COVID-19 vaccination before or during pregnancy results in high, sustained maternal neutralizing activity to SARS-CoV-2 wild-type and Delta/Omicron variants of concern, particularly following a booster dose or infection

COVID-19 vaccination before or during pregnancy results in high, sustained maternal neutralizing activity to SARS-CoV-2 wild-type and Delta/Omicron variants of concern, particularly following a booster dose or infection

International Journal of Infectious Diseases

10.1016/j.ijid.2024.107121

https://doi.org/10.1016/j.ijid.2024.107121

Aniza P. Mahyuddin, Hannah L.F. Swa, Ruifen Weng, Jingxian Zhang, Janice P. Dhanaraj, Binny P. Sesurajan, Mary Rauff, Pradip Dashraath, Abhiram Kanneganti, Rachel Lee, Lin-Fa Wang, Barnaby E. Young, Paul A. Tambyah, David C. Lye, Louis Y.A. Chai, Sidney Yee, Mahesh Choolani, Citra N.Z. Mattar

31 May 2024

Mahyuddin, A. P., Swa, H. L. F., Weng, R., Zhang, J., Dhanaraj, J. P., Sesurajan, B. P., Rauff, M., Dashraath, P., Kanneganti, A., Lee, R., Wang, L.-F., Young, B. E., Tambyah, P. A., Lye, D. C., Chai, L. Y. A., Yee, S., Choolani, M., & Mattar, C. N. Z. (2024). COVID-19 vaccination before or during pregnancy results in high, sustained maternal neutralizing activity to SARS-CoV-2 wild-type and Delta/Omicron variants of concern, particularly following a booster dose or infection. International Journal of Infectious Diseases, 146, 107121. https://doi.org/10.1016/j.ijid.2024.107121

Objectives: To investigate multi-dose and timings of COVID-19 vaccines in preventing antenatal infection. Design: Prospective observational study investigating primary vaccinations, boosters, antenatal COVID-19 infections, neutralizing antibody (Nab) durability, and cross-reactivity to Delta and Omicron variants of concern (VOCs). Results: Ninety-eight patients completed primary vaccination prepregnancy (29.6%) and antenatally (63.3%), 24.2% of whom had antenatal COVID-19, while 7.1% were unvaccinated (28.6% had antenatal COVID-19). None had severe COVID-19. Prepregnancy vaccination resulted in vaccination-to-infection de- lay of 23.3 weeks, which extended to 45.2 weeks with a booster, compared to 16.9 weeks following ante- natal vaccination ( P < 0.001). Infections occurred at 26.2 weeks gestation in women vaccinated prepreg- nancy compared to 36.2 weeks gestation in those vaccinated during pregnancy ( P < 0.007). The risk of COVID-19 infection was higher without antenatal vaccination (hazard ratio [HR] 14.6, P = 0.05) and after prepregnancy vaccination without a booster (HR 10.4, P = 0.002). Antenatal vaccinations initially led to high Nab levels, with mild waning but subsequent rebound. Significant Nab enhancement occurred with a third-trimester booster. Maternal-neonatal Nab transfer was efficient (transfer ratio > 1), and cross- reactivity to VOCs was observed. Conclusion: Completing vaccination during any trimester delays COVID-19 infection and maintains ef- fective neutralizing activity throughout pregnancy, with robust cross-reactivity to VOCs and efficient maternal-neonatal transfer.

Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

This research / project is supported by the National Research Foundation - Innovation & Enterprise (I&E) Cluster Fund
Grant Reference no. : NRF2020-IE-IECF-005

This research / project is supported by the MOH National Medical Research Council - Clinician Scientist Award
Grant Reference no. : NMRC/MOH000672, NMRC/MOH000668

https://oar.a-star.edu.sg/communities-collections/articles/22225

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