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. 2019 Jun 6;37(26):3464-3471.
doi: 10.1016/j.vaccine.2019.04.098. Epub 2019 May 10.

Clinical characteristics and outcomes of respiratory syncytial virus infection in pregnant women

Anne M Hause  1 , Vasanthi Avadhanula  2 , Maurizio L Maccato  3 , Phillip M Pinell  3 , Nanette Bond  2 , Patricia Santarcangelo  2 , Laura Ferlic-Stark  2 , Xunyan Ye  2 , Obinna Iwuchukwu  2 , Lauren Maurer  2 , Letisha Aideyan  2 , Kelly Dao  2 , Trevor McBride  2 , Pedro A Piedra  4 , Flor M Munoz  5
Affiliations

Clinical characteristics and outcomes of respiratory syncytial virus infection in pregnant women

Anne M Hause et al. Vaccine. .

Abstract

Objective: To describe the clinical presentation and laboratory diagnosis of pregnant women with respiratory syncytial virus (RSV) infection.

Methods: Pregnant women in their second and third trimester were enrolled during the course of routine prenatal care visits when they were asymptomatic within the preceding two weeks (healthy controls) or when they reported symptoms of acute respiratory illness (ARI) of ≤7 days of duration (cases). Clinical outcomes were assessed at enrollment and two weeks after. Re-enrollment was allowed. Nasal-pharyngeal secretions were evaluated for respiratory pathogens by real-time reverse transcription polymerase chain reaction (PCR). Sera were tested for RSV-specific antibody responses by Western Blot, microneutralization assay, and palivizumab competitive antibody assay.

Results: During the 2015-2016 respiratory virus season, 7 of 65 (11%) pregnant women with ARI at their initial enrollment and 8 of 77 (10%) pregnant women with ARI during the study period (initial or re-enrollment) had PCR-confirmed RSV infection. Four (50%) PCR-confirmed RSV ARI cases reported symptoms of a lower respiratory tract illness (LRTI), one was hospitalized. Combining PCR and serology data, the RSV attack rate at initial enrollment was 12% (8 of 65), and 13% (10 of 77) based on ARI episodes. Among healthy controls, 28 of 88 (32%) had a Western Blot profile suggestive of a recent RSV infection either in the prior and/or current season.

Conclusion: RSV had an attack rate of 10-13% among ambulatory pregnant women receiving routine prenatal care during the respiratory virus season. The serology results of healthy controls suggest a potentially higher attack rate. Future studies should be aware of the combined diagnostic strength of PCR and serology to identify RSV infection. As maternal RSV vaccine candidates are evaluated to protect young infants, additional priority should be placed on outcomes of pregnant women.

Keywords: Acute respiratory illness; Maternal infection; Maternal vaccine; Pregnancy; Respiratory syncytial virus.

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Figures

Fig. 1
Fig. 1
Enrollment summary for the number of pregnant women (N) in Houston, Texas, 2015–2016. Pregnant women in their second or third trimester of gestation were enrolled if they were asymptomatic (healthy controls) in the prior two weeks or if they had symptoms of ARI in the prior seven days. At any point in the study, pregnant women were allowed to re-enroll. The total number of women initially enrolled with symptoms of ARI was 65. Taking into consideration those 12 healthy controls who re-enrolled when they developed symptoms of ARI, the total number of women with ARI during the study period was 77. The total number of women who re-enrolled was 15.
Fig. 2
Fig. 2
Respiratory syncytial virus (RSV) laboratory results for pregnant women in Houston, Texas, 2015–2016. (A) Presence or absence of a recent prior RSV infection Western Blot profile for healthy pregnant women (n = 90) by CDC Week. The red line indicates the total positive RSV antigen tests for the Houston area as reported by the Texas Department of State Health Services. (B) Pregnant women with PCR-confirmed RSV (n = 8) and RSV infection profile (n = 3) by CDC Week. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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