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. 2017 Oct:95:90-95.
doi: 10.1016/j.jcv.2017.08.017. Epub 2017 Sep 2.

Transplacental transfer of maternal respiratory syncytial virus (RSV) antibody and protection against RSV disease in infants in rural Nepal

Helen Y Chu  1 , James Tielsch  2 , Joanne Katz  3 , Amalia S Magaret  4 , Subarna Khatry  5 , Stephen C LeClerq  5 , Laxman Shrestha  6 , Jane Kuypers  4 , Mark C Steinhoff  7 , Janet A Englund  8
Affiliations

Transplacental transfer of maternal respiratory syncytial virus (RSV) antibody and protection against RSV disease in infants in rural Nepal

Helen Y Chu et al. J Clin Virol. 2017 Oct.

Abstract

Background: Respiratory 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.

Objectives: To describe the effect of RSV antibody on RSV infection risk in infants in a resource-limited setting.

Study design: In 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.

Results: Cord: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).

Conclusions: Transplacental 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.

Keywords: Preterm birth; Respiratory syncytial virus; Transplacental antibody transfer; Vaccine.

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Figures

Fig. 1
Fig. 1
Comparison of RSV antibody in maternal (x-axis) and infant cord blood (y-axis) at time of delivery in 310 mother-infant pairs (Pearson’s correlation coefficient 0.77, p < 0.0001).
Fig. 2
Fig. 2
Comparison of cord:maternal RSV antibody transfer ratio by gestational age at delivery. No significant correlation was found between RSV antibody ratio and gestational age in weeks at birth (R = 0.05; P = 0.37).
Fig. 3
Fig. 3
3A. Side-by-side boxplot comparing estimated RSV antibody concentrations at time of infection in infants with RSV upper respiratory tract versus lower respiratory tract infection. Infant antibody concentrations at time of RSV infection were estimated based on a decay rate of 0.026 log2 concentration/day. Of the 30 infants with RSV infection, 21 had LRTI. Estimated RSV antibody concentrations at the time of infection did not differ significantly between infants with URTI vs. LRTI (10.7 [1.2] vs. 9.8 [1.7], respectively; P = 0.37). 3B. Scatterplot comparing weeks at RSV illness against cord blood RSV antibody concentrations shows no relationship between age at illness and cord blood antibody titers among infants with RSV infection (R = 0.11; P = 0.57; Fig. 3B).
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