Date of Award

8-3-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Marietta Vazquez

Second Advisor

Alia Bazzy-Asaad

Third Advisor

Jeffrey Kahn

Abstract

THE ROLE OF MATERNALLY-DERIVED HUMAN METAPNEUMOVIRUS ANTIBODIES IN THE PROTECTION OF INFANTS AGAINST INFECTION. Carolyn Avery, Kristina DePeau, Eugene Shapiro, Jeffrey Kahn, and Marietta Vazquez. Section of Infectious Diseases, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. The aim was to determine whether the concentration of maternally-derived serum neutralizing antibodies against human metapneumovirus (hMPV) in cord blood correlated with the development and severity of hMPV infection in infants during the first year of life. This was a prospective, community-based, cohort study at the Yale Pediatric Primary Care Center. Subjects were enrolled at birth and an aliquot of cord blood was obtained to measure the concentration of maternally-derived hMPV antibody by ELISA. Results were divided into quartiles. Subjects were followed longitudinally for one year. Each time they presented with respiratory symptoms to a medical provider a nasal wash was obtained to screen for the presence of hMPV by RT-PCR and a clinical severity score was given based on vital signs, work of breathing, and disposition. At one year of age a serum sample was obtained from subjects to measure the concentration of hMPV antibody. Multivariable logistic regression was performed to determine the risk ratios for the likelihood of hMPV infection in each antibody quartile. This is an ongoing study. To date, 554 infants have enrolled (84% of those eligible) and 142 (25%) have completed one year of follow-up. 235 infants have presented with respiratory symptoms on 363 occasions. Of nasal specimens tested, 12/209 samples (5.7%) were PCR+ for hMPV. Of serum samples tested, 28/142 (19.7%) were ELISA+ for hMPV infection at one year. There was no statistical significance between antibody quartile and risk of hMPV infection in the first year of life. Twenty percent of this cohort had serologic evidence of hMPV infection at one year of age. At present, the study is underpowered and further analysis on the complete data set will better answer the stated hypothesis.

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