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Milucky J, Patel K, Patton ME, Kirley PD, Austin E, Meek J, Anderson EJ, Brooks A, Brown C, Mumm E, Salazar-Sanchez Y, Barney G, Popham K, Sutton M, Talbot HK, Crossland MT, Havers FP. Characteristics and Outcomes of Pregnant Women Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus Before and During the COVID-19 Pandemic. Open Forum Infect Dis 2024; 11:ofae042. [PMID: 38524226 PMCID: PMC10960599 DOI: 10.1093/ofid/ofae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/25/2024] [Indexed: 03/26/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause severe disease among infants and older adults. Less is known about RSV among pregnant women. Methods To analyze hospitalizations with laboratory-confirmed RSV among women aged 18 to 49 years, we used data from the RSV Hospitalization Surveillance Network (RSV-NET), a multistate population-based surveillance system. Specifically, we compared characteristics and outcomes among (1) pregnant and nonpregnant women during the pre-COVID-19 pandemic period (2014-2018), (2) pregnant women with respiratory symptoms during the prepandemic and pandemic periods (2021-2023), and (3) pregnant women with and without respiratory symptoms in the pandemic period. Using multivariable logistic regression, we examined whether pregnancy was a risk factor for severe outcomes (intensive care unit admission or in-hospital death) among women aged 18 to 49 years who were hospitalized with RSV prepandemic. Results Prepandemic, 387 women aged 18 to 49 years were hospitalized with RSV. Of those, 350 (90.4%) had respiratory symptoms, among whom 33 (9.4%) were pregnant. Five (15.2%) pregnant women and 74 (23.3%) nonpregnant women were admitted to the intensive care unit; no pregnant women and 5 (1.6%) nonpregnant women died. Among 279 hospitalized pregnant women, 41 were identified prepandemic and 238 during the pandemic: 80.5% and 35.3% had respiratory symptoms, respectively (P < .001). Pregnant women were more likely to deliver during their RSV-associated hospitalization during the pandemic vs the prepandemic period (73.1% vs 43.9%, P < .001). Conclusions Few pregnant women had severe RSV disease, and pregnancy was not a risk factor for a severe outcome. More asymptomatic pregnant women were identified during the pandemic, likely due to changes in testing practices for RSV.
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Affiliation(s)
- Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kadam Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica E Patton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California, USA
| | - Elizabeth Austin
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Departments of Medicine and Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Alicia Brooks
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Chloe Brown
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Erica Mumm
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Kevin Popham
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Fiona P Havers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kenmoe S, Chu HY, Dawood FS, Milucky J, Kittikraisak W, Matthewson H, Kulkarni D, Suntarattiwong P, Frivold C, Mohanty S, Havers F, Li Y, Nair H. Burden of Respiratory Syncytial Virus-Associated Acute Respiratory Infections During Pregnancy. J Infect Dis 2024; 229:S51-S60. [PMID: 37824420 DOI: 10.1093/infdis/jiad449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND With the licensure of maternal respiratory syncytial virus (RSV) vaccines in Europe and the United States, data are needed to better characterize the burden of RSV-associated acute respiratory infections (ARI) in pregnancy. The current study aimed to determine among pregnant individuals the proportion of ARI testing positive for RSV and the RSV incidence rate, RSV-associated hospitalizations, deaths, and perinatal outcomes. METHODS We conducted a systematic review, following PRISMA 2020 guidelines, using 5 databases (Medline, Embase, Global Health, Web of Science, and Global Index Medicus), and including additional unpublished data. Pregnant individuals with ARI who had respiratory samples tested for RSV were included. We used a random-effects meta-analysis to generate overall proportions and rate estimates across studies. RESULTS Eleven studies with pregnant individuals recruited between 2010 and 2022 were identified, most of which recruited pregnant individuals in community, inpatient and outpatient settings. Among 8126 pregnant individuals, the proportion with ARI that tested positive for RSV ranged from 0.9% to 10.7%, with a meta-estimate of 3.4% (95% confidence interval [CI], 1.9%-54%). The pooled incidence rate of RSV among pregnant individuals was 26.0 (95% CI, 15.8-36.2) per 1000 person-years. RSV hospitalization rates reported in 2 studies were 2.4 and 3.0 per 1000 person-years. In 5 studies that ascertained RSV-associated deaths among 4708 pregnant individuals, no deaths were reported. Three studies comparing RSV-positive and RSV-negative pregnant individuals found no difference in the odds of miscarriage, stillbirth, low birth weight, and small size for gestational age. RSV-positive pregnant individuals had higher odds of preterm delivery (odds ratio, 3.6 [95% CI, 1.3-10.3]). CONCLUSIONS Data on RSV-associated hospitalization rates are limited, but available estimates are lower than those reported in older adults and young children. As countries debate whether to include RSV vaccines in maternal vaccination programs, which are primarily intended to protect infants, this information could be useful in shaping vaccine policy decisions.
