Level of maternal antibodies against respiratory syncytial virus (rsv) nucleoprotein at birth and risk of rsv very-severe lower respiratory tract infection

Background: The nucleoprotein (N protein) of respiratory syncytial virus (RSV) is a candidate antigen for new RSV vaccine development. The aim of the present study was to investigate the association between maternal antibody titers against the RSV N protein at birth and the newborns’ risk of developing very-severe lower respiratory tract infection (VS-LRTI). Methods: In this single-center prospective cohort study, 578 infants born during the RSV epidemic season in France were included. Among these, 36 were hospitalized for RSV VS-LRTI. A generalized linear model was used to test the occurrence of a VS-LRTI in function of sex, mode of delivery, parity of the mother, type of pregnancy, date of birth in relation to the peak of the epidemic, and antibody titer against N protein. Results: All cord blood samples had detectable antibodies against N protein. The mean titers were significantly lower in newborns with risk factors for RSV severe LRTI (preterm infants, birth before the peak epidemic, multiparous mother). There was no association between antibody titer against the N protein and a protection against VS-LRTI. Conclusions The present study found that transfer of maternal antibodies against the RSV N protein may not provide a significant immune protection early in infancy. Clinical Trials Registration. NCT04144816.