1887

Journal of Medical Microbiology logo

Volume 67, Issue 10

Review of vaccination in pregnancy to prevent pertussis in early infancy Free

Abstract

Maternal pertussis vaccination has been introduced in several countries to protect infants from birth until routine infant vaccination takes place. This review assesses existing evidence on the effectiveness and safety of immunization in pregnancy. The search was finalized in April 2017 and was based on searches using several databases. The selection criteria included any experimental or observational study reporting on the immunogenicity, effectiveness or safety of vaccination with a pertussis-containing vaccine in pregnant women and their infants. Following de-duplication and exclusions, we identified 8395 studies, which were reduced to 46 for inclusion. The overall risk of bias was low, with the exception of some early studies and pharmacovigilance safety data. The evidence demonstrates efficient transplacental transfer of maternal antibodies in infants whose mothers were vaccinated with Tdap or Tdap/IPV in pregnancy, with good evidence that this protects against disease in young infants. Safety studies covering more than 150 000 women vaccinated mostly in the late second or third trimesters are generally consistent and provide reassurance of no significant increased risk of recognized maternal conditions or of adverse events (including congenital anomalies) in infants born to vaccinated women. The clinical significance of reduced seroconversion to pertussis following routine immunization is not yet clear, but no increased risk of pertussis in infants whose mothers were vaccinated in pregnancy was found following primary immunizations in North American and English studies. Most post-booster studies suggest that any blunting effect is short-lived and that longer-term protection in infants from active immunization is not compromised.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): maternal vaccination , pertussis , review , vaccine effectiveness and vaccine safety
© Crown copyright 2018 You may re-use this information (excluding logos) free of charge
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000829
2018-09-17
2024-04-24
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/10/1426.html?itemId=/content/journal/jmm/10.1099/jmm.0.000829&mimeType=html&fmt=ahah

