Effect of Maternal Vaccination of PCV-10, PPV-23 or Placebo on the Immunogenicity of PCV-10 in HIV-exposed Uninfected Infants: A Randomized Clinical Trial

Abstract Background The effect of pneumococcal vaccination of mothers with HIV on infant responses to childhood vaccination has not been studied. We compared the immunogenicity of PCV-10 in HIV-exposed uninfected infants born to mothers who received PCV-10, PPV-23 or placebo during pregnancy. Methods Antibody levels against seven serotypes were measured at birth, before the 1 st and 2 nd doses of PCV-10 and after the completion of the 2-dose regimen in 347 infants, including 112 born to mothers who received PPV-23, 112 PCV-10, and 119 placebo during pregnancy. Seroprotection was defined by antibody levels ≥0.35µg/ml. Results At birth and 8 weeks of life, antibody levels were similar in infants born to PCV-10- or PPV-23-recipient mothers and higher than infants of placebo-recipient mothers. After the last dose of PCV-10, infants in the maternal PCV-10 group had significantly lower antibody levels against five serotypes compared to infants in the maternal PPV-23 group; against three serotypes compared to infants in the maternal placebo group; and did not have higher antibody levels against any serotype. The seroprotection rate against seven serotypes was 50% in infants in the maternal PCV-10 compared to 71% in each of the maternal PPV-23 and placebo groups (p<0.0001). Conclusions Administration of PCV-10 during pregnancy was associated with decreased antibody responses to PCV-10 and seroprotection rates in infants. Considering that PCV-10 and PPV-23 had similar immunogenicity in pregnant women with HIV and that administration of PPV-23 did not affect the immunogenicity of PCV-10 in infants, PPV-23 in pregnancy may be preferred over PCV-10.