Impact of Placental Malaria and Hypergammaglobulinemia on Transplacental Transfer of Respiratory Syncytial Virus Antibody in Papua New Guinea

J Infect Dis. 2016 Feb 1;213(3):423-31. doi: 10.1093/infdis/jiv401. Epub 2015 Aug 3.


Background: Passively acquired respiratory syncytial virus (RSV) neutralizing antibody protects against RSV-associated lower respiratory infections, but placental malaria (PM) and maternal hypergammaglobulinemia might interfere with transplacental immunoglobulin transport.

Methods: We measured RSV plaque-reduction neutralization (PRN) antibody in 300 full-term maternal/cord serum pairs in 2 cohorts in malaria-endemic Papua New Guinea: Alexishafen (2005-2008) and the Fetal Immunity Study (FIS) (2011-2013). We defined impaired transport as a cord-to-maternal titer ratio <1.0 and a protective RSV PRN titer (PRNT) ≥1:200.

Results: PM and hypergammaglobulinemia occurred in 60% and 54% of Alexishafen mothers versus 8% and 9% of FIS mothers, respectively. 34% of Alexishafen and 32% of FIS pairs demonstrated impaired transport. Multivariate modeling revealed significant associations between increasing maternal IgG (log2) and impaired transport (adjusted OR, Alexishafen: 2.68 [1.17-6.14], FIS: 6.94 [1.94-24.8]) but no association with PM. 34% of Alexishafen and 31% of FIS cord PRNTs were <1:200.

Conclusions: Impaired RSV antibody transport was observed in approximately one-third of maternal/cord pairs. Hypergammaglobulinemia, but not PM, was associated with impaired transport, particularly among women with low RSV PRNT. Detection of RSV PRNT <1:200 in one-third of cord sera confirms the need to increase levels of RSV neutralizing antibody in pregnant women through maternal immunization.

Keywords: RSV; hypergammaglobulinemia; maternal immunization; placental malaria; transplacental transfer of antibody.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Viral / metabolism*
  • Cohort Studies
  • Female
  • Fetal Blood
  • Humans
  • Hypergammaglobulinemia*
  • Infectious Disease Transmission, Vertical*
  • Malaria / complications*
  • Malaria / epidemiology
  • Malaria / transmission
  • Middle Aged
  • Papua New Guinea / epidemiology
  • Placenta Diseases / parasitology
  • Pregnancy
  • Pregnancy Complications, Parasitic / parasitology*
  • Respiratory Syncytial Viruses / immunology*
  • Risk Factors
  • Viral Plaque Assay
  • Young Adult


  • Antibodies, Viral