مرور سیستماتیک ایمنی‌زایی واکسن‌های کووید-19 در شیر و سرم مادران شیرده بر اساس شواهد موجود

نوع مقاله : مروری

نویسندگان

1 دانشیار گروه علوم پایه، دکترای تخصصی فیزیولوژی پزشکی، گروه علوم پایه، دانشگاه فرهنگیان، تهران، ایران.

2 دانشجوی کارشناسی مامایی، دانشکده پرستاری و مامایی، واحد نجف‌آباد، دانشگاه آزاد اسلامی، اصفهان، ایران.

چکیده

مقدمه: واکسن‌های کرونا ویروس سندرم حاد تنفسی 2 (SARS-CoV-2) در سراسر جهان در حال تجویز هستند. بااین‌حال، زنان شیرده از روند آزمایش‌های بالینی حذف شدند و اطلاعات محدودی درباره ایمنی واکسن‌ها در برابر SARS-CoV-2 در زنان شیرده در دسترس است. بنابراین، اطلاعات جامعی برای تصمیم‌گیری آگاهانه مادران در مورد لزوم واکسیناسیون در مهار گسترش این ویروس مورد نیاز است. مطالعه مروری حاضر با هدف آشنایی با لزوم واکسیناسیون مادران شیرده علیه ویروس SARS-COV2 و آگاهی از پاسخ‌های ایمنی ایجاد شده در پلاسما و شیر مادران پس از تزریق واکسن‌های COVID-19 انجام شد.
روش‌کار: در این مطالعه مروری سیستماتیک، از منابع اطلاعاتی Google Scholar، PubMed وScience Direct در محدوده زمانی 2021 تا 2022 برای استخراج مقالات پژوهشی حاوی اطلاعات و ایمنی شیر و سرم مادران شیرده واکسینه شده علیه SARS-COV-2 استفاده شد. مقالاتی که با هدف نگارش مقاله ارتباط نداشتند، از روند مطالعه حذف شدند.
یافته ­ها: از 1770 مقاله مربوط به جستجوی اولیه، داده‌های 30 مقاله دربرگیرنده معیارهای ورود بودند. از بین واکسن‌های موجود، تنها اثرات 3 واکسن آسترازنکا، فایزر و مدرنا بر روی ترشح آنتی‌بادی در شیر و سرم مادر مشخص‌ شده بود. نتایج تحقیقات حاضر تأییدکننده حضور آنتی‌بادی‌های ضد SARS-CoV-2 در سرم و شیر مادران واکسینه شده است؛ به‌طوری‌که IgG پس از واکسیناسیون، آنتی‌بادی غالب گزارش ‌شده در بسیاری از پژوهش‌ها بود. بنابراین، برخلاف ایمنی پس از ابتلاء به ویروس، پاسخ اختصاصی واکسن در تسلط IgG است و نه IgA. نقش IgM نیز کم‌رنگ‌تر از سایر آنتی‌بادی‌ها بود.
نتیجه ­گیری: واکسیناسیون مادران شیرده اثرات حفاظتی شیر در برابر عفونت COVID-19 را تقویت می‌کند. لازم است تلاش بیشتری برای تشویق مادران شیرده به واکسیناسیون و حمایت از شیردهی در طول همه‌گیری این بیماری انجام شود.

کلیدواژه‌ها

عنوان مقاله [English]

A systematic review of immunogenicity of Covid-19 vaccines in milk and serum of breastfeeding mothers based on existing evidence

نویسندگان [English]

  • Firoozeh Alavian 1
  • Kimia Alavian 2
1 Associate Professor, PhD in Medical Physiology, Department of Basic Sciences, Farhangian University, Tehran, Iran.
2 B.Sc. Student of Midwifery, School of Nursing and Midwifery, Najafabad Branch, Islamic Azad University, Isfahan, Iran.
چکیده [English]

