Start Of Respiratory Syncytial Virus Season Research Articles

Access to palivizumab among children at high risk of respiratory syncytial virus complications in English hospitals.

Palivizumab is a monoclonal antibody which can prevent infection with respiratory syncytial virus (RSV). Due to its high cost, it is recommended for high-risk infants only. We aimed to determine the proportion of infants eligible for palivizumab treatment in England who receive at least one dose. We used the Hospital Treatment Insights database, which contains hospital admission records linked to hospital pