. 2023 Nov 1;152(5):e2023062664.

doi: 10.1542/peds.2023-062664.

Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis

Annette K Regan^{1

2

3}, Hannah C Moore^{1

4}, Michael J Binks⁵, Lisa McHugh⁶, Christopher C Blyth^{4

7}, Gavin Pereira^{1

8}, Karin Lust⁹, Mohinder Sarna^{1

4}, Ross Andrews¹⁰, Damien Foo^{1

4

11}, Paul V Effler¹², Stephen Lambert^{10

13}, Paul Van Buynder¹⁴

Affiliations

¹ School of Population Health, Curtin University, Perth, Western Australia, Australia.
² School of Nursing and Health Professions, University of San Francisco, San Francisco, California.
³ Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
⁴ Wesfarmers Centre of Vaccines and Infectious Diseases.
⁵ Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
⁶ School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
⁷ Division of Pediatrics, University of Western Australia, Nedlands, Western Australia, Australia.
⁸ Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.
⁹ Women's and Newborn Services, Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia.
¹⁰ Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia.
¹¹ Yale School of Environment, Yale University, New Haven, Connecticut.
¹² Department of Health Western Australia, Communicable Disease Control Directorate, Perth, Western Australia, Australia.
¹³ National Centre for Immunization Research and Surveillance, Westmead, New South Wales, Australia.
¹⁴ School of Medicine, Griffith University, Southport, Queensland, Australia.

PMID: 37807881
PMCID: PMC10598625
DOI: 10.1542/peds.2023-062664

Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis

Annette K Regan et al. Pediatrics. 2023.

. 2023 Nov 1;152(5):e2023062664.

doi: 10.1542/peds.2023-062664.

Authors

Affiliations

¹ School of Population Health, Curtin University, Perth, Western Australia, Australia.
² School of Nursing and Health Professions, University of San Francisco, San Francisco, California.
³ Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
⁴ Wesfarmers Centre of Vaccines and Infectious Diseases.
⁵ Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
⁶ School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
⁷ Division of Pediatrics, University of Western Australia, Nedlands, Western Australia, Australia.
⁸ Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.
⁹ Women's and Newborn Services, Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia.
¹⁰ Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia.
¹¹ Yale School of Environment, Yale University, New Haven, Connecticut.
¹² Department of Health Western Australia, Communicable Disease Control Directorate, Perth, Western Australia, Australia.
¹³ National Centre for Immunization Research and Surveillance, Westmead, New South Wales, Australia.
¹⁴ School of Medicine, Griffith University, Southport, Queensland, Australia.

PMID: 37807881
PMCID: PMC10598625
DOI: 10.1542/peds.2023-062664

Abstract

Objectives: Following the introduction of jurisdictional maternal pertussis vaccination programs in Australia, we estimated maternal vaccine effectiveness (VE) and whether maternal pertussis vaccination modified the effectiveness of the first 3 primary doses of pertussis-containing vaccines.

Methods: We conducted a population-based cohort study of 279 418 mother-infant pairs using probabilistic linkage of administrative health records in 3 Australian jurisdictions. Infants were maternally vaccinated if their mother had a documented pertussis vaccination ≥14 days before birth. Jurisdictional immunization records were used to identify receipt of the first 3 infant doses of pertussis-containing vaccines. Infant pertussis infections were identified using notifiable disease records. VE was estimated using Cox proportional hazard models.

Results: Pertussis was administered during 51.7% (n = 144 429/279 418) of pregnancies, predominantly at 28-31 weeks' gestation. VE of maternal pertussis vaccination declined from 70.4% (95% confidence interval [CI], 50.5-82.3) among infants <2 months old to 43.3% (95% CI, 6.8-65.6) among infants 7-8 months old and was not significant after 8 months of age. Although we observed slightly lower VE point estimates for the third dose of infant pertussis vaccine among maternally vaccinated compared with unvaccinated infants (76.5% vs 92.9%, P = .002), we did not observe higher rates of pertussis infection (hazard ratio, 0.70; 95% CI, 0.61-3.39).

Conclusions: Pertussis vaccination near 28 weeks' gestation was associated with lower risk of infection among infants through 8 months of age. Although there was some evidence of lower effectiveness of infant vaccination among maternally vaccinated infants, this did not appear to translate to greater risk of disease.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Moore has received institutional honoraria for participation in advisory groups for Merck Sharpe & Dohme and Pfizer unrelated to the work in this manuscript. Dr Moore is supported by a Stan Perron Charitable Foundation Fellowship and a previous NHMRC fellowship (GNT1034254). Drs Moore and Sarna have received travel funding from Seqirus unrelated to the work in this manuscript. MJB was supported by an NHMRC Early Career Fellowship (GNT1088733). Dr McHugh was supported by a University of Queensland Stimulus grant. Dr Blyth was supported by an NHMRC Career Development Fellowship (GNT1111596). Dr Foo was supported by scholarships provided by the NHMRC and the Wesfarmers Centre of Vaccines and Infectious Disease at the Telethon Kids Institute. Dr Regan was supported by an NHMRC Early Career Fellowship (GNT1138425). Dr Pereira was supported with funding from the NHMRC Project and Investigator Grants 1099655 and 1173991, and the Research Council of Norway through its Centres of Excellence funding scheme 262700. All other authors have no conflicts to disclose.

Figures

**FIGURE 1**
Effectiveness of pertussis vaccination during pregnancy against notified pertussis infection, by infant age in months. Dashed lines indicate 95% confidence intervals. Adjusted estimates controlled for maternal age, First Nations status, asthma, diabetes, hypertension, coronary heart disease, diagnosis of a pregnancy complication, parity, smoking status, trimester of prenatal care initiation, year of conception, socioeconomic status, and receipt of influenza vaccine; inverse probability of treatment weighted (IPTW) estimates were weighted by the inverse probability of receiving diphtheria-tetanus-acellular pertussis vaccine during pregnancy. Probabilities were derived from multivariable logistic regressions predicting the odds of vaccination by maternal age, First Nations status, asthma, diabetes, hypertension, coronary heart disease, diagnosis of a pregnancy complication, parity, smoking status, trimester of prenatal care initiation, year of conception, socioeconomic status, and receipt of influenza vaccine.

**FIGURE 2**
Survival against pertussis infection among (A) maternally vaccinated infants and (B) infants with no record of maternal vaccination, by number of diphtheria-tetanus-acellular pertussis (DTaP) vaccine doses.

See this image and copyright information in PMC

Comment in

Impact of Vaccination During Pregnancy on Infant Pertussis Disease.
Edwards KM. Edwards KM. Pediatrics. 2023 Nov 1;152(5):e2023063067. doi: 10.1542/peds.2023-063067. Pediatrics. 2023. PMID: 37807871 No abstract available.

References

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Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis

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Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis

Authors

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Conflict of interest statement

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