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are administered worldwide. However, lactating women have been excluded from clinical trials, and limited information is available on the safety of vaccines against SARS-CoV-2 in lactating women. Therefore, comprehensive information is needed for mothers to make informed decisions about the need for vaccination to control the spread of the virus. This review study was conducted aimed to know the necessity of vaccination of breastfeeding mothers against the SARS-COV2 virus and to know the immune responses created in plasma and breast milk after the injection of COVID-19 vaccines.
Methods: In this systematic review study, Google Scholar, PubMed, and Science Direct information sources were used in the period of 2021 to 2022 to extract research articles containing information and the safety of milk and serum of lactating mothers vaccinated against SARS-COV-2. The articles which were not related to the purpose of the article were removed from the study process.
Results: Out of 1770 articles related to the initial search, data from 30 papers met the inclusion criteria. Among the available vaccines, only the effects of AstraZeneca, Pfizer, and Moderna vaccines wereidentified on antibody secretion in breast milk and serum. The results of the presentresearch confirmed the presence of anti-SARS-CoV-2 antibodies in vaccinated serum and breast milk. So, IgG was the predominant antibody reported in many studies after vaccination.Thus, unlike post-viral immunity, the specific response of the vaccine is to dominate IgG and not IgA.The role of IgM was also less than that of other antibodies.
Conclusion: Vaccination of lactating mothers enhances the protective effects of milk against COVID-19 infection. More efforts are needed to encourage breastfeeding mothers to be vaccinated and support breastfeeding during the outbreak.

کلیدواژه‌ها [English]

