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Meta-Analysis
. 2024 Mar 1;229(Supplement_1):S51-S60.
doi: 10.1093/infdis/jiad449.

Burden of Respiratory Syncytial Virus-Associated Acute Respiratory Infections During Pregnancy

Sebastien Kenmoe  1 , Helen Y Chu  2 , Fatimah S Dawood  3 , Jennifer Milucky  3 , Wanitchaya Kittikraisak  4 , Hamish Matthewson  1 , Durga Kulkarni  1 , Piyarat Suntarattiwong  5 , Collrane Frivold  2   6 , Sarita Mohanty  3 , Fiona Havers  3 , You Li  1   7 , Harish Nair  1   7   8 ; PROMISE Investigators
Collaborators, Affiliations
Meta-Analysis

Burden of Respiratory Syncytial Virus-Associated Acute Respiratory Infections During Pregnancy

Sebastien Kenmoe et al. J Infect Dis. .

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using 5 databases (Medline, Embase, Global Health, Web of Science, and Global Index Medicus), and including additional unpublished data.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.

Keywords: disease burden; pregnancy; respiratory syncytial virus.

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Conflict of interest statement

Potential conflicts of interest . H. Y. C. reports consulting with Ellume, Pfizer, the Bill & Melinda Gates Foundation, GSK, and Merck. She has received research funding from Emergent Ventures, Gates Ventures, Sanofi Pasteur, and the Bill & Melinda Gates Foundation and support and reagents from Ellume and Cepheid, outside the submitted work. Y. L. reports grants from GSK, the World Health Organization, Wellcome Trust, and MSD, outside the submitted work, and consulting fees from Pfizer. H. N. reports grants from the Innovative Medicines Initiative, related to the submitted work; grants from the World Health Organization, the National Institute for Health Research, Pfizer, and Icosavax; and personal fees from the Bill & Melinda Gates Foundation, Pfizer, GSK, Merck, AbbVie, Janssen, Icosavax, Sanofi, Novavax, outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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