References

  1. Amirthalingam G, Gupta S, Campbell H. Pertussis immunisation and control in England and Wales, 1957 to 2012: a historical review. Euro Surveill 2013; 18:20587 [View Article][PubMed]
     [Google Scholar]
  2. World Health Organisation Pertussis vaccines: WHO position paper. Wkly Epidemiol Rec 2010; 85:385–400[PubMed]
     [Google Scholar]
  3. Campbell H, Amirthalingam G, Fry NK, Litt D, Harrison TG et al. Oral fluid testing for pertussis, England and Wales, June 2007-August 2009. Emerg Infect Dis 2014; 20:968–975 [View Article][PubMed]
     [Google Scholar]
  4. Zhang L, Prietsch SO, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Database Syst Rev 2014 Art. No.:CD001478 [View Article][PubMed]
     [Google Scholar]
  5. World Health Organisation Pertussis vaccines: WHO position paper - September 2015. Wkly Epidemiol Rec 2015; 90:433–458[PubMed]
     [Google Scholar]
  6. World Health Organisation Revised guidance on the choice of pertussis vaccines: July 2014. Wkly Epidemiol Rec 2014; 89:337–340[PubMed]
     [Google Scholar]
  7. Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci USA 2014; 111:787–792 [View Article][PubMed]
     [Google Scholar]
  8. Quinn HE, McIntyre PB. Pertussis epidemiology in Australia over the decade 1995-2005-trends by region and age group. Commun Dis Intell Q Rep 2007; 31:205–215[PubMed]
     [Google Scholar]
  9. Skowronski DM, de Serres G, MacDonald D, Wu W, Shaw C et al. The changing age and seasonal profile of pertussis in Canada. [Erratum appears in J Infect Dis 2002 Jun 1;185(11):1696]. J Infect Dis 2002; 185:1448–1453
     [Google Scholar]
  10. Tan T, Trindade E, Skowronski D. Epidemiology of pertussis. Pediatr Infect Dis J 2005; 24:S10–S18 [View Article][PubMed]
     [Google Scholar]
  11. Somerville RL, Grant CC, Scragg RK, Thomas MG. Hospitalisations due to pertussis in New Zealand in the pre-immunisation and mass immunisation eras. J Paediatr Child Health 2007; 43:147–153 [View Article][PubMed]
     [Google Scholar]
  12. Spokes PJ, Gilmour RE. NSW Annual vaccine-preventable Disease report, 2009. NSW Public Heal Bull 2009; 21:
     [Google Scholar]
  13. Tanaka M, Vitek CR, Pascual FB, Bisgard KM, Tate JE et al. Trends in pertussis among infants in the United States, 1980-1999. JAMA 2003; 290:2968–2975 [View Article][PubMed]
     [Google Scholar]
  14. Centers for Disease Control and Prevention (CDC) Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep 2011; 60:1424–1426[PubMed]
     [Google Scholar]
  15. Centers for Disease Control and Prevention (CDC) Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women-Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 2013; 62:131–135[PubMed]
     [Google Scholar]
  16. Vizzotti C, Neyro S, Katz N, Juárez MV, Perez Carrega ME et al. Maternal immunization in Argentina: A storyline from the prospective of a middle income country. Vaccine 2015; 33:6413–6419 [View Article][PubMed]
     [Google Scholar]
  17. Department of Health 2012; Pregnant women to be offered whooping cough vaccination. www.dh.gov.uk/health/2012/09/whooping-cough/
  18. Demicheli V, Barale A, Rivetti A. Vaccines for women for preventing neonatal tetanus. Cochrane Database Syst Rev 2015; 7:CD002959
     [Google Scholar]
  19. World Health Organisation Vaccines against influenza WHO position paper – November 2012. Wkly Epidemiol Rec 2012; 87:461–476[PubMed]
     [Google Scholar]
  20. Halperin BA, Morris A, MacKinnon-Cameron D, Mutch J, Langley JM et al. Kinetics of the antibody response to tetanus-diphtheria-acellular pertussis vaccine in women of childbearing age and postpartum women. Clin Infect Dis 2011; 53:885–892 [View Article][PubMed]
     [Google Scholar]
  21. van Rie A, Wendelboe AM, Englund JA. Role of maternal pertussis antibodies in infants. Pediatr Infect Dis J 2005; 24:S62–S65 [View Article][PubMed]
     [Google Scholar]