  • Antibody
  • Breastfeeding
  • COVID-19
  • SARS-CoV-2
  • Vaccine

مراجع

  1. Alavian F, Alavian K. Pregnancy and COVID-19: Physiology, some Challenges, and Solutions. Iran J Obstet Gynecol Infertil 2021; 24(1):99-111.
  2. Fayazi M, Rahmani R, Rahmani Bilandi R. Clinical manifestations, maternal, fetal and neonatal outcomes in pregnant women with COVID-19: A systematic review. Iran J Obstet Gynecol Infertil 2021; 24(7):108-19.‎
  3. Bayrami R, Ebrahimi S. The perception and experiences of pregnant women facing the COVID-19 epidemic: A Qualitative study. Iran J Obstet Gynecol Infertil 2021; 24(8):47-58.
  4. Wang J, Young BE, Li D, Seppo A, Zhou Q, Wiltse A, et al. Broad Cross-reactive IgA and IgG Against Human Coronaviruses in Milk Induced by COVID-19 Vaccination and Infection. Vaccines 2022; 10(6):980.
  5. Jakuszko K, Kościelska-Kasprzak K, Żabińska M, Bartoszek D, Poznański P, Rukasz D, et al. Immune response to vaccination against COVID-19 in breastfeeding health workers. Vaccines 2021; 9(6):663.
  6. Low JM, Gu Y, Ng MS, Amin Z, Lee LY, Ng YP, et al. Codominant IgG and IgA expression with minimal vaccine mRNA in milk of BNT162b2 vaccinees. NPJ vaccines 2021; 6(1):1-8.
  7. Fu W, Sivajohan B, McClymont E, Albert A, Elwood C, Ogilvie G, et al. Systematic review of the safety, immunogenicity, and effectiveness of COVID‐19 vaccines in pregnant and lactating individuals and their infants. International Journal of Gynecology & Obstetrics 2022; 156(3):406-17.
  8. Vitiello A, La Porta R, Troiano V, Ferrara F. COVID-19 vaccination in pregnancy. Drugs & Therapy Perspectives 2021; 37(7):313-4.
  9. Principi N, Esposito S. Is the immunization of pregnant women against COVID-19 justified?. Vaccines 2021; 9(9):970.
  10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology 2009; 62(10):e1-34.
  11. Baird JK, Jensen SM, Urba WJ, Fox BA, Baird JR. SARS-CoV-2 antibodies detected in mother’s milk post-vaccination. Journal of Human Lactation 2021; 37(3):492-8.
  12. Bertrand K, Honerkamp-Smith G, Chambers CD. Maternal and child outcomes reported by breastfeeding women following messenger RNA COVID-19 vaccination. Breastfeeding Medicine 2021; 16(9):697-701.
  13. Schwartz A, Nir O, Toussia-Cohen S, Leibovich L, Strauss T, Asraf K, et al. Presence of SARS-CoV-2 antibodies in lactating women and their infants following BNT162b2 messenger RNA vaccine. American Journal of Obstetrics & Gynecology 2021; 225(5):577-9.
  14. Selma-Royo M, Bäuerl C, Mena-Tudela D, Aguilar-Camprubí L, Pérez-Cano FJ, Parra-Llorca A, et al. Anti-SARS-CoV-2 IgA and IgG in human milk after vaccination is dependent on vaccine type and previous SARS-CoV-2 exposure: A longitudinal study. Genome medicine 2022; 14(1):1-1.
  15. Fox A, Norris C, Amanat F, Zolla-Pazner S, Powell RL. The vaccine-elicited immunoglobulin profile in milk after COVID-19 mRNA-based vaccination is IgG-dominant and lacks secretory antibodies. MedRxiv 2021.
  16. Esteve-Palau E, Gonzalez-Cuevas A, Guerrero ME, Garcia-Terol C, Alvarez MC, Casadevall D, et al. Quantification of specific antibodies against SARS-CoV-2 in breast milk of lactating women vaccinated with an mRNA vaccine. JAMA Network Open 2021; 4(8):e2120575.
  17. Low JM, Gu Y, Ng MS, Amin Z, Ng YP, Bhuvaneshwari D, et al. BNT162b2 vaccination induces SARS-CoV-2 specific antibody secretion into human milk with minimal transfer of vaccine mRNA. medRxiv 2021.
  18. Ai-ris YC, McMahan K, Yu J, Tostanoski LH, Aguayo R, Ansel J, et al. Immunogenicity of COVID-19 mRNA vaccines in pregnant and lactating women. Jama 2021; 325(23):2370-80.
  19. Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N, et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. American journal of obstetrics and gynecology 2021; 225(3):303-e1.
  20. Perl SH, Uzan-Yulzari A, Klainer H, Asiskovich L, Youngster M, Rinott E, et al. SARS-CoV-2–specific antibodies in breast milk after COVID-19 vaccination of breastfeeding women. Jama 2021; 325(19):2013-4.
  21. Friedman MR, Kigel A, Bahar Y, Yogev Y, Dror Y, Lubetzky R, et al. BNT162b2 COVID-19 mRNA vaccine elicits a rapid and synchronized antibody response in blood and milk of breastfeeding women. MedRxiv 2021.
