G492 Access to palivizumab against respiratory syncytial virus in high-risk children in england

Abstract

Aims Bronchiolitis due to respiratory syncytial virus (RSV) is a leading cause of hospitalisations in infants. High-risk babies are eligible for passive RSV immunisation throughout the RSV season (October to March in England) using palivizumab (Synagis®, MedImmune), a humanised monoclonal antibody. There is currently no data on access to palivizumab in high-risk children in England. This study aimed to explore factors associated with uptake of palivizumab in English hospitals. Methods We used the Hospital Treatment Insights (HTI), database containing hospital admission records linked to hospital pharmacy data for 43 acute hospital trusts in England in 2010–2016. We identified eligible children if their medical records indicated chronic lung disease (CLD), congenital heart disease (CHD), severe immunodeficiency, and they met additional criteria based on their gestational age at birth and age at the start of RSV season. We calculated the proportion of children prescribed at least one dose of palivizumab in their first RSV season according to the child’s gestational age, birth weight, sex, ethnicity, age, and presence of CLD, CHD and severe immunodeficiency. We used logistic regression models to determine which of these risk factors were independently associated with the highest odds of treatment. Results We identified 7078 eligible children, of which 4802 had complete information on all risk factors of interest. 83% of eligible children had CHD, and 46% had CLD. Palivizumab was prescribed to 18% (876) of eligible children; uptake ranged from 0% to over 40% between hospital trusts. The adjusted odds of treatment were four times higher for children with CLD compared to children without CLD (odds ratio 4.19, 95% confidence interval 2.91–6.02) and 90% higher for children with severe immunodeficiency compared to children without (1.89, 0.98–3.62). There was no difference in odds of treatment between eligible children with and without CHD (0.94, 0.77–1.15). Conclusion We found that palivizumab is infrequently prescribed to eligible children. Further research is needed to explore variation in prescribing between hospitals and to examine whether long-term respiratory outcomes vary according to palivizumab treatment in this group of high-risk children.