  22. Healy CM, Munoz FM, Rench MA, Halasa NB, Edwards KM et al. Prevalence of pertussis antibodies in maternal delivery, cord, and infant serum. J Infect Dis 2004; 190:335–340 [View Article][PubMed]
     [Google Scholar]
  23. van Savage J, Decker MD, Edwards KM, Sell SH, Karzon DT. Natural history of pertussis antibody in the infant and effect on vaccine response. J Infect Dis 1990; 161:487–492 [View Article][PubMed]
     [Google Scholar]
  24. Gonik B, Puder KS, Gonik N, Kruger M. Seroprevalence of Bordetella pertussis antibodies in mothers and their newborn infants. Infect Dis Obstet Gynecol 2005; 13:59–61 [View Article][PubMed]
     [Google Scholar]
  25. Healy CM, Rench MA, Edwards KM, Baker CJ. Pertussis serostatus among neonates born to Hispanic women. Clin Infect Dis 2006; 42:1439–1442 [View Article][PubMed]
     [Google Scholar]
  26. Healy CM, Baker CJ. Prospects for prevention of childhood infections by maternal immunization. Curr Opin Infect Dis 2006; 19:271–276 [View Article][PubMed]
     [Google Scholar]
  27. Wharton M, Bisgard KM, Murphy TV. Use of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine as a five-dose series. Supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2000; 49:1–8
     [Google Scholar]
  28. Englund JA, Anderson EL, Reed GF, Decker MD, Edwards KM et al. The effect of maternal antibody on the serologic response and the incidence of adverse reactions after primary immunization with acellular and whole-cell pertussis vaccines combined with diphtheria and tetanus toxoids. Pediatrics 1995; 96:580–584[PubMed]
     [Google Scholar]
  29. Niewiesk S. Maternal antibodies: clinical significance, mechanism of interference with immune responses, and possible vaccination strategies. Front Immunol 2014; 5: [View Article][PubMed]
     [Google Scholar]
  30. Halasa NB, O'Shea A, Shi JR, Lafleur BJ, Edwards KM. Poor immune responses to a birth dose of diphtheria, tetanus, and acellular pertussis vaccine. J Pediatr 2008; 153:327–332 [View Article][PubMed]
     [Google Scholar]
  31. Jones C, Pollock L, Barnett SM, Battersby A, Kampmann B. The relationship between concentration of specific antibody at birth and subsequent response to primary immunization. Vaccine 2014; 32:996–1002 [View Article][PubMed]
     [Google Scholar]
  32. Egger M, Zellweger-Zähner T, Schneider M, Junker C, Lengeler C et al. Language bias in randomised controlled trials published in English and German. Lancet 1997; 350:326–329 [View Article][PubMed]
     [Google Scholar]
  33. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343:d5928 [View Article][PubMed]
     [Google Scholar]
  34. Cohen P, Scadron S. The placental transmission of protective antibodies against whooping cough: By inoculation of the pregnant mother. JAMA 1943; 121:656–662
     [Google Scholar]
  35. Lichty JA, Slavin B, Bradford WL. An attempt to increase resistance to pertussis in newborn infants by immunizing their mothers during pregnancy. J Clin Invest 1938; 17:613–621 [View Article][PubMed]
     [Google Scholar]
  36. Moro PL, Cragan J, Tepper N, Zheteyeva Y, Museru O et al. Enhanced surveillance of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines in pregnancy in the Vaccine Adverse Event Reporting System (VAERS), 2011-2015. Vaccine 2016; 34:2349–2353 [View Article][PubMed]
     [Google Scholar]
  37. Zheteyeva YA, Moro PL, Tepper NK, Rasmussen SA, Barash FE et al. Adverse event reports after tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines in pregnant women. Am J Obstet Gynecol 2012; 207:59.e1–7 [View Article][PubMed]
     [Google Scholar]
  38. Kent A, Ladhani SN, Andrews NJ, Matheson M, England A et al. Pertussis antibody concentrations in infants born prematurely to mothers vaccinated in pregnancy. Pediatrics 2016; 138:e20153854 [View Article][PubMed]
     [Google Scholar]
