Antibody in Breastmilk Following Pertussis Vaccination in Three-time Windows in Pregnancy

Background: Pertussis-containing vaccines are routinely offered in the UK at 16–32 weeks of gestation and have been shown to be safe and effective, but there remains debate about the best timing for vaccination. Most research into this has focused on serologic immunity, but breastmilk is also important in infant immunity, and the amount of IgA in breastmilk may impact mucosal immunity. It is important to understand if the timing of vaccination in pregnancy affects the concentration of IgA in breastmilk. Methods: Participants recruited as part of the MAMA (Maternal Antibody in Milk After Vaccination) and OpTIMUM (Optimizing the Timing of Whooping Cough Immunisations in Mums) trials received a pertussis-containing vaccine during pregnancy, either before 24 weeks, between 24 and 27⁺⁶ weeks or between 28 and 31⁺⁶ weeks. Samples of colostrum within 24 hours of delivery and breastmilk at 14 days were collected. Pertussis toxin, pertactin, tetanus toxoid and diphtheria toxoid specific-IgA levels were measured using a multiplex immunoassay. Results: There was no difference in specific IgA levels against pertussis toxin, pertactin, tetanus toxoid and diphtheria toxoid between the groups vaccinated within different time periods. For all antigens, there was decay in antigen-specific IgA levels between colostrum and breastmilk at 14 days. Conclusion: Our results suggest that the timing of administration of a pertussis-containing vaccine in pregnancy does not impact on antigen-specific IgA concentration in colostrum or breastmilk at 14 days.