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Affiliation(s)
- Sebastien Kenmoe
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Helen Y Chu
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Fatimah S Dawood
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Hamish Matthewson
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Durga Kulkarni
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Piyarat Suntarattiwong
- Pediatric Infectious Diseases Unit, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Collrane Frivold
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sarita Mohanty
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fiona Havers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - You Li
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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3
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Abrams EM, Doyon-Plourde P, Davis P, Brousseau N, Irwin A, Siu W, Killikelly A. Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2024; 50:1-15. [PMID: 38511049 PMCID: PMC10949905 DOI: 10.14745/ccdr.v50i12a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Passive immunization products for infants and pregnant women and people have sparked interest in understanding Canada's respiratory syncytial virus (RSV) burden. This rapid review examines RSV burden of disease in infants, young children and pregnant women and people. Methods Electronic databases were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit admissions, deaths and preterm labour associated with RSV. We also contacted Canadian respiratory virus surveillance experts for additional data. Results Overall, 17 studies on infants and young children and 10 studies on pregnant women and people were included, in addition to primary surveillance data from one Canadian territory (Yukon). There were higher rates of medical utilization for infants than older children. Hospitalization rates were highest in infants under six months (more than 1% annually), with 5% needing intensive care unit admission, but mortality was low. Severe outcomes often occurred in healthy full-term infants and burden was higher than influenza. Respiratory syncytial virus attack rate was 10%-13% among pregnant women and people. Only one study found a higher hospitalization rate in pregnant women and people compared to non-pregnant women and people. Limited evidence was found on intensive care unit admission, death and preterm birth for pregnant women and people. Conclusion While risk of severe outcomes is larger in high-risk infants and children, healthcare burden is greatest in healthy term infants. The RSV severity for pregnant women and people appears to be similar to that for non-pregnant women and people.
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Affiliation(s)
- Elissa M Abrams
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Manitoba, Department of Pediatrics, Section of Allergy and Clinical Immunology, Winnipeg, MB
- University of British Columbia, Department of Pediatrics, Division of Allergy and Immunology, Vancouver, BC
| | | | - Phaedra Davis
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | | | - Andrea Irwin
- Yukon Communicable Disease Control, Health and Social Services, Government of Yukon, Whitehorse, YT
| | - Winnie Siu
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | - April Killikelly
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
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Nowalk MP, D'Agostino H, Dauer K, Stiegler M, Zimmerman RK, Balasubramani GK. Estimating the burden of adult hospitalized RSV infection including special populations. Vaccine 2022; 40:4121-4127. [PMID: 35667912 PMCID: PMC10642722 DOI: 10.1016/j.vaccine.2022.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Numerous studies in the U.S. have made estimates of the RSV burden among adults that vary widely due to differences in methodology, reliance on influenza surveillance, which does not adequately capture all RSV clinical symptoms, and lack of diagnostic methods to identify RSV when viral loads are low. Nevertheless, accurate burden estimates can inform healthcare planning, resource allocation and potentially, RSV vaccine policy. METHODS A simple method combined with statewide and local hospitalization, medical record and U.S. Census data were used to estimate population-based RSV hospitalization burden among adults ages 18-64 years, ≥65 years, and including immunocompetent, immunocompromised and pregnant individuals during 2015-2018 for Allegheny County, Pennsylvania. Economic burden of hospitalization was estimated using state-provided average hospitalization charges for comparisons across patient groups. RESULTS The largest burden was borne by adults ≥ 65 years of age whose rates per 100,000 population of that age group (939/100,000) were 7.0-9.0 times those of adults 18-64 years of age (118/100,000). Immunosuppressed patients bore the greatest relative burden of RSV hospitalizations (1,288-1,562/100,000 immunosuppressed individuals). RSV burden ranged from 0 to 808/100,000 pregnant women. Average total charges for RSV hospitalization in Allegheny County across all adults increased from $39 million in 2015-2016 to $57 million in 2016-2017 to $89 million in 2017-2018, due to both increased average charges for an acute respiratory hospitalization and increased numbers of RSV cases. CONCLUSIONS These RSV burden estimates add to the body of knowledge to guide public health policy makers and offer a method for simply and easily producing population-based burden estimates.
