Serdar GÜL, Cemile SÖNMEZ, Gökçe AYVAZ, Selçuk KILIÇ

Investigation of immunity against Bordetella pertussis in pregnant women and an overview of the vaccination schedule in Turkey

Background. Pertussis caused by Bordetella pertussis, is a disease leading to significant morbidity and mortality in neonates and infants. Direct protection of the infant may be achieved by maternal and neonatal vaccination. Despite primary vaccination, infants under six months pose the greatest risk of infection with pertussis. Maternal immunization provides a high level of infant protection from birth until immunity is achieved by active vaccination. There is no routine Tdap vaccination recommendation for pregnant women in Turkey. This study was carried out to determine pertussis antibody levels in pregnant women and provide data for improving vaccine planning. Methods. The study was carried out with 133 pregnant women in Turkey. Antibody titers to pertussis toxin (anti-PT) and filamentous hemagglutinin (anti-FHA) were measured by the commercially available ELISA. Results. Among 133 participants, 93 (69.9%) were found to be immune according to anti-PT IgG antibody levels. According to anti-FHA IgG antibody levels, 123 (92.5%) participants were considered to be immune. A positive correlation was observed between PT and FHA and the findings were statistically significant (P

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1. Waters V, Halperin SA. Bordetella pertussis. In Bennet JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases (8th ed) Vol 2, Chapter 232. Philadelphia: Saunders, 2015: 2619-2628e3. https:// doi.org/10.1016/B978-1-4557-4801-3.00232-0

2. Mooi FR, van Loo IH, King AJ. Adaptation of Bordetella pertussis to vaccination: a cause for its reemergence? Emerg Infect Dis 2001; 7(Suppl 3): 526-528. https://doi.org/10.3201/eid0707.017708

3. Mooi FR, de Greff SC. The case for maternal vaccination against pertussis. Lancet Infect Dis 2007; 7: 614-624. https://doi.org/10.1016/S1473- 3099(07)70113-5

4. Subaiya S, Dumolard L, Lydon P, Gacic-Dobo M, Eggers R, Conklin L. Global routine vaccination coverage, 2014. MMWR Morb Mortal Wkly Rep 2015; 64: 1252-1255. https://doi.org/10.15585/mmwr. mm6444a5

5. WHO. Pertussis vaccines: WHO position paper, August 2015. Wkly Epidemiol Rec 2015; 90: 433-460.

6. Özbek ÖA, Öktem İMA, Hekimoğlu CH, et al. Hücre içermeyen boğmaca aşı uygulamasının altıncı yılında Türkiye’nin Manisa ili’ndeki pertussis toksin antikoru seroprevalansı. Mikrobiyoloji Bülteni 2018; 52: 180-189. https://doi.org/10.5578/mb.57534

7. Republic of Turkey Ministry of Health. Health Statistics Yearbook 2018. Ankara: General Directorate of Health Information Systems, 2019. https://sbsgm. saglik.gov.tr/Eklenti/36164/0/siy2018en2pdf.pdf

8. Juretzko P, von Kries R, Hermann M, Wirsing von König CH, Weil J, Giani G. Effec-tiveness of acellular pertussis vaccine assessed by hospital-based active surveillance in Germany. Clin Infect Dis 2002; 35: 162-167. https://doi.org/10.1086/341027

9. Quinn HE, Snelling TL, Macartney KK, McIntyre PB. Duration of protection after first dose of acellular pertussis vaccine in infants. Pediatrics 2014; 133: e513-e519. https://doi.org/10.1542/peds.2013-3181

10. Greenberg DP, von Konig CH, Heininger U. Health burden of pertussis in infants and children. Pediatr Infect Dis J 2005; 24 (Suppl 5): S39-S43. https://doi. org/10.1097/01.inf.0000160911.65632.e1

11. Forsyth K, Plotkin S, Tan T, Wirsing von König CH. Strategies to decrease pertussis transmission to infants. Pediatrics 2015; 135: e1475-e1482. https://doi. org/10.1542/peds.2014-3925

12. Villena R, Vidal P, Carrillo F, Salinas M. Pertussis vaccination in pregnancy: security and effectiveness in the protection of the infant. Rev Chil Pediatr 2017; 88: 318-323. https://doi.org/10.4067/S0370- 41062017000300002

13. Van Rie A, Wendelboe AM, Englund JA. Role of maternal antibodies in infants. Pediatr Infect Dis J 2005; 24: S62-S65. https://doi.org/10.1097/01. inf.0000160915.93979.8f

14. Munoz FM, Bond NH, Maccato M, et al. Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014; 311: 1760-1769. https://doi.org/10.1001/ jama.2014.3633

15. Abu Raya B, Srugo I, Bamberger E, Kessel A. The avidity of pertussis antibodies following gestational acellular pertussis immunization. Vaccine 2015; 33: 5490-5491. https://doi.org/10.1016/j. vaccine.2015.05.090

16. Fallo AA, Neyro SE, Manonelles GV, et al. Prevalence of pertussis antibodies in maternal blood, cord serum, and infants from mothers with and those without Tdap booster vaccination during pregnancy in Argentina. J Pediatric Infect Dis Soc 2018; 7: 11-17.

