Englund J A
Department of Microbiology and Immunology, Baylor College of Medicine, Houston, TX 77030.
Pediatr Infect Dis J. 1994 May;13(5):449-53. doi: 10.1097/00006454-199405000-00037.
Respiratory syncytial virus (RSV) is responsible for serious respiratory disease in young infants. More than 75% of the 678 children hospitalized for RSV at Baylor-affiliated hospitals in Houston, TX, between October, 1992, and March, 1993, were 5 months of age or younger. The importance of maternal antibody in the immunity against RSV disease has been debated. More recent epidemiologic studies have demonstrated protection against RSV in babies born to mothers with high levels of neutralizing RSV antibody. The contribution of IgG fusion or F protein antibody as a correlate with immunity from disease also has been described. With the availability of purified F protein vaccines such as the purified F protein vaccines manufactured by Lederle-Praxis-Biologicals (Pearl River, NY), immunization of pregnant women with RSV surface glycoproteins to arm the newborn with high neutralizing antibody can be considered. Advantages of maternal immunization to augment naturally occurring maternal RSV antibody are that babies most at risk for infection are least responsive to vaccines, that pregnant women respond well immunologically to vaccines in general and that placental transfer of maternal IgG antibody occurs naturally during the third trimester. The safety of maternally derived antibody would likely surpass that of exogenously administered immunoglobulin as well as would have a decreased cost. Disadvantages of maternal immunization to protect infants against RSV could include the potential inhibition of the infant's response to active immunization or subsequent disease, the lack of antibody transfer in premature infants, and liability issues. Evaluation of purified F protein vaccine in postpartum women is under way.
呼吸道合胞病毒（RSV）可导致幼儿患上严重的呼吸道疾病。1992年10月至1993年3月期间，在得克萨斯州休斯顿市贝勒附属医院因RSV住院的678名儿童中，超过75%的患儿年龄在5个月及以下。母体抗体在抵抗RSV疾病免疫中的重要性一直存在争议。最近的流行病学研究表明，母亲体内具有高水平RSV中和抗体的婴儿可获得对RSV的保护。也有研究描述了IgG融合或F蛋白抗体与疾病免疫之间的关联。随着纯化F蛋白疫苗的出现，如Lederle-Praxis-Biologicals公司（纽约州珍珠河）生产的纯化F蛋白疫苗，可以考虑用RSV表面糖蛋白对孕妇进行免疫，以使新生儿获得高中和抗体。母体免疫增强自然产生的母体RSV抗体的优势在于，最易感染的婴儿对疫苗反应最差，孕妇总体上对疫苗的免疫反应良好，且在妊娠晚期母体IgG抗体可自然发生胎盘转移。母体来源抗体的安全性可能超过外源性免疫球蛋白，且成本更低。母体免疫保护婴儿免受RSV感染的缺点可能包括潜在抑制婴儿对主动免疫或后续疾病的反应、早产儿缺乏抗体转移以及责任问题。目前正在对产后妇女进行纯化F蛋白疫苗的评估。
