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Durability of Anti-Spike Antibodies in Infants After Maternal COVID-19 Vaccination or Natural Infection

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

COVID-19 vaccination in pregnancy generates functional anti-spike (anti-S) IgG antibodies in maternal circulation that are detectable in umbilical cord blood at birth and can protect newborns and infants from COVID-19.14 Anti-S IgG titers in the umbilical cord are correlated with maternal titers and are highest after late second and early third trimester vaccination.24 We characterized the persistence of vaccine-induced maternal anti-S IgG in infant blood and compared persistence of infant anti-S IgG after maternal vaccination vs natural infection.

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Article Information

Accepted for Publication: January 21, 2022.

Published Online: February 7, 2022. doi:10.1001/jama.2022.1206

Corresponding Author: Andrea G. Edlow, MD, MSc, Department of Obstetrics & Gynecology, Massachusetts General Hospital, 55 Fruit St, Their Bldg, Floor 9, Boston, MA 02114 (aedlow@mgh.harvard.edu).

Author Contributions: Drs Alter and Edlow had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Shook and Ms Atyeo contributed equally to this work. Drs Alter and Edlow contributed equally to this work.

Concept and design: Yonker, Fasano, Alter, Edlow.

Acquisition, analysis, or interpretation of data: Shook, Atyeo, Yonker, Gray, Alter, Edlow.

Drafting of the manuscript: Shook, Atyeo, Yonker, Alter, Edlow.

Critical revision of the manuscript for important intellectual content: Shook, Atyeo, Yonker, Fasano, Gray, Alter.

Statistical analysis: Shook, Atyeo, Alter, Edlow.

Obtained funding: Fasano, Alter, Edlow.

Administrative, technical, or material support: Yonker, Gray, Alter, Edlow.

Supervision: Yonker, Fasano, Gray, Alter, Edlow.

Conflict of Interest Disclosures: Dr Fasano reported being a cofounder and stockholder of Alba Therapeutics; serving on the scientific advisory board of Viome; and receiving personal fees from Milky Way and Mead Johnson Nutrition. Dr Gray reported receiving nonfinancial support from Illumina, Aetion, and BillionToOne. Dr Alter reported being the founder of and consultant to Systems Seromyx; receiving grants from Sanofi, GlaxoSmithKline, BioNTech, and Medicago; and being a consultant to Leyden Labs. No other disclosures were reported.

Funding/Support: This study was supported by grants 1R01HD100022-01 and 3R01HD100022-02S2 (Dr Edlow) and 1K12HD103096 (Dr Shook) from the National Institute of Child Health and Human Development; grant 6-FY20-223 from the March of Dimes (Dr Edlow); grants K08HL1469630-03 and 3K08HL146963-02S1 (Dr Gray) and 5K08HL143183 (Dr Yonker) from the National Heart, Lung, and Blood Institute; the Ragon Institute of MGH, MIT, and Harvard and the MGH ECOR Scholars award (Dr Alter); the Nancy Zimmerman, Samana Kay MGH Research Scholars award (Dr Alter); grants 3R37AI080289-11S1, R01AI146785, U19AI42790-01, U19AI135995-02, 1U01CA260476-01, and CIVIC5N93019C00052 from the National Institute of Allergy and Infectious Diseases (Dr Alter); and grants OPP1146996 and INV-001650 from the Gates Foundation Global Health Vaccine Accelerator Platform (Dr Alter). The TAPII blood collection devices for infant blood draw were provided at reduced cost by YourBio Health.

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Madeleine Burns, BS, MS, of the Massachusetts General Hospital Department of Pediatrics, for her contributions to participant recruitment and sample collection. She was not compensated for this work beyond her salary as a clinical research coordinator.

Gray  KJ , Bordt  EA , Atyeo  C ,  et al.  Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study.   Am J Obstet Gynecol. 2021;225(3):303-303. doi:10.1016/j.ajog.2021.03.023PubMedGoogle ScholarCrossref
Prabhu  M , Murphy  EA , Sukhu  AC ,  et al.  Antibody response to coronavirus disease 2019 (COVID-19) messenger RNA vaccination in pregnant women and transplacental passage into cord blood.   Obstet Gynecol. 2021;138(2):278-280. doi:10.1097/AOG.0000000000004438PubMedGoogle Scholar
Beharier  O , Plitman Mayo  R , Raz  T ,  et al.  Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine.   J Clin Invest. 2021;131(13):e150319. doi:10.1172/JCI150319PubMedGoogle Scholar
Mithal  LB , Otero  S , Shanes  ED , Goldstein  JA , Miller  ES .  Cord blood antibodies following maternal coronavirus disease 2019 vaccination during pregnancy.   Am J Obstet Gynecol. 2021;225(2):192-194. doi:10.1016/j.ajog.2021.03.035PubMedGoogle ScholarCrossref
Yang  YJ , Murphy  EA , Singh  S ,  et al.  Association of gestational age at coronavirus disease 2019 (COVID-19) vaccination, history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and a vaccine booster dose with maternal and umbilical cord antibody levels at delivery.   Obstet Gynecol. Published online December 28, 2021. doi:10.1097/AOG.0000000000004693PubMedGoogle Scholar
Dong  Y , Mo  X , Hu  Y ,  et al.  Epidemiology of COVID-19 among children in China.   Pediatrics. 2020;145(6):e20200702. doi:10.1542/peds.2020-0702PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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