Respiratory syncytial virus neutralizing antibodies in cord blood, respiratory syncytial virus hospitalization, and recurrent wheeze

doi:10.1016/j.jaci.2008.10.043

Journal of Allergy and Clinical Immunology

Volume 123, Issue 2, February 2009, Pages 398-403

https://doi.org/10.1016/j.jaci.2008.10.043 Get rights and content

Background

Respiratory syncytial virus (RSV) hospitalization is associated with wheeze.

Objective

To examine the influence of maternally derived RSV neutralizing antibodies in cord blood on RSV hospitalization and recurrent wheeze in infancy.

Methods

Among children from the Danish National Birth Cohort, we selected a subcohort of 459 randomly selected children, 408 children with RSV hospitalization, 408 children with recurrent wheeze, and all 289 children who experienced both RSV hospitalization and recurrent wheeze. The influence of cord blood RSV neutralizing antibodies was examined as predictors for (1) RSV hospitalization, (2) RSV hospitalization after recurrent wheeze, (3) recurrent wheeze, and (4) recurrent wheeze after RSV hospitalization.

Results

Neutralizing antibody levels were inversely associated with RSV hospitalization in infants below 6 months of age (adjusted incidence rate ratio [IRR], 0.74; 95% CI, 0.62-0.87), and also inversely associated with RSV hospitalization in infants with recurrent wheeze (IRR, 0.83; 0.71-0.97). In contrast, neutralizing antibody levels were directly associated with an increased risk of recurrent wheeze in infants below 6 months of age (IRR, 1.28; 1.04-1.57) and with an increased risk of recurrent wheeze after RSV hospitalization in infants below 6 months of age (IRR, 1.44; 1.10-1.90).

Conclusion

Maternally derived RSV neutralizing antibodies protect infants against RSV hospitalization, and also when the infant has recurrent wheeze. However, high maternally derived RSV neutralizing antibody levels were associated with an increased risk of recurrent wheeze.

Section snippets

Methods

We designed a case-cohort study that included randomly selected children, children with RSV hospitalization, children with recurrent wheeze, and children with both RSV hospitalization and recurrent wheeze. We used data from The Danish National Birth Cohort (DNBC, www.bsmb.dk)¹⁹ and the RSV database and followed the children from birth to 18 months of age.

Results

The geometric mean of maternally derived RSV neutralizing antibodies in 1418 cord blood samples (3 samples had insufficient quantity for the analysis) was 7.83 (SD, 1.60; range, 3.5-16; percentiles, 10%, 6; 25%, 6.5; 50%, 7.5; 75%, 9; 90%, 10). The results of the multivariable analysis for the 4 comparisons are as follows.

Discussion

The main findings of the current case-cohort study are that the titer of maternally derived RSV neutralizing antibodies in cord blood is associated with a decreased risk of RSV hospitalization in healthy infants below 6 months of age, a decreased risk of RSV hospitalization among infants age 6 to 11 months with recurrent wheeze, and an increased risk of recurrent wheeze in children both with and without RSV hospitalization.

The finding of a protective effect of maternally derived RSV

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: Supported by the Lundbeck Foundation, the Novo Nordisk Foundation, the Danish National Research Foundation, and the Augustinus Foundation. The Danish Epidemiology Science Center was established by a grant from the Danish National Research Foundation, and the center initiated and created the Danish National Birth Cohort. The cohort is furthermore a result of a major grant from the Danish National Research Foundation. Additional support for the Danish National Birth Cohort was obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation.

: Disclosure of potential conflict of interest: E. A. F. Simões has received research grants from MedImmune Inc, the Centers for Disease Control and Prevention, and PATH. K. Kristensen has received research support from Abbott Laboratories. The rest of the authors have declared that they have no conflict of interest.

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Asthma and lower airway diseaseRespiratory syncytial virus neutralizing antibodies in cord blood, respiratory syncytial virus hospitalization, and recurrent wheeze

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Lancet

J Pediatr

Vaccine

J Pediatr

J Pediatr

J Clin Epidemiol

J Allergy Clin Immunol

Aust N Z J Public Health

J Allergy Clin Immunol

Vaccine

Chest

Wheezing following lower respiratory tract infections with respiratory syncytial virus and influenza A in infancy

Pediatr Allergy Immunol

Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7

Am J Respir Crit Care Med

Asthma and wheezing in the first six years of life. The Group Health Medical Associates

N Engl J Med

Atopic disposition, wheezing, and subsequent respiratory syncytial virus hospitalization in Danish children younger than 18 months: a nested case-control study

Pediatrics

Respiratory syncytial virus in early infancy: circulating antibody and the severity of infection

Am J Dis Child

Maternal antibody and respiratory syncytial virus infection in infancy

J Med Virol

Antibodies to respiratory syncytial virus polypeptides and their significance in human infection

J Gen Virol

Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life

Am J Epidemiol

Prevalence of respiratory syncytial virus IgG antibodies in infants living in a rural area of Mozambique

J Med Virol

Asthma and lower airway disease
Respiratory syncytial virus neutralizing antibodies in cord blood, respiratory syncytial virus hospitalization, and recurrent wheeze