breastmilk transfer? Does the transfer of humoral immunity from mother to baby confer long-lasting protection? The COVID-19 pandemic and the rapid development of novel vaccines to combat it present an unprecedented opportunity to decode the rules of vaccine-induced immunity in pregnant and lactating individuals. In this review, we aim to review the literature to date on COVID-19 Rabbit Polyclonal to EIF5B vaccination in pregnancy and lactation and highlight opportunities for future investigation. Figure?1 illustrates the key findings presented in this review as well as gaps in understanding. Knowledge gained through investigation of COVID-19 vaccines in pregnant Danusertib (PHA-739358) and lactating people has the potential to lead to a deeper understanding of vaccine-induced immunity in pregnant individuals and their newborns, and to inform future vaccine development and implementation strategies. Open in a separate window Figure?1 Summary of immune protection from COVID-19 vaccines in pregnancy and lactation. (A) Although excluded from initial vaccine trials, pregnant and lactating individuals have been eligible to receive Pfizer/BioNTech and Moderna mRNA vaccines and the Janssen/Johnson&Johnson Ad26-vector vaccine. Safety and reactogenicity profiles are similar to non-pregnant, non-lactating individuals. Immunization with the two-dose protocol for mRNA vaccines results in comparable IgG, IgA and IgM titers in fully-vaccinated pregnant and lactating individuals compared to non-pregnant controls. The longevity of immunity derived during pregnancy and the ability to confer protection against variants has not been directly Danusertib (PHA-739358) studied in these populations. (B) COVID-19 vaccines generate anti-Spike antibodies in pregnant and lactating individuals with similar immunogenicity compared with nonpregnant controls. Vaccine-induced anti-Spike antibodies demonstrate neutralizing capacity, antibody-dependent neutrophil phagocytosis (ADNP), antibody-dependent cellular phagocytosis (ADCP), and antibody-dependent complement deposition (ADCD), and NK cell activation. Spike-specific CD4+ and CD8+ T-cell activity is similar to that observed in non-pregnant individuals. Anti-Spike IgG and IgA with binding, neutralizing and functional activity are also detectable in breastmilk. Whether breastmilk contains vaccine-induced cellular or other protective immune factors is not yet known. No vaccine mRNA has been detected in breastmilk immediately following vaccination. (C) Neutralizing anti-Spike IgG is transplacentally transferred from mother to fetus. Vaccine timing and maternal antibody titers impact cord titers. IgG, IgM and IgA are transferred through breastmilk. Neither the amount of maternally-derived antibodies required to confer neonatal protection from COVID-19 infection, nor the duration of this protection, is known. Created with BioRender.com. ADNP, antibody-dependent neutrophil phagocytosis; ADCP,.

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