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Am J Perinatol
DOI: 10.1055/a-2512-9453
Short Communication

Increased Respiratory Syncytial Virus-Associated Hospitalizations and Ambulatory Visits in Very Preterm Infants in the First Year of Life following Discontinuation of Access to Palivizumab

Yolanda Evong
1   Department of Pediatrics, Dalhousie University Faculty of Medicine, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
,
Jiaxin Luo
2   Canadian Center for Vaccinology (Dalhousie University, IWK Health and Nova Scotia Health), Halifax, Nova Scotia, Halifax, Nova Scotia, Canada
,
Lingyun Ye
3   Canadian Centre for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
,
John Fahey
4   Department of Reproductive Care of Nova Scotia, IWK Health Centre, Halifax, Nova Scotia, Canada
,
Janis L. Breeze
3   Canadian Centre for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada
,
Rebecca Attenborough
4   Department of Reproductive Care of Nova Scotia, IWK Health Centre, Halifax, Nova Scotia, Canada
,
Kenny Wong
5   Division of Pediatric Cardiology, Department of Pediatrics, Dalhousie University Faculty of Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada
,
Joanne M. Langley 
2   Canadian Center for Vaccinology (Dalhousie University, IWK Health and Nova Scotia Health), Halifax, Nova Scotia, Halifax, Nova Scotia, Canada
6   Department of Pediatrics and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
› Author Affiliations Funding This study was funded in part by an IWK Health Centre Mentored Research Grant to Y.E. who was a trainee at the time of the work; J.M.L. was the mentor. J.M.L.'s institution received grants from GlaxoSmithKline, Moderna, and Merck for the conduct of RSV vaccine clinical trials and from Merck for the conduct of clinical trials of anti-RSV monoclonal antibodies, outside of this study.
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Abstract

Objective From 2002 to 2023, palivizumab was the only intervention to reduce respiratory syncytial virus (RSV)-associated hospitalizations in high-risk infants in Canada but advances in RSV prevention are drastically changing this landscape. Eligibility criteria for this monoclonal antibody for preterm infants varied over time across each of 10 Canadian provinces and 3 territories. The National Professional Pediatric Association (Canadian Pediatric Society) revised its eligibility recommendations in 2015, removing access for preterm infants 30 to 32 weeks gestation (WG). The province of Nova Scotia followed these recommendations the next season. This study aimed to determine if the removal of access to palivizumab in these previously eligible infants was associated with a change in hospital admissions, deaths, or ambulatory visits associated with RSV.

Study Design We identified a retrospective cohort of Nova Scotia infants born between 30 and 32 WG, without other risk factors for RSV-H, from April 2012 to September 2019 by linking six population-based provincial databases, and followed each infant through the first year of life. Episodes of RSV-associated hospitalization (RSV-H), ambulatory visits (RSV-A), or death were identified by the International Statistical Classification of Diseases and Related Health Disorders (ICD) RSV-associated diagnostic codes.

Results Of 4,835 infants born during the study period, 250 were 30 to 32 WG and eligible for the cohort. RSV-H increased approximately 10-fold following restricted access to palivizumab (from no RSV-H (0/123) to 9.4%; 95% CI 5.0, 15.9; risk difference 9.4), but no RSV-associated deaths occurred. RSV-A also increased from 5.7 to 17.3% (risk difference 11.6).

Conclusion Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants was associated with a higher risk of RSV-H and RSV-A. Evaluation of health care policy change on patient well-being is essential to assess the impact and guide future decision-making at the population level.

Key Points

  • Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants 30 to 32 WG was associated with a higher risk of RSV-H and RSV-A. Evaluation of changes to health care policy on patient well-being is essential to assess impact and guide future decision-making at the population level.

  • Removing access to palivizumab led to higher RSV admissions in 30 to 32 WG infants.

  • The effect of health care policy changes on child well-being should be assessed routinely.

  • No deaths associated with RSV were identified prior to or after the policy change.

Keywords

infant - premature - antibodies - monoclonal - respiratory syncytial virus - health policy


Publication History

Received: 08 December 2024

Accepted: 08 January 2025

Accepted Manuscript online:
09 January 2025

Article published online:
31 January 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Hall CB, Weinberg GA, Iwane MK. et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009; 360 (06) 588-598
    CrossrefPubMedSearch in Google Scholar
  • 2 Li Y, Wang X, Blau DM. et al; Respiratory Virus Global Epidemiology Network, RESCEU investigators. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet 2022; 399 (10340): 2047-2064
    CrossrefPubMedSearch in Google Scholar
  • 3 Government of Canada. Statement on the prevention of respiratory syncytial virus (RSV) disease in infants. 2024 . Vol. 67
    PubMedSearch in Google Scholar
  • 4 American Academy of Pediatrics Committee on Infectious Diseases, American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134 (02) 415-420
    CrossrefPubMedSearch in Google Scholar
  • 5 American Academy of Pediatrics Committee on Infectious Diseases, American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014; 134 (02) e620-e638
    CrossrefPubMedSearch in Google Scholar
  • 6 Fergie J, Goldstein M, Krilov LR, Wade SW, Kong AM, Brannman L. Update on respiratory syncytial virus hospitalizations among U.S. preterm and term infants before and after the 2014 American Academy of Pediatrics policy on immunoprophylaxis: 2011-2017. Hum Vaccin Immunother 2021; 17 (05) 1536-1545
    CrossrefPubMedSearch in Google Scholar
  • 7 Fergie J, Suh M, Jiang X, Fryzek JP, Gonzales T. Respiratory syncytial virus and all-cause bronchiolitis hospitalizations among preterm infants using the Pediatric Health Information System (PHIS). J Infect Dis 2022; 225 (07) 1197-1204
    CrossrefPubMedSearch in Google Scholar
  • 8 Kong AM, Winer IH, Zimmerman NM. et al. Increasing rates of RSV hospitalization among preterm infants: a decade of data. Am J Perinatol 2023; 40 (14) 1529-1536
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Moore D, Sinilaite A, Killikelly A. Summary of the National Advisory Committee on Immunization (NACI) statement update on the recommended use of palivizumab to reduce complications of respiratory syncytial virus infection in infants. Can Commun Dis Rep 2022; 48 (7-8): 363-366
    CrossrefPubMedSearch in Google Scholar