Burden of respiratory syncytial virus infection in South African HIV-infected and HIV-uninfected pregnant and post-partum women: A longitudinal cohort study

Abstract

Background

There are limited data on the burden of respiratory syncytial virus (RSV) illness among pregnant and post-partum women, to determine their potential benefit from maternal RSV vaccination aimed primarily at protecting their probands. We evaluated the incidence of RSV-illness from mid-pregnancy until 24-weeks post-partum in HIV-uninfected and HIV-infected women and their infants.

Methods

Mother-infant dyads were enrolled in phase-III 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 by PCR.

Results

The incidence (per 1000 person-months) of RSV-illness (n=43 overall) among HIV-uninfected women was lower in 2011 (1.2; 95%CI: 0.6, 2.2) than in 2012 (4.0; 95%CI: 2.8, 5.6; p=0.001). The incidence of RSV-illness (n=5) in HIV-infected women was 3.4 (95%CI: 1.4, 8.1) in 2011. Maternal RSV-infection was associated with respiratory symptoms including cough (72.1%), rhinorrhoea (39.5%), sore-throat (37.2%); and headache (42%), but fever was absent in all cases. RSV-infection during pregnancy was not associated with adverse pregnancy outcomes. Post-partum, RSV-infection in mothers (n=27) was associated with concurrent infection among 51.9% of their infants; and conversely 29.8% of mothers with an investigated respiratory illness within 7 days of their infants having a RSV illness also tested positive for RSV.

Conclusions

RSV-infection is associated with respiratory illness during pregnancy and post-partum in women. Vaccination of pregnant women against RSV could benefit the mother, albeit primarily against non-febrile illness, and her infant.