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Affiliation(s)
- Mary Patricia Nowalk
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh PA, USA.
| | - Helen D'Agostino
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
| | - Klancie Dauer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
| | - Myla Stiegler
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
| | - Richard K Zimmerman
- Department of Family Medicine, School of Medicine, University of Pittsburgh, Pittsburgh PA, USA
| | - G K Balasubramani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, USA
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Baraldi E, Checcucci Lisi G, Costantino C, Heinrichs JH, Manzoni P, Riccò M, Roberts M, Vassilouthis N. RSV disease in infants and young children: Can we see a brighter future? Hum Vaccin Immunother 2022; 18:2079322. [PMID: 35724340 DOI: 10.1080/21645515.2022.2079322] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a highly contagious seasonal virus and the leading cause of Lower Respiratory Tract Infections (LRTI), including pneumonia and bronchiolitis in children. RSV-related LRTI cause approximately 3 million hospitalizations and 120,000 deaths annually among children <5 years of age. The majority of the burden of RSV occurs in previously healthy infants. Only a monoclonal antibody (mAb) has been approved against RSV infections in a restricted group, leaving an urgent unmet need for a large number of children potentially benefiting from preventive measures. Approaches under development include maternal vaccines to protect newborns, extended half-life monoclonal antibodies to provide rapid long-lasting protection, and pediatric vaccines. RSV has been identified as a major global priority but a solution to tackle this unmet need for all children has yet to be implemented. New technologies represent the avenue for effectively addressing the leading-cause of hospitalization in children <1 years old.
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Affiliation(s)
- Eugenio Baraldi
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | | | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Paolo Manzoni
- Department of Pediatrics and Neonatology, University Hospital Degli Infermi, Biella, Italy
| | - Matteo Riccò
- Dipartimento di Sanità Pubblica, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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6
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Respiratory Syncytial Virus in Pregnant Women: Systematic Review and Meta-Analysis. WOMEN 2022. [DOI: 10.3390/women2020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a highly contagious viral pathogen. In infants, it is usually listed among the main causes of medical referrals and hospitalizations, particularly among newborns. While waiting for the results of early randomized controlled trials on maternal vaccination against RSV, the present systematic review and meta-analysis aimed to collect available evidence on maternal RSV infections. According to the PRISMA statement, Pubmed, Embase, and pre-print archive medRxiv.og were searched for eligible studies published up to 1 April 2022. Raw data included the incidence of RSV infection among sampled pregnant women, and the occurrence of complications. Data were then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 5 studies for 282,918 pregnancies were retrieved, with a pooled prevalence of 0.2 per 100 pregnancies and 2.5 per 100 pregnancies with respiratory tract infections. Neither maternal deaths nor miscarriages were reported. Even though detailed data were available only for 6309 pregnancies and 33 RSV cases, infant outcomes such as low birth weight and preterm delivery were rare (in both cases 0.04%), but up to 9.1% in cases where RSV diagnosis was confirmed. No substantially increased risk for preterm delivery (RR 1.395; 95%CI 0.566 to 3.434) and giving birth to a low-birth-weight infant (RR 0.509; 95%CI 0.134 to 1.924) was eventually identified. Conclusions. Although RSV is uncommonly detected among pregnant women, incident cases were associated with a relatively high share of complications. However, heterogeneous design and the quality of retrieved reports stress the need for specifically designed studies.
