title: Clinical Presentation and Birth Outcomes Associated with Respiratory Syncytial Virus Infection in Pregnancy.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is the most important cause of viral pneumonia in children worldwide. A maternal vaccine may protect both the mother and infant from RSV illness. The epidemiology and clinical presentation of RSV in pregnant and postpartum women is not well-described.
  
  
  METHODS
  Data were collected from a prospective, randomized trial of influenza immunization in pregnant women in rural southern Nepal. Women were enrolled in their second trimester of pregnancy and followed until six months postpartum. Active weekly home-based surveillance for febrile respiratory illness was performed. Mid-nasal swabs collected with episodes of respiratory illness were tested for RSV by real-time polymerase chain reaction.
  
  
  RESULTS
  RSV was detected in 14 (0.4%) illness episodes in 3693 women over 3554 person-years of surveillance from 2011-2014. RSV incidence was 3.9/1000 person-years overall, and 11.8/1000 person-years between September and December. Seven (50%) women sought care for RSV illness; none died. Of the 7 (50%) illness episodes during pregnancy, all had live births with 2 (29%) preterm births and a median birthweight of 3060 grams. This compares to 469 (13%) preterm births and a median birthweight of 2790 grams in women without RSV during pregnancy. Of the 7 mothers with postpartum RSV infection, RSV was detected in 4 (57%) of their infants.
  
  
  CONCLUSIONS
  RSV was an uncommon cause of febrile respiratory illness in mothers during pregnancy in Nepal. These data will inform prevention and therapeutic strategies against RSV in resource-limited settings.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, 98102, United States of America.
authors.forename: Helen Y
authors.initials: HY
authors.lastname: Chu
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.affiliation: Department of Global Health, George Washington University, Washington, D.C., United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Tielsch
authors.affiliation: Nepal Nutrition Intervention Project-Sarlahi, Sarlahi, Nepal.
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.affiliation: Department of Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Laxman
authors.initials: L
authors.lastname: Shrestha
authors.affiliation: Nepal Nutrition Intervention Project-Sarlahi, Sarlahi, Nepal.
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA, 98102, United States of America.|Department of Biostatistics, University of Washington, Seattle, WA, 98102, United States of America.
authors.forename: Amalia
authors.initials: A
authors.lastname: Magaret
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA, 98102, United States of America.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Global Health Center, Cincinnati Children's Hospital, Cincinnati, OH, 45229, United States of America.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Steinhoff
authors.affiliation: Department of Infectious Diseases, Seattle Children's Hospital, University of Washington, Seattle, WA, 98105, United States of America.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D005260:Female; D006801:Humans; D007114:Immunization; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000517:prevention & control; D009390:Nepal / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000821:virology; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000175:diagnosis*; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification*; D012424:Rural Population; D055815:Young Adult