Abstract
BackgroundRespiratory syncytial virus (RSV) is the most important viral cause of pneumonia in children. RSV-specific antibody (ab) protects infants from disease, and may be increased by a potential strategy of maternal RSV vaccination. ObjectivesTo describe the effect of RSV antibody on RSV infection risk in infants in a resource-limited setting. Study designIn a prospective study in Nepal, women were enrolled during pregnancy and maternal and infant cord blood were collected at birth. Weekly surveillance for respiratory illness was performed from birth to 180days. Nasal swabs were tested for RSV by PCR and serum was tested using an RSV antibody microneutralization assay. Antibody concentrations at time of RSV infection were estimated based on a decay rate of 0.026 log2/day. ResultsCord:maternal RSV antibody transfer ratio was 1.03 (0.88–1.19), with RSV antibody concentration of log2 11.3 and log2 11.7 in 310 paired maternal and infant samples, respectively. Cord blood RSV antibody was log2 12.1 versus 11.6 in those with or without RSV infection (P=0.86). Among infants with RSV infection, estimated RSV antibody concentration at time of infection did not differ in infants with upper (n=8; log2 10.7) versus lower respiratory tract infection (n=21; log2 9.8; P=0.37). Cord blood RSV antibody concentrations did not correlate with age at primary RSV infection (R=0.11; P=0.57). ConclusionsTransplacental transfer of RSV antibody from mother to the fetus was highly efficient in mother-infant pairs in rural Nepal, though higher antibody concentrations were not protective against earlier or more severe RSV infection in infants.
Highlights
Respiratory syncytial virus (RSV) is the most important viral cause of pneumonia in children
Because transplacental antibody transfer has been shown to be impacted by gestational age at birth, we evaluated the frequency of preterm birth in infants with and without RSV infection
In a prospective longitudinal study conducted in rural Nepal, RSV serum antibody transfer from mother to infant was highly efficient
Summary
Respiratory syncytial virus (RSV) is the most important viral cause of pneumonia in children. Objectives: To describe the effect of RSV antibody on RSV infection risk in infants in a resource-limited setting. Conclusions: Transplacental transfer of RSV antibody from mother to the fetus was highly efficient in motherinfant pairs in rural Nepal, though higher antibody concentrations were not protective against earlier or more severe RSV infection in infants. Respiratory syncytial virus (RSV) is the most important cause of viral pneumonia in infants worldwide, with an estimated global burden of 64 million infections and 160,000 deaths annually. Maternal RSV antibody is protective against severe disease in neonates, and palivizumab, a high-titered RSV-specific monoclonal antibody, is administered to high-risk infants in developed countries to prevent hospitalization [4,5]. 99% of deaths due to RSV occur in resource-limited settings, making vaccine development critical in preventing RSV-associated mortality [6]
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