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7
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Manti S, Leonardi S, Rezaee F, Harford TJ, Perez MK, Piedimonte G. Effects of Vertical Transmission of Respiratory Viruses to the Offspring. Front Immunol 2022; 13:853009. [PMID: 35359954 PMCID: PMC8963917 DOI: 10.3389/fimmu.2022.853009] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
Overt and subclinical maternal infections in pregnancy can have multiple and significant pathological consequences for the developing fetus, leading to acute perinatal complications and/or chronic disease throughout postnatal life. In this context, the current concept of pregnancy as a state of systemic immunosuppression seems oversimplified and outdated. Undoubtedly, in pregnancy the maternal immune system undergoes complex changes to establish and maintain tolerance to the fetus while still protecting from pathogens. In addition to downregulated maternal immunity, hormonal changes, and mechanical adaptation (e.g., restricted lung expansion) make the pregnant woman more susceptible to respiratory pathogens, such as influenza virus, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Depending on the infectious agent and timing of the infection during gestation, fetal pathology can range from mild to severe, and even fatal. Influenza is associated with a higher risk of morbidity and mortality in pregnant women than in the general population, and, especially during the third trimester of pregnancy, mothers are at increased risk of hospitalization for acute cardiopulmonary illness, while their babies show higher risk of complications such as prematurity, respiratory and neurological illness, congenital anomalies, and admission to neonatal intensive care. RSV exposure in utero is associated with selective immune deficit, remodeling of cholinergic innervation in the developing respiratory tract, and abnormal airway smooth muscle contractility, which may predispose to postnatal airway inflammation and hyperreactivity, as well as development of chronic airway dysfunction in childhood. Although there is still limited evidence supporting the occurrence of vertical transmission of SARS-CoV-2, the high prevalence of prematurity among pregnant women infected by SARS-CoV-2 suggests this virus may alter immune responses at the maternal-fetal interface, affecting both the mother and her fetus. This review aims at summarizing the current evidence about the short- and long-term consequences of intrauterine exposure to influenza, RSV, and SARS-CoV-2 in terms of neonatal and pediatric outcomes.
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Affiliation(s)
- Sara Manti
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Leonardi
- Pediatric Pulmonology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Fariba Rezaee
- Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
- Center for Pediatric Pulmonology, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Terri J. Harford
- Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Miriam K. Perez
- Department of General Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Giovanni Piedimonte
- Department of Pediatrics, Biochemistry and Molecular Biology, Tulane University, New Orleans, LA, United States
- *Correspondence: Giovanni Piedimonte,
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8
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Andrade CA, Kalergis AM, Bohmwald K. Potential Neurocognitive Symptoms Due to Respiratory Syncytial Virus Infection. Pathogens 2021; 11:47. [PMID: 35055995 PMCID: PMC8780657 DOI: 10.3390/pathogens11010047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 01/03/2023] Open
Abstract
Respiratory infections are among the major public health burdens, especially during winter. Along these lines, the human respiratory syncytial virus (hRSV) is the principal viral agent causing acute lower respiratory tract infections leading to hospitalization. The pulmonary manifestations due to hRSV infection are bronchiolitis and pneumonia, where the population most affected are infants and the elderly. However, recent evidence suggests that hRSV infection can impact the mother and fetus during pregnancy. Studies have indicated that hRSV can infect different cell types from the placenta and even cross the placenta barrier and infect the fetus. In addition, it is known that infections during the gestational period can lead to severe consequences for the development of the fetus due not only to a direct viral infection but also because of maternal immune activation (MIA). Furthermore, it has been described that the development of the central nervous system (CNS) of the fetus can be affected by the inflammatory environment of the uterus caused by viral infections. Increasing evidence supports the notion that hRSV could invade the CNS and infect nervous cells, such as microglia, neurons, and astrocytes, promoting neuroinflammation. Moreover, it has been described that the hRSV infection can provoke neurological manifestations, including cognitive impairment and behavioral alterations. Here, we will review the potential effect of hRSV in brain development and the potential long-term neurological sequelae.
