Abstract
BackgroundPalivizumab, a monoclonal antibody and the only licensed immunization product for preventing respiratory syncytial virus (RSV) infection, is recommended for children with certain high-risk conditions. Other antibody products and maternal vaccines targeting young infants are in clinical development. Few studies have compared products closest to potential licensure and have primarily focused on the effects on hospitalizations only. Estimates of the impact of these products on medically-attended (MA) infections in a variety of healthcare settings are needed to assist with developing RSV immunization recommendations. MethodsWe developed a tool for practicing public health officials to estimate the impact of immunization strategies on RSV-associated MA lower respiratory tract infections (LRTIs) in various healthcare settings among infants <12 months. Users input RSV burden and seasonality and examine the influence of altering product efficacy and uptake assumptions. We used the tool to evaluate candidate products’ impacts among a US birth cohort. ResultsWe estimated without immunization, 407,360 (range: 339,650–475,980) LRTIs are attended annually in outpatient clinics, 147,240 (126,070–168,510) in emergency departments (EDs), and 33,180 (24,760–42,900) in hospitals. A passive antibody candidate targeting all infants prevented the most LRTIs: 196,470 (48% of visits without immunization) outpatient clinic visits (range: 163,810–229,650), 75,250 (51%) EDs visits (64,430–86,090), and 18,140 (55%) hospitalizations (13,770–23,160). A strategy combining maternal vaccine candidate and palivizumab prevented 58,210 (14% of visits without immunization) LRTIs in outpatient clinics (range: 48,520–67,970), 19,580 (13%) in EDs (16,760–22,400), and 8,190 (25%) hospitalizations (6,390–10,150). ConclusionsResults underscore the potential for anticipated products to reduce serious RSV illness. Our tool (provided to readers) can be used by different jurisdictions and accept updated data. Results can aid economic evaluations and public health decision-making regarding RSV immunization products.
Highlights
Respiratory syncytial virus (RSV) is a leading cause of severe respiratory tract infections among young children
Strategy II prevented the most annual lower respiratory tract infections (LRTIs). (Fig. 1) This strategy prevents an estimated 196,470 (48% of visits without immunization) respiratory syncytial virus (RSV)-associated LRTIs attended in the outpatient clinic setting, 75,250 (51%) LRTIs attended in the emergency departments (EDs), and 18,140 (55%) LRTI hospitalizations
Strategy III, prevented an estimated 58,210 (14% of visits without immunization) RSV-associated LRTIs attended in the outpatient clinic setting, 19,580 (13%) LRTIs attended in the ED, and 8190 (25%) LRTI hospitalizations
Summary
Respiratory syncytial virus (RSV) is a leading cause of severe respiratory tract infections among young children. In 2015, there were an estimated 33.1 million acute lower respiratory tract infections, 3.2 million hospital admissions and 59,600 in-hospital deaths attributed to RSV infections (RSVi) among children < 5 years of age worldwide. Each year in the United States, ~1.5 million outpatient visits, ~500,000 emergency department (ED) visits, ~58,000 hospitalizations and ~150 deaths are associated with RSVi among children under 5 years of age [2,3]. Palivizumab, a monoclonal antibody and the only licensed immunization product for preventing respiratory syncytial virus (RSV) infection, is recommended for children with certain high-risk conditions. Estimates of the impact of these products on medically-attended (MA) infections in a variety of healthcare settings are needed to assist with developing RSV immunization recommendations
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