  39. Hardy-Fairbanks AJ, Pan SJ, Decker MD, Johnson DR, Greenberg DP et al. Immune responses in infants whose mothers received Tdap vaccine during pregnancy. Pediatr Infect Dis J 2013; 32:1257–1260 [View Article][PubMed]
     [Google Scholar]
  40. Healy CM, Rench MA, Baker CJ. Importance of timing of maternal combined tetanus, diphtheria, and acellular pertussis (Tdap) immunization and protection of young infants. Clin Infect Dis 2013; 56:539–544 [View Article][PubMed]
     [Google Scholar]
  41. Hoang HT, Leuridan E, Maertens K, Nguyen TD, Hens N et al. Pertussis vaccination during pregnancy in Vietnam: Results of a randomized controlled trial Pertussis vaccination during pregnancy. Vaccine 2016; 34:151–159 [View Article][PubMed]
     [Google Scholar]
  42. Maertens K, Caboré RN, Huygen K, Hens N, van Damme P et al. Pertussis vaccination during pregnancy in Belgium: Results of a prospective controlled cohort study. Vaccine 2016; 34:142–150 [View Article][PubMed]
     [Google Scholar]
  43. Maertens K, Hoang TT, Nguyen TD, Caboré RN, Duong TH et al. The Effect of Maternal Pertussis Immunization on Infant Vaccine Responses to a Booster Pertussis-Containing Vaccine in Vietnam. Clin Infect Dis 2016; 63:S197–S204 [View Article][PubMed]
     [Google Scholar]
  44. Maertens K, Caboré RN, Huygen K, Vermeiren S, Hens N et al. Pertussis vaccination during pregnancy in Belgium: Follow-up of infants until 1 month after the fourth infant pertussis vaccination at 15 months of age. Vaccine 2016; 34:3613–3619 [View Article][PubMed]
     [Google Scholar]
  45. Petousis-Harris H, Walls T, Watson D, Paynter J, Graham P et al. Safety of Tdap vaccine in pregnant women: an observational study. BMJ Open 2016; 6:e010911 [View Article][PubMed]
     [Google Scholar]
  46. Cohen P, Scadron SJ. The effects of active immunization of the mother upon the offspring. J Pediatr 1946; 29:609–619 [View Article][PubMed]
     [Google Scholar]
  47. Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E et al. Effectiveness of maternal pertussis vaccination in England: an observational study. Lancet 2014; 384:1521–1528 [View Article][PubMed]
     [Google Scholar]
  48. Amirthalingam G, Campbell H, Ribeiro S, Fry NK, Ramsay M et al. Sustained Effectiveness of the Maternal Pertussis Immunization Program in England 3 Years Following Introduction. Clin Infect Dis 2016; 63:S236–S243 [View Article][PubMed]
     [Google Scholar]
  49. Dabrera G, Amirthalingam G, Andrews N, Campbell H, Ribeiro S et al. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012-2013. Clin Infect Dis 2015; 60:333–337 [View Article][PubMed]
     [Google Scholar]
  50. Winter K, Cherry JD, Harriman K. Effectiveness of prenatal tetanus, diphtheria, and acellular pertussis vaccination on pertussis severity in infants. Clin Infect Dis 2017; 64:9–14 [View Article][PubMed]
     [Google Scholar]
  51. Winter K, Nickell S, Powell M, Harriman K. Effectiveness of prenatal versus postpartum tetanus, diphtheria, and acellular pertussis vaccination in preventing infant pertussis. Clin Infect Dis 2017; 64:3–8 [View Article][PubMed]
     [Google Scholar]
  52. Baxter R, Bartlett J, Fireman B, Lewis E, Klein NP. Effectiveness of vaccination during pregnancy to prevent infant pertussis. Pediatrics 2017; 139:e20164091 [View Article][PubMed]
     [Google Scholar]
  53. Mishulow L, Leifer L, Sherwood C, Schlesinger S, Berkey S. Pertussis antibodies in pregnant women: protective, agglutinating and complement-fixing antibodies before and after vaccination. Am J Dis Child 1942; 64:608–617
     [Google Scholar]
  54. Donegan K, King B, Bryan P. Safety of pertussis vaccination in pregnant women in UK: observational study. BMJ 2014; 349:g4219 [View Article][PubMed]
     [Google Scholar]
  55. Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Klein NP, Cheetham TC et al. Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes. JAMA 2014; 312:1897–1904 [View Article][PubMed]
     [Google Scholar]