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Affiliation(s)
- Catalina A. Andrade
- Department of Molecular and Microbiology, Faculty of Biological Science, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile;
| | - Alexis M. Kalergis
- Department of Molecular and Microbiology, Faculty of Biological Science, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile;
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
| | - Karen Bohmwald
- Department of Molecular and Microbiology, Faculty of Biological Science, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile;
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Abstract
Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infection and is responsible for a large proportion of infant morbidity and mortality worldwide. Most RSV-related deaths occur in children under six months, and the majority of these occur in low-income settings. To date, there is no known efficacious treatment for RSV infection; hence, prevention remains an important strategy to reduce the global burden of disease. Monoclonal antibodies and vaccinations are currently the two main approaches for prevention of RSV disease. Maternal RSV vaccination is of particular interest as a strategy to protect infants during their most vulnerable period as this approach has proven highly efficacious in other vaccine-preventable conditions such as pertussis and influenza. As results from ongoing phase III clinical trials become available, important decisions will need to be made about the priority and potential implementation of RSV vaccines alongside other public health measures.
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Affiliation(s)
- Ahinsa Gunatilaka
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
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10
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Koivisto K, Nieminen T, Mejias A, Capella C, Ye F, Mertz S, Peeples M, Ramilo O, Saxén H. RSV Specific Antibodies in Pregnant Women and Subsequent Risk of RSV Hospitalization in Young Infants. J Infect Dis 2021; 225:1189-1196. [PMID: 34129040 PMCID: PMC8974854 DOI: 10.1093/infdis/jiab315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background The fusion (F) glycoprotein of respiratory syncytial virus (RSV) represents the major neutralizing antigen, and antibodies against the pre-F conformation have the most potent neutralizing activity. This study aimed to assess the correlation between maternal antibody titers against the pre-F, post-F, and G glycoproteins and the child’s risk of developing severe RSV bronchiolitis early in infancy. Methods We identified previously healthy term infants <3 months of age hospitalized with RSV bronchiolitis from December 2015 to March 2016. We measured IgG antibody titers to pre-F, post-F, and G proteins in maternal sera obtained at 9–12 weeks of pregnancy of these hospitalized infants’ mothers (n = 94) and compared them with serum antibody titers of control pregnant mothers (n = 130) whose children were not hospitalized. Results All maternal samples (n = 224) had detectable pre-F antibodies. Pre-F antibody titers were significantly lower in mothers whose infants were hospitalized with RSV bronchiolitis compared with those mothers whose infants were not hospitalized (23.9 [range (or antibody titer range), 1.4–273.7] µg/L vs 30.6 [XXX, 3.4–220.0] µg/L; P = .0026). There were no significant differences in maternal post-F and G antibody titers between hospitalized and nonhospitalized infants. Conclusions Our findings indicate that maternal pre-F antibodies are fundamental for providing immune protection to the infant.
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Affiliation(s)
- K Koivisto
- Helsinki University Hospital and University of Helsinki, Children's Hospital, Helsinki, Finland
| | - T Nieminen
- Helsinki University Hospital and University of Helsinki, Children's Hospital, Helsinki, Finland
| | - A Mejias
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - C Capella
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - F Ye
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - S Mertz
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - M Peeples
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - O Ramilo
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - H Saxén
- Helsinki University Hospital and University of Helsinki, Children's Hospital, Helsinki, Finland
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11
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Hause AM, Panagiotakopoulos L, Weintraub ES, Sy LS, Glenn SC, Tseng HF, McNeil MM. Adverse Outcomes in Pregnant Women Hospitalized With Respiratory Syncytial Virus Infection: A Case Series. Clin Infect Dis 2021; 72:138-140. [PMID: 32484508 DOI: 10.1093/cid/ciaa668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
We identified 10 women hospitalized with respiratory syncytial virus infection during pregnancy. Diagnoses included pneumonia/atelectasis (5), respiratory failure (2), and sepsis (2). Six had obstetrical complications during hospitalization, including 1 induced preterm birth. One required intensive care unit admission and mechanical ventilation. Four infants had complications at birth.
