Febrile Rhinovirus Illness During Pregnancy Is Associated With Low Birth Weight in Nepal.

Erin K Philpott,Stephen C Leclerq,Subarna Khatry,Helen Y Chu,Laxman Shrestha,Jane Kuypers,Janet A Englund,Mark C Steinhoff,Joanne Katz,James Tielsch,Amalia S Magaret

doi:10.1093/ofid/ofx073

Abstract

BackgroundAdverse birth outcomes, including low birth weight (LBW), defined as <2500 grams, small-for-gestational-age (SGA), and prematurity, contribute to 60%–80% of infant mortality worldwide and may be related to infections during pregnancy. The aim of this study was to assess whether febrile human rhinovirus (HRV) illness is associated with adverse birth outcomes.MethodsActive household-based weekly surveillance was performed for respiratory illness episodes in pregnant women as part of a community-based, prospective, randomized trial of maternal influenza immunization in rural Nepal. Rhinovirus (HRV) febrile illness episodes were defined as fever plus cough, sore throat, runny nose, and/or myalgia with HRV detected on mid-nasal swab. Multivariate regression analysis evaluated the association between febrile HRV respiratory illness and adverse birth outcomes.ResultsOverall, 96 (3%) of 3693 pregnant women had HRV-positive febrile respiratory illnesses. Infants born to pregnant women with HRV febrile illness had a 1.6-fold increased risk of being LBW compared with those with non-HRV febrile illness (28 of 96 [38%] vs 109 of 458 [24%]; relative risk [RR], 1.6; 95% confidence interval [CI], 1.1–2.3). No difference in risk of LBW was observed between infants born to mothers with non-HRV febrile respiratory illness and those without respiratory illness during pregnancy (109 of 458 [24%] vs 552 of 2220 [25%], respectively; RR, 1.0; 95% CI, 0.8–1.2).ConclusionsFebrile illness due to rhinovirus during pregnancy was associated with increased risk of LBW in a rural South Asian population. Interventions to reduce the burden of febrile respiratory illness due to rhinovirus during pregnancy may have a significant impact on LBW and subsequent infant mortality.

Highlights

Over 400 million people are infected with hookworm, predominantly in resource-limited tropical regions of the world [1]
Hookworm infection caused by Necator americanus is a major neglected tropical disease with significant associated morbidity
Glutathione-S-Transferase-1 of N. americanus (Na-glutathione S-transferase-1 (GST-1)) is one of the lead hookworm vaccine candidates; antibodies induced by this vaccine are postulated to interfere with the digestion of host hemoglobin by adult N. americanus hookworms, thereby impairing their development and survival

Summary

Introduction

Over 400 million people are infected with hookworm, predominantly in resource-limited tropical regions of the world [1]. Hookworm is a soil-transmitted nematode helminth that is primarily acquired after skin contact with infective larvae found in soil contaminated with human feces. Following penetration of the skin, larvae migrate through tissues before entering the gastrointestinal tract where they develop into adult worms that attach to the intestinal mucosa and feed on host blood [2]. Chronic infection, which often lasts for years, can result in pathology due to intestinal blood loss, with morbidity being proportional to the number of worms present in the host [3]. Heavier infections are more likely to result in iron-deficiency anemia, which impairs physical and intellectual development in children, negatively impacts birth outcomes, and is thought to significantly reduce future economic productivity [4]. New estimates of the global burden of disease caused by hookworm indicate that over 4 million disability-adjusted life years are lost annually and economic costs may exceed $100 billion [5]

Methods

Results

Discussion

Conclusion