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. 2021 Dec 6;73(11):e4421-e4427.
doi: 10.1093/cid/ciaa648.

Respiratory Syncytial Virus (RSV) Neutralizing Antibodies at Birth Predict Protection from RSV Illness in Infants in the First 3 Months of Life

Andrea G Buchwald  1 , Barney S Graham  2 , Awa Traore  3 , Fadima Cheick Haidara  3 , Man Chen  2 , Kaitlyn Morabito  2 , Bob C Lin  2 , Samba O Sow  3 , Myron M Levine  4 , Marcela F Pasetti  4 , Milagritos D Tapia  4
Affiliations

Respiratory Syncytial Virus (RSV) Neutralizing Antibodies at Birth Predict Protection from RSV Illness in Infants in the First 3 Months of Life

Andrea G Buchwald et al. Clin Infect Dis. .

Abstract

Background: Respiratory syncytial virus (RSV) is a leading cause of viral pneumonia and bronchiolitis during the first 6 months of life. Placentally transferred antibodies can prevent severe RSV illness, and maternal immunization may reduce illness in young infants. Identification of protective antibody levels facilitates the advancement of vaccine candidates and maternal immunization.

Methods: We conducted a nested case-control study with 587 Malian mother-infant pairs, followed from birth to age 6 months. RSV cases were infants who developed influenza-like illness (ILI) or pneumonia and were RSV-positive by polymerase chain reaction. Cases were matched to healthy controls and RSV-negative ILI controls. RSV-A and RSV-B neutralizing antibodies were measured in maternal, cord blood, and infant sera at age 3 and 6 months.

Results: Maternal antibodies were efficiently transferred to infants. Maternal and infant RSV titers were strongly correlated. Infant antibody titers against RSV-A were 3 times higher than those against RSV-B. At birth, infants who remained healthy had significantly higher RSV-A and RSV-B titers compared with infants who subsequently contracted RSV. RSV-A inhibitory concentration (IC)80 titer >239 or RSV-B titer >60 at birth was significantly associated with being a healthy control compared with an RSV case within the first 3 months of life. RSV-A IC80 titers in cord blood were associated with decreased episodes of pneumonia.

Conclusions: Maternally acquired RSV antibodies were associated with protection of infants against community-detected cases of RSV-ILI and pneumonia. RSV titers in cord blood can predict whether an infant will be infected with RSV or remain uninfected.

Keywords: maternal antibodies; protective threshold; respiratory syncytial virus.

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Figures

Figure 1.
Figure 1.
Maternal and infant RSV neutralizing activity (IC80) at birth. (A) RSV-A and (B) RSV-B. Data show log transformed (base 2) reciprocal IC80 sera dilution for mothers and infants in healthy controls, ILI (RSV neg), and RSV (ILI pos) groups. Abbreviations: IC80, 80% inhibitory concentration; ILI, influenza-like illness; RSV, respiratory syncytial virus.
Figure 2.
Figure 2.
Infant RSV neutralizing antibody (IC80) kinetics by case status. (A) RSV-A and (B) RSV-B. Data show log transformed (base 2) titers in RSV cases and healthy controls. (+) indicate RSV cases and (o) indicate healthy controls. Abbreviations: IC80, 80% inhibitory concentration; RSV, respiratory syncytial virus.
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