  56. Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Klein NP, Cheetham TC et al. Maternal Tdap vaccination: coverage and acute safety outcomes in the vaccine safety datalink, 2007-2013. Vaccine 2016; 34:968–973 [View Article][PubMed]
     [Google Scholar]
  57. Morgan JL, Baggari SR, McIntire DD, Sheffield JS. Pregnancy outcomes after antepartum tetanus, diphtheria, and acellular pertussis vaccination. Obstet Gynecol 2015; 125:1433–1438 [View Article][PubMed]
     [Google Scholar]
  58. Shakib JH, Korgenski K, Sheng X, Varner MW, Pavia AT et al. Tetanus, diphtheria, acellular pertussis vaccine during pregnancy: pregnancy and infant health outcomes. J Pediatr 2013; 163:1422–1426 [View Article][PubMed]
     [Google Scholar]
  59. Walls T, Graham P, Petousis-Harris H, Hill L, Austin N. Infant outcomes after exposure to Tdap vaccine in pregnancy: an observational study. BMJ Open 2016; 6:e009536 [View Article][PubMed]
     [Google Scholar]
  60. Villarreal Pérez JZ, Ramírez Aranda JM, de La O Cavazos M, Zamudio Osuna MJ, Perales Dávila J et al. Randomized clinical trial of the safety and immunogenicity of the Tdap vaccine in pregnant Mexican women. Hum Vaccin Immunother 2017; 13:128–135 [View Article][PubMed]
     [Google Scholar]
  61. Berenson AB, Hirth JM, Rahman M, Laz TH, Rupp RE et al. Maternal and infant outcomes among women vaccinated against pertussis during pregnancy. Hum Vaccin Immunother 2016; 12:1965–1971 [View Article][PubMed]
     [Google Scholar]
  62. Desilva M, Vazquez-Benitez G, Nordin JD, Lipkind HS, Romitti PA et al. Tdap vaccination during pregnancy and microcephaly and other structural birth defects in offspring. JAMA 2016; 316:1823–1825 [View Article][PubMed]
     [Google Scholar]
  63. Munoz FM, Bond NH, Maccato M, Pinell P, Hammill HA et al. Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. JAMA 2014; 311:1760–1769 [View Article][PubMed]
     [Google Scholar]
  64. Kendrick P. Immunity response of mothers and babies to injections of pertussis vaccine during pregnancy. Arch Pediatr Adolesc Med 1945; 70:25–28 [View Article]
     [Google Scholar]
  65. Naidu MA, Muljadi R, Davies-Tuck ML, Wallace EM, Giles ML. The optimal gestation for pertussis vaccination during pregnancy: a prospective cohort study. Am J Obstet Gynecol 2016; 215:237.e1-6 [View Article][PubMed]
     [Google Scholar]
  66. Gall SA, Myers J, Pichichero M. Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels. Am J Obstet Gynecol 2011; 204:334.e1–5 [View Article][PubMed]
     [Google Scholar]
  67. Fallo AA, Neyro SE, Manonelles GV, Lara C, Hozbor D et al. Prevalence of pertussis antibodies in maternal blood, cord serum, and infants from mothers with and those without Tdap booster vaccination during pregnancy in Argentina. J Pediatric Infect Dis Soc 2018; 7:piw069–7 [View Article][PubMed]
     [Google Scholar]
  68. Vilajeliu A, Goncé A, López M, Costa J, Rocamora L et al. Combined tetanus-diphtheria and pertussis vaccine during pregnancy: transfer of maternal pertussis antibodies to the newborn. Vaccine 2015; 33:1056–1062 [View Article][PubMed]
     [Google Scholar]
  69. Huygen K, Caboré RN, Maertens K, van Damme P, Leuridan E. Humoral and cell mediated immune responses to a pertussis containing vaccine in pregnant and nonpregnant women. Vaccine 2015; 33:4117–4123 [View Article][PubMed]
     [Google Scholar]
  70. Abu Raya B, Srugo I, Kessel A, Peterman M, Vaknin A et al. The Decline of Pertussis-Specific Antibodies After Tetanus, Diphtheria, and Acellular Pertussis Immunization in Late Pregnancy. J Infect Dis 2015; 212:1869–1873 [View Article][PubMed]
     [Google Scholar]
  71. Greenberg L, Royer A. Prenatal immunization for the protection of infants against whooping cough. Antonie van Leeuwenhoek 1961; 27:91–97 [View Article][PubMed]
     [Google Scholar]
  72. Vilajeliu A, Ferrer L, Munrós J, Goncé A, López M et al. Pertussis vaccination during pregnancy: antibody persistence in infants. Vaccine 2016; 34:3719–3722 [View Article][PubMed]
