Quantification of Vaccine-induced Antipertussis Toxin Secretory IgA Antibodies in Breast Milk Comparison of Different Vaccination Strategies in Women

Background: Pertussis vaccination during pregnancy or immediately after delivery is a strategy that is increasingly being recommended to protect young infants from disease. Breast milk contains disease-specific antibodies that can contribute to the protection of young infants. The composition of breast milk could be altered by vaccination during pregnancy or near delivery. However, the quantification of these antibodies in breast milk lacks standardization. Methods: In this paper, sample preparation procedures and detection methods for total and antipertussis toxin (anti-PT) secretory immunoglobulin (sIg) A are proposed that can be accurately repeated and are in accordance with European Medicines Agency and Food and Drug Administration requirements. Both antibody analytes were measured in breast milk samples of lactating women obtained 8-9 weeks postpartum to compare different maternal pertussis vaccination strategies: vaccination during pregnancy, shortly after or at delivery (cocoon), less than 5 years before delivery or more than 5 years before delivery. Results: The validated immunoassays could quantitatively detect total and anti-PT sIgA in the processed breast milk samples. Significantly higher levels of anti-PT sIgA were measured in breast milk after pertussis vaccination during pregnancy or at delivery [geometric mean concentration (GMC): 2.56 and 2.15 IU/mg] in contrast to mothers with no recent (> 5 years) pertussis vaccination (GMC: 0.96 IU/mg; P = 0.014 and P = 0.028). Conclusion: Vaccination against pertussis in the second/third trimester of pregnancy or immediately postpartum significantly increased the levels of anti-PT sIgA in breast milk.