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.
Departments of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX 77030, United States.
Vaccine. 2019 Jun 6;37(26):3464-3471. doi: 10.1016/j.vaccine.2019.04.098. Epub 2019 May 10.
To describe the clinical presentation and laboratory diagnosis of pregnant women with respiratory syncytial virus (RSV) infection.
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.
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.
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.
描述呼吸道合胞病毒（RSV）感染孕妇的临床症状表现和实验室诊断结果。
在常规产前保健就诊期间，纳入妊娠中期和晚期无症状的孕妇（健康对照组）或有≤7 天急性呼吸道疾病（ARI）症状的孕妇（病例组）。在入组时和两周后评估临床结局。允许再次入组。通过实时逆转录聚合酶链反应（PCR）评估鼻咽喉分泌物中的呼吸道病原体。通过 Western Blot、微量中和试验和帕利珠单抗竞争抗体试验检测血清中的 RSV 特异性抗体反应。
在 2015-2016 年呼吸道病毒流行季，7 名初次入组时患有 ARI 的孕妇和 8 名在研究期间（初次或再次入组）患有 ARI 的孕妇经 PCR 确认为 RSV 感染。4 名（50%）PCR 确诊的 RSV ARI 病例报告有下呼吸道疾病（LRTI）症状，1 名住院。综合 PCR 和血清学数据，初次入组时 RSV 发病率为 12%（8/65），根据 ARI 发作次数为 13%（10/77）。在健康对照组中，88 名中有 28 名（32%）在前一个和/或当前季节 Western Blot 图谱提示近期 RSV 感染。
在呼吸道病毒流行季，接受常规产前保健的门诊孕妇 RSV 发病率为 10-13%。健康对照组的血清学结果表明发病率可能更高。未来的研究应注意结合 PCR 和血清学检测以识别 RSV 感染，因为正在评估 RSV 母体疫苗候选物以保护婴幼儿，因此应额外优先关注孕妇的结局。
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