17. Kent A, Ladhani SN, Andrews NJ, et al; PUNS Study Group. Pertussis antibody concentrations in infants born prematurely to mothers vaccinated in pregnancy. Pediatrics 2016; 138: e20153854. https:// doi.org/10.1542/peds.2015-3854

18. de Greeff SC, de Melker HE, Westerhof A, Schellekens JF, Mooi FR, van Boven M. Estimation of household transmission rates of pertussis and the effect of cocooning vaccination strategies on infant pertussis. Epidemiology 2012; 23: 852-860. https:// doi.org/10.1097/EDE.0b013e31826c2b9e

19. Ercan TE, Sönmez C, Vural M, Erginoz E, Torunoğlu MA, Perk Y. Seroprevalance of pertussis antibodies in maternal and cord blood of preterm and term infants. Vaccine 2013; 31: 4172-4176. https://doi. org/10.1016/j.vaccine.2013.06.088

20. Bigham M, Konrad S, Van Buynder P, et al. Low pertussis toxin antibody levels in two regional cohorts of Canadian pregnant women. Vaccine 2014; 32: 6493-6498. https://doi.org/10.1016/j. vaccine.2014.09.028

21. Healy CM, Munoz FM, Rench MA, Halasa NB, Edwards KM, Baker CJ. Prevalence of pertussis antibodies in maternal delivery, cord, and infant serum. J Infect Dis 2004; 190: 335-340. https://doi. org/10.1086/421033

22. Gonik B, Puder KS, Gonik N, Kruger M. Seroprevalence of Bordetella pertussis antibodies in mothers and their newborn infants. Infect Dis Obstet Gynecol 2005; 13: 59-61. https://doi. org/10.1080/10647440500068289

23. Türkoğlu E, Sönmez C, Özer E, Çöplü N, Kurugöl Z. Low pertussis antibody levels in maternal and umbilical cord blood samples in Turkey. Turk J Pediatr 2016; 58: 573-578. https://doi.org/10.24953/ turkjped.2016.06.001

24. WHO and UNICEF estimates of national immunization coverage. Available at: https://www. who.int/immunization/monitoring_surveillance/ data/tur.pdf (Accessed on May 15, 2020).

25. WHO vaccine preventable diseases: monitoring system 2019 global summary. Avaliable at https://apps.who.int/immunization_monitoring/ globalsummary/timeseries/tsincidencepertussis (Accessed on May 15, 2020).

26. Sönmez C, Çöplü N, Gözalan A, et al. Uzamış öksürüğü olan erişkinlerde Bordetella pertussis enfeksiyonunun serolojik olarak değerlendirilmesi. Mikrobiyoloji Bülteni 2016; 50: 361-370. https://doi. org/10.5578/mb.27692

27. Narchi H, Osman W, George JA, Almekhaini LA, Souid AK, Alsuwaidi AR. Pertussis seronegativity in pregnant women in the city of Al Ain, United Arab Emirates. Int J Infect Dis 2019; 89: 96-101. https://doi. org/10.1016/j.ijid.2019.08.031

28. Kurtoğlu D, Gözalan A, Çöplü N, et al. Seçilmiş üç ilde boğmaca seroprevalansı ve aşılanma durumu. Mikrobiyoloji Bülteni 2008; 42: 389-398.

29. Gürsel D, Aslan A, Sönmez C, et al. Uzamış öksürüğü olan çocuklarda kültür, gerçek zamanlı polimeraz zincir reaksiyonu ve seroloji ile Bordetella pertussis enfeksiyonunun araştırılması. Mikrobiyoloji Bülteni 2012; 46: 211-224.

30. Eberhardt CS, Blanchard-Rohner G, Lemaitre B, et al. Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis. Clin Infect Dis 2016; 62: 829-836. https://doi.org/10.1093/cid/ciw027

31. Eberhardt CS, Blanchard-Rohner G, Lemaître B, et al. Pertussis antibody transfer to preterm neonates after second-versus third-trimester maternal immunization. Clin Infect Dis 2017; 64: 1129-1132. https://doi.org/10.1093/cid/cix046

32. Winter K, Nickell S, Powell M, Harriman K. Effectiveness of prenatal versus postpartum tetanus, diphtheria, and acellular pertussis vaccination in preventing infant pertussis. Clin Infect Dis 2017; 64: 3-8. https://doi.org/10.1093/cid/ciw634

33. Amirthalingam G, Andrews N, Campbell H, et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet 2014; 384: 1521-1528. https://doi.org/10.1016/S0140- 6736(14)60686-3

34. Winter K, Cherry JD, Harriman K. Effectiveness of prenatal tetanus, diphtheria, and acellular pertussis vaccination in pertussis severity in infants. Clin Infect Dis 2017; 64: 9-14. https://doi.org/10.1093/cid/ ciw633

35. Sartori AMC, de Soárez PC, Fernandes EG, Gryninger LCF, Viscondi JYK, Novaes HMD. Cost-effectiveness analysis of universal maternal immunization with tetanus-diphteria-acellular pertussis (Tdap) vaccine in Brazil. 2016; 34: 1531- 1539. https://doi.org/10.1016/j.vaccine.2016.02.026

36. Amirthalingam G, Campbell H, Ribeiro S, et al. Sustained effectiveness of the maternal pertussis immunization program in England 3 years following introduction. Clin Infect Dis 2016; 63(Suppl 4): S236-S243. https://doi.org/10.1093/cid/ciw559

37. Dabrera G, Amirthalingam G, Andrews N, et al. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012- 2013. Clin Infect Dis 2015; 60: 333-337. https://doi. org/10.1093/cid/ciu821