Effect of Maternally Derived Anti-protein and Anticapsular IgG Antibodies on the Rate of Acquisition of Nasopharyngeal Carriage of Pneumococcus in Newborns
BACKGROUND: In developing countries, introduction of pneumococcal conjugate vaccine has not eliminated circulation of vaccine
serotypes. Vaccinating pregnant mothers to increase antibody concentrations in their newborn infants may reduce the acquisition
of pneumococcal carriage and subsequent risk of disease. We explored the efficacy of passive immunity, attributable to anti-protein
and anticapsular pneumococcal antibodies, against acquisition of carriage.
METHODS: We examined the rate of nasopharyngeal acquisition of pneumococci in the first 90 days of life associated with varying
anticapsular and anti-protein antibody concentrations in infant cord/maternal venous blood in Kilifi, Kenya. We used multivariable
Cox proportional hazard models to estimate continuous functions relating acquisition of nasopharyngeal carriage to the concentration
of maternally derived antibody.
RESULTS: Cord blood or maternal venous samples were collected from 976 mother-infant pairs. Pneumococci were acquired 561
times during 33,905 person-days of follow-up. Increasing concentrations of anti-protein antibodies were associated with either a
reduction (PhtD1, PspAFam2, Spr0096, StkP) or, paradoxically, an increase (CbpA, LytC, PcpA, PiaA, PspAFam1, RrgBT4) in acquisition
rate. We observed a nonsignificant reduction in the incidence of homologous carriage acquisition with high concentrations of
maternally derived anticapsular antibodies to 5 serotypes (6A, 6B, 14, 19F, and 23F).
CONCLUSION: The protective efficacy of several anti-protein antibodies supports the strategy of maternal vaccination to protect
young infants from carriage and invasive disease. We were not able to demonstrate that passive anticapsular antibodies were protective
against carriage acquisition at naturally occurring concentrations though it remains possible they may do so at the higher
concentrations elicited by vaccination