Maternal hybrid immunity and risk of infant COVID-19 hospitalizations: national case-control study in Israel

Joshua Guedalia, Michal Lipschuetz (), Adva Cahen-Peretz, Sarah M. Cohen, Yishai Sompolinsky, Galit Shefer, Eli Melul, Zivanit Ergaz-Shaltiel, Debra Goldman-Wohl, Simcha Yagel, Ronit Calderon-Margalit and Ofer Beharier ()
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Joshua Guedalia: Faculty of Medicine of the Hebrew University of Jerusalem
Michal Lipschuetz: Faculty of Medicine of the Hebrew University of Jerusalem
Adva Cahen-Peretz: Faculty of Medicine of the Hebrew University of Jerusalem
Sarah M. Cohen: Faculty of Medicine of the Hebrew University of Jerusalem
Yishai Sompolinsky: Faculty of Medicine of the Hebrew University of Jerusalem
Galit Shefer: Israel Ministry of Health
Eli Melul: Israel Ministry of Health
Zivanit Ergaz-Shaltiel: Faculty of Medicine of the Hebrew University of Jerusalem
Debra Goldman-Wohl: Faculty of Medicine of the Hebrew University of Jerusalem
Simcha Yagel: Faculty of Medicine of the Hebrew University of Jerusalem
Ronit Calderon-Margalit: Faculty of Medicine of the Hebrew University of Jerusalem
Ofer Beharier: Faculty of Medicine of the Hebrew University of Jerusalem

Nature Communications, 2024, vol. 15, issue 1, 1-9

Abstract: Abstract Hybrid immunity, acquired through vaccination followed or preceded by a COVID-19 infection, elicits robust antibody augmentation. We hypothesize that maternal hybrid immunity will provide greater infant protection than other forms of COVID-19 immunity in the first 6 months of life. We conducted a case-control study in Israel, enrolling 661 infants up to 6 months of age, hospitalized with COVID-19 (cases) and 59,460 age-matched non-hospitalized infants (controls) between August 24, 2021, and March 15, 2022. Infants were grouped by maternal immunity status at delivery: Naïve (never vaccinated or tested positive, reference group), Hybrid-immunity (vaccinated and tested positive), Natural-immunity (tested positive before or during the study period), Full-vaccination (two-shot regimen plus 1 booster), and Partial-vaccination (less than full three shot regimen). Applying Cox proportional hazards models to estimate the hazard ratios, which was then converted to percent vaccine effectiveness, and using the Naïve group as the reference, maternal hybrid-immunity provided the highest protection (84% [95% CI 75-90]), followed by full-vaccination (66% [95% CI 56-74]), natural-immunity (56% [95% CI 39-68]), and partial-vaccination (29% [95% CI 15-41]). Maternal hybrid-immunity was associated with a reduced risk of infant hospitalization for Covid-19, as compared to natural-immunity, regardless of exposure timing or sequence. These findings emphasize the benefits of vaccinating previously infected individuals during pregnancy to reduce COVID-19 hospitalizations in early infancy.

Date: 2024
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DOI: 10.1038/s41467-024-46694-x

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