Cord‐blood respiratory syncytial virus antibodies and respiratory health in first 5 years of life

Abstract

Objective: To determine the potential longer-term effects of maternal antenatal respiratory syncytial virus (RSV) vaccination, we examined the association between cord-blood RSV-neutralizing antibodies (RSV-NA) and RSV infections in the first 2 years of life, RSV-NA at 3 years, and respiratory health to age 5 years.Methods: Two community-based Australian birth cohorts were combined. For children with at least one atopic parent, paired serum RSV-NA levels were compared in cord blood and at age 3 years. Weekly nasal swabs were collected in one cohort and during acute respiratory infections (ARI) in the other. Wheeze history up to age 5 years and physician-diagnosed asthma at 5 years was collected by parent report.Results: In 264 children, each log 10 increase of cord-blood RSV-NA level was associated with 37% decreased risk (adjusted incidence-rate-ratio [aIRR] 0.63; 95% confidence interval [CI]: 0.40-1.01) of RSV-ARI and 49% decreased risk (aIRR 0.51; 95% CI: 0.25-1.02) of RSV acute lower respiratory infections (ALRI) at 12-24 months of age. However, higher cord-blood RSV-NA was associated with increased risk of all-cause ALRI (aIRR 1.29; 95% CI: 0.99-1.69), wheeze-associated ALRI (aIRR 1.75; 95% CI: 1.08-2.82), and severe ALRI (aIRR 2.76; 95% CI: 1.63-4.70) at age 6-<12 months.

Incidence and risk factors of hospitalisations for respiratory syncytial virus among children aged less than 2 years

“…Such vaccine candidate might be an active vaccine given shortly after birth or a maternal vaccine given during late pregnancy anticipating placental transfer of anti-RSV maternal IgG antibodies to the foetus [ 45 – 47 ]. A recent study showed no protective effect of increased level of cord-blood RSV-neutralizing antibodies against acute RSV infection during the first 6 months of life, although protection was evident at age 12–24 months [ 48 ]. A randomised controlled phase III clinical trial with RSV fusion protein nanoparticle vaccine, which included 4579 pregnant women, showed no significant protection against the prespecified endpoint for the efficacy of RSV-associated, medically significant lower respiratory tract infection up to age 90 days after vaccination (vaccine efficacy was 39.4%) [ 20 ].…”

RSV disease in infants and young children: Can we see a brighter future?

“…Nevertheless, most cases of RSV occur in the first months of life, when the levels of maternal NA may be considered substantially higher. 82 , 149 , 150 …”