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Affiliation(s)
- Anne M Hause
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lakshmi Panagiotakopoulos
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Sungching C Glenn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Respiratory viral infections during pregnancy: effects of SARS-CoV-2 and other related viruses over the offspring. J Dev Orig Health Dis 2021; 13:3-8. [PMID: 33526164 DOI: 10.1017/s2040174420001373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Little is known about the consequences of viral infection for pregnant woman or for the fetus. This issue became important with the appearance of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The infection with SARS-CoV-2 causes a respiratory syndrome known as COVID-19. The fast spreading around the world and the fact that without a treatment or vaccine humans are completely exposed, converts emerging viral diseases in a significant risk for pregnant women and their infants. At this time, during SARS-CoV-2 pandemics pregnant women are not considered as a risk population and little is known about the effects of viral infections over the offspring although the amount of emerging evidence showing detrimental effects for the mother and the fetus. This issue highlights the importance to understand the effects of viral infections during pregnancy. In this work, we analyze the effects of viral infections, like SARS-CoV-2 and other related viruses during pregnancy over the mother and the consequences for the offspring.
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13
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Respiratory syncytial virus. MATERNAL IMMUNIZATION 2020. [PMCID: PMC7149541 DOI: 10.1016/b978-0-12-814582-1.00011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Respiratory Syncytial Virus (RSV) is a leading cause of hospitalization and mortality associated with lower respiratory tract illness in infants and young children worldwide. The World Health Organization recognizes the need to develop and implement prevention strategies to reduce the impact of RSV in early life as a global health priority. RSV vaccination during pregnancy is a feasible strategy to achieve this goal. Vaccines for maternal immunization against RSV are in active development and could be implemented in the near future within existing maternal-child health platforms. In addition, infant protection may be achieved through either passive antibody administration or active immunization, depending on infant health status, given that options for these complementary interventions are being developed in parallel to vaccines for maternal immunization.
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Gonik B. The Burden of Respiratory Syncytial Virus Infection in Adults and Reproductive-Aged Women. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:515-520. [PMID: 31791975 PMCID: PMC6927832 DOI: 10.9745/ghsp-d-19-00121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/01/2019] [Indexed: 11/15/2022]
Abstract
Currently available data on respiratory syncytial virus (RSV) disease burden in adults and reproductive-aged women are limited. These data are critically needed to assist in the advancement of strategies related to maternal RSV vaccination for the passive protection of their newborn children.
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Affiliation(s)
- Bernard Gonik
- Wayne State University School of Medicine, Detroit, MI, USA.
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15
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Hause AM, Avadhanula V, Maccato ML, Pinell PM, Bond N, Santarcangelo P, Ferlic-Stark L, Ye X, Iwuchukwu O, Maurer L, Aideyan L, Dao K, McBride T, Piedra PA, Munoz FM. Clinical characteristics and outcomes of respiratory syncytial virus infection in pregnant women. Vaccine 2019; 37:3464-3471. [PMID: 31085002 PMCID: PMC7126758 DOI: 10.1016/j.vaccine.2019.04.098] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 11/01/2022]
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.
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Affiliation(s)
- Anne M Hause
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States; Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, United States.
| | - Vasanthi Avadhanula
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Maurizio L Maccato
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States; Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States; Woman's OB/GYN Specialists, Houston, TX 77054, United States
| | - Phillip M Pinell
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States; Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States; Woman's OB/GYN Specialists, Houston, TX 77054, United States
| | - Nanette Bond
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Patricia Santarcangelo
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Laura Ferlic-Stark
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Xunyan Ye
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Obinna Iwuchukwu
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Lauren Maurer
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Letisha Aideyan
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Kelly Dao
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Trevor McBride
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Pedro A Piedra
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States; Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
| | - Flor M Munoz
- Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States; Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States.
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