     [Google Scholar]
  73. Abu Raya B, Srugo I, Kessel A, Peterman M, Bader D et al. The effect of timing of maternal tetanus, diphtheria, and acellular pertussis (Tdap) immunization during pregnancy on newborn pertussis antibody levels - a prospective study. Vaccine 2014; 32:5787–5793 [View Article][PubMed]
     [Google Scholar]
  74. Ladhani SN, Andrews NJ, Southern J, Jones CE, Amirthalingam G et al. Antibody responses after primary immunization in infants born to women receiving a pertussis-containing vaccine during pregnancy: single arm observational study with a historical comparator. Clin Infect Dis 2015; 61:1637–1644 [View Article][PubMed]
     [Google Scholar]
  75. Eberhardt CS, Blanchard-Rohner G, Lemaître B, Boukrid M, Combescure C et al. Maternal immunization earlier in pregnancy maximizes antibody transfer and expected infant seropositivity against pertussis. Clin Infect Dis 2016; 62:829–836 [View Article][PubMed]
     [Google Scholar]
  76. Abu Raya B, Bamberger E, Almog M, Peri R, Srugo I et al. Immunization of pregnant women against pertussis: the effect of timing on antibody avidity. Vaccine 2015; 33:1948–1952 [View Article][PubMed]
     [Google Scholar]
  77. Eberhardt CS, Blanchard-Rohner G, Lemaître B, Combescure C, Othenin-Girard V et al. Pertussis antibody transfer to preterm neonates after second- versus third-trimester maternal immunization. Clin Infect Dis 2017; 64:1129–1132 [View Article][PubMed]
     [Google Scholar]
  78. Naidu M, Wallace E, Giles M. Pertussis vaccine: When is the optimal time to vaccinate during pregnancy?. BJOG An Int J Obstet Gynaecol 2015; 122:365
     [Google Scholar]
  79. Caboré RN, Maertens K, Dobly A, Leuridan E, van Damme P et al. Influence of maternal vaccination against diphtheria, tetanus, and pertussis on the avidity of infant antibody responses to a pertussis containing vaccine in Belgium. Virulence 2017; 8:1245–1254 [View Article][PubMed]
     [Google Scholar]
  80. Maertens K, Burbidge P, van Damme P, Goldblatt D, Leuridan E. Pneumococcal immune response in infants whose mothers received tetanus, diphtheria and acellular pertussis vaccination during pregnancy. Pediatr Infect Dis J 2017; 36:1186–1192 [View Article][PubMed]
     [Google Scholar]
  81. Byrne L, Campbell H, Andrews N, Ribeiro S, Amirthalingam G. Hospitalisation of preterm infants with pertussis in the context of a maternal vaccination programme in England. Arch Dis Child 2018; 103:224 [View Article][PubMed]
     [Google Scholar]
  82. Public Health England Pertussis vaccination programme for pregnant women update: vaccine coverage in England, April to June 2017. Health Protection Report vol. 11 2017
     [Google Scholar]
  83. Layton JB, Butler AM, Li D, Boggess KA, Weber DJ et al. Prenatal Tdap immunization and risk of maternal and newborn adverse events. Vaccine 2017; 35:4072–4078 [View Article][PubMed]
     [Google Scholar]
  84. Desilva M, Vazquez-Benitez G, Nordin JD, Lipkind HS, Klein NP et al. Maternal Tdap vaccination and risk of infant morbidity. Vaccine 2017; 35:3655–3660 [View Article][PubMed]
     [Google Scholar]
  85. Berlin JA. Does blinding of readers affect the results of meta-analyses? University of Pennsylvania Meta-analysis Blinding Study Group. Lancet 1997; 350:185–186[PubMed]
     [Google Scholar]
  86. Sauer LW. Immunization with Bacillus pertussis vaccine. JAMA 1933; 101:1449 [View Article]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000829
Loading
Review of vaccination in pregnancy to prevent pertussis in early infancy
J. Med. Microbiol. 67, 1426 (2018); https://doi.org/10.1099/jmm.0.000829
/content/journal/jmm/10.1099/jmm.0.000829
/content/journal/jmm/10.1099/jmm.0.000829
Loading

Data & Media loading...

Supplements

Supplementary File 1

PDF

Supplementary File 2

PDF

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error