Burden of Respiratory Syncytial Virus Infection in South African Human Immunodeficiency Virus (HIV)-Infected and HIV-Uninfected Pregnant and Postpartum Women: A Longitudinal Cohort Study

Shabir A Madhi, Clare L Cutland, Sarah Downs, Stephanie Jones, Nadia van Niekerk, Eric A F Simoes, Marta C Nunes, Shabir A Madhi, Clare L Cutland, Sarah Downs, Stephanie Jones, Nadia van Niekerk, Eric A F Simoes, Marta C Nunes

Abstract

Background: Limited data exist on the burden of respiratory syncytial virus (RSV) illness among pregnant women, to determine their potential benefit from RSV vaccination. We evaluated the incidence of RSV illness from midpregnancy until 24 weeks postpartum in human immunodeficiency virus (HIV)-uninfected and HIV-infected women and their infants.

Methods: Mother-infant dyads were enrolled in maternal influenza vaccine efficacy trials. These included 1060 and 1056 HIV-uninfected pregnant women in 2011 and 2012, respectively, 194 HIV-infected pregnant women in 2011, and their infants. Upper respiratory tract samples obtained at illness visits were tested for RSV.

Results: The incidence (per 1000 person-months) of RSV illness (n = 43 overall) among HIV-uninfected women was lower in 2011 (1.2; 95% confidence interval [CI], .6-2.2) than in 2012 (4.0; 95% CI, 2.8-5.6). The incidence of RSV illness (n = 5) in HIV-infected women was 3.4 (95% CI, 1.4-8.1). Maternal RSV infection was associated with respiratory symptoms including cough (72.1%), rhinorrhea (39.5%), sore throat (37.2%), and headache (42%), but fever was absent. RSV infection during pregnancy was not associated with adverse pregnancy outcomes. Postpartum, RSV infection in mothers (n = 27) was associated with concurrent infection among 51.9% of their infants and, conversely, 29.8% of mothers investigated within 7 days of their infants having an RSV illness also tested positive for RSV.

Conclusions: RSV infection is associated with respiratory illness during pregnancy and postpartum. Vaccination of pregnant women against RSV could benefit the mother, albeit primarily against nonfebrile illness, and her infant.

Clinical trial registration: NCT01306669 and NCT01306682.

Figures

Figure 1.
Figure 1.
Number of participants in the study by week and respiratory syncytial virus (RSV) and influenza seasonality. RSV and influenza positivity rate were calculated using data from the South Africa national surveillance system. Underlined are the weeks considered part of the RSV season. A, Enrollment of pregnant women into the study. B, Maternal study illness visits during pregnancy and postpartum. C, Infants born from mothers in the study and infant study illness visits.

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