  22. Low JM, Lee LY, Ng YP, Zhong Y, Amin Z. Breastfeeding mother and child clinical outcomes after Covid-19 vaccination. Journal of Human Lactation 2022; 38(1):37-42.
  23. Golan Y, Prahl M, Cassidy AG, Gay C, Wu AH, Jigmeddagva U, et al. COVID-19 mRNA vaccination in lactation: assessment of adverse events and vaccine related antibodies in mother-infant dyads. Frontiers in immunology 2021: 4596.
  24. Juncker HG, Mulleners SJ, van Gils MJ, Bijl TP, de Groot CJ, Pajkrt D, et al. Comparison of sars-cov-2-specific antibodies in human milk after mrna-based covid-19 vaccination and infection. Vaccines 2021; 9(12):1475.
  25. Charepe N, Gonçalves J, Juliano AM, Lopes DG, Canhão H, Soares H. COVID-19 mRNA vaccine and antibody response in lactating women: a prospective cohort study. BMC pregnancy and childbirth 2021; 21(1):1-9.
  26. Atyeo C, DeRiso EA, Davis C, Bordt EA, De Guzman RM, Shook LL, et al. COVID-19 mRNA vaccines drive differential antibody Fc-functional profiles in pregnant, lactating, and nonpregnant women. Science translational medicine 2021; 13(617):eabi8631.
  27. Guida M, Terracciano D, Cennamo M, Aiello F, La Civita E, Esposito G, et al. COVID-19 vaccine mRNABNT162b2 elicits human antibody response in milk of breastfeeding women. Vaccines 2021; 9(7):785.
  28. Valcarce V, Stafford LS, Neu J, Cacho N, Parker L, Mueller M, et al. Detection of SARS-CoV-2-specific IgA in the human milk of COVID-19 vaccinated lactating health care workers. Breastfeeding Medicine 2021; 16(12):1004-9.
  29. Juncker HG, Mulleners SJ, van Gils MJ, de Groot CJ, Pajkrt D, Korosi A, et al. The levels of SARS-CoV-2 specific antibodies in human milk following vaccination. Journal of Human Lactation 2021; 37(3):477-84.
  30. Narayanaswamy V, Pentecost BT, Schoen CN, Alfandari D, Schneider SS, Baker R, et al. Neutralizing antibodies and cytokines in breast milk after coronavirus disease 2019 (COVID-19) mRNA vaccination. Obstetrics and gynecology 2022; 139(2):181-91.
  31. Henle AM. Increase in SARS-CoV-2 RBD-specific IgA and IgG Antibodies in Breast Milk from Lactating Women Following the COVID-19 Booster Vaccination. medRxiv 2022.
  32. Scrimin F, Campisciano G, Comar M, Ragazzon C, Davanzo R, Quadrifoglio M, et al. IgG and IgA antibodies post SARS-CoV-2 vaccine in the breast milk and sera of breastfeeding women. Vaccines 2022; 10(1):125.
  33. Low JM, Gu Y, Ng MS, Wang LW, Amin Z, Zhong Y, et al. Human milk antibodies after Bnt162b2 vaccination exhibit reduced binding against SARS-CoV-2 variants of concern. Vaccines 2022; 10(2):225.
  34. Lechosa-Muñiz C, Paz-Zulueta M, Mendez-Legaza JM, Irure-Ventura J, Cuesta González R, Calvo Montes J, et al. Induction of SARS-CoV-2-specific IgG and IgA in serum and milk with different SARS-CoV-2 vaccines in breastfeeding women: a cross-sectional study in northern Spain. International Journal of Environmental Research and Public Health 2021; 18(16):8831.
  35. Gonçalves J, Juliano AM, Charepe N, Alenquer M, Athayde D, Ferreira F, et al. Secretory IgA and T cells targeting SARS-CoV-2 spike protein are transferred to the breastmilk upon mRNA vaccination. Cell Reports Medicine 2021; 2(12):100468.
  36. Golan Y, Prahl M, Cassidy A, Lin CY, Ahituv N, Flaherman VJ, et al. COVID-19 mRNA vaccine is not detected in human milk. medRxiv 2021.
  37. Romero Ramírez DS, Lara Pérez MM, Carretero Pérez M, Suárez Hernández MI, Martín Pulido S, Pera Villacampa L, et al. SARS-CoV-2 antibodies in breast milk after vaccination. Pediatrics 2021; 148(5).
  38. Adhikari EH, Spong CY. COVID-19 vaccination in pregnant and lactating women. Jama 2021; 325(11):1039-40.
  39. Stuebe A. Considerations for COVID-19 vaccination in lactation. Breastfeeding Medicine 2021; 16(1):2.
  40. Rasmussen SA, Jamieson DJ. Pregnancy, postpartum care, and COVID-19 vaccination in 2021. Jama 2021; 325(11):1099-100.
  41. World Health Organization. COVID-19 vaccines: safety surveillance manual: module on safety surveillance of COVID-19 vaccines in pregnant and breastfeeding women. World health organization; 2021.
مجله زنان، مامایی و نازایی ایران
دوره 25، شماره 9
آذر 1401
صفحه 96-111

فایل ها

هم رسانی

ارجاع به این مقاله

آمار