Eick Angelia, Karron Ruth, Shaw Jana, Thumar Bhagvanji, Reid Raymond, Santosham Mathuram, O'Brien Katherine L
Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pediatr Infect Dis J. 2008 Mar;27(3):207-12. doi: 10.1097/INF.0b013e31815ac585.
Navajo and White Mountain Apache infants have respiratory syncytial virus (RSV) hospitalization rates 2-5 times that of the general U.S. infant population. To evaluate whether these high rates can be attributable to low concentrations of maternally derived RSV neutralizing antibodies, we conducted a case-control study.
Study subjects enrolled in a prospective, hospital-based surveillance study of RSV disease and a group randomized clinical trial of a 7-valent pneumococcal conjugate vaccine. Cord blood specimens were assayed for neutralizing RSV antibody titers. Infants hospitalized with a respiratory illness had a nasal aspirate obtained to determine whether RSV was present. Infants with an RSV respiratory hospitalization were matched by date of birth and geographic location to infants who did not have an RSV hospitalization before 6 months of age.
For every 1 log2 increase in titer of cord blood RSV neutralizing antibodies there was a 30% reduced risk of hospitalization with RSV (OR = 0.69, P = 0.003). However, among infants hospitalized with RSV, there was no association between cord blood RSV neutralizing antibody and the severity of the RSV illness.
These findings indicate that American Indian infants with high concentrations of maternally derived RSV neutralizing antibodies are protected from RSV hospitalization before 6 months of age. However, these antibodies do not modify the severity of illness once disease has occurred. The basis for elevated rates of RSV disease among American Indian infants cannot be attributed to a failure of maternal RSV neutralizing antibodies to confer protection.
纳瓦霍族和白山阿帕契族婴儿的呼吸道合胞病毒（RSV）住院率是美国普通婴儿人群的2至5倍。为了评估这些高住院率是否可归因于母体来源的RSV中和抗体浓度低，我们进行了一项病例对照研究。
研究对象纳入了一项基于医院的RSV疾病前瞻性监测研究以及一项7价肺炎球菌结合疫苗的群组随机临床试验。检测脐血标本中的RSV中和抗体滴度。因呼吸道疾病住院的婴儿采集鼻吸出物以确定是否存在RSV。RSV呼吸道住院的婴儿按出生日期和地理位置与6个月龄前未发生RSV住院的婴儿进行匹配。
脐血RSV中和抗体滴度每增加1个log2，RSV住院风险降低30%（OR = 0.69，P = 0.003）。然而，在因RSV住院的婴儿中，脐血RSV中和抗体与RSV疾病严重程度之间无关联。
这些发现表明，母体来源的RSV中和抗体浓度高的美国印第安婴儿在6个月龄前可免受RSV住院。然而，一旦发病，这些抗体并不会改变疾病的严重程度。美国印第安婴儿中RSV疾病发病率升高的原因不能归因于母体RSV中和抗体未能提供保护。
