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Vertical transmission and humoral immune response following maternal infection with SARS-CoV-2 - A prospective multicenter cohort study
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  • Manal Massalha,
  • Enav Yefet,
  • Orit Rozenberg ,
  • Sofia Soltsman ,
  • Jamal Hasanein ,
  • Tatiana Smolkin ,
  • Adi Alter ,
  • Yuri Perlitz,
  • Zohar Nachum
Manal Massalha
Emek Medical Center

Corresponding Author:[email protected]

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Enav Yefet
Emek Medical Center
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Orit Rozenberg
Emek Medical Center
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Sofia Soltsman
Baruch Padeh Medical Center Poriya
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Jamal Hasanein
Emek Medical Center
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Tatiana Smolkin
Baruch Padeh Medical Center Poriya
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Adi Alter
Baruch Padeh Medical Center Poriya
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Yuri Perlitz
The Baruch Padeh Medical Center, Poriya. Affiliated to the Faculty of Medicine in the Galilee. Bar-Ilan University Safed, Israel.
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Zohar Nachum
Emek Medical Center
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Abstract

Objective: To explore maternal humoral immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the rate of vertical transmission. Design: A prospective cohort study. Setting: Two university-affiliated medical centers in Israel. Population: Women positive for SARS-CoV-2 reverse-transcription-polymerase-chain-reaction (RT-PCR) test, during pregnancy were enrolled just prior to delivery. Methods: Levels of anti-SARS-CoV-2 spike-IgM, spike-IgG and nucleocapsid-IgG were tested in maternal and cord blood at delivery, and neonatal nasopharyngeal swabs were subjected to PCR testing. Main outcomes measures: The primary endpoint was the rate of vertical transmission, defined as either positive neonatal IgM, positive neonatal IgG with sero-negative mother or positive neonatal PCR. Results: Among 72 women, 36 (50%), 39 (54%) and 30 (42%) were positive for anti-spike-IgM, anti-spike-IgG and anti-nucleocapsid-IgG, respectively (p<0.0001 for IgG antibodies-comparison). At least 8/72 (11%) neonates were infected in utero; one had a positive PCR result and seven had positive IgG antibodies while their mothers were seronegative for the same IgG. IgM was not detected in cord blood. Anti-nucleocapsid-IgG and anti-spike-IgG were detected in 83% and 85% of neonates of seropositive mothers, respectively (Pearson coefficient correlation 0.8, p<0.001). The highest rate of positive maternal serology tests was 8-12 weeks post-infection (89% anti-spike IgG, 78% anti-spike-IgM and 67% anti-nucleocapsid-IgG). Thereafter, the rate of positive serology tests declined gradually; at 20 weeks post-infection, only anti-spike-IgG was detected in 33-50%. Conclusions: The rate of vertical transmission was at least 11%. Vaccination should be considered 3 months post-infection in pregnant women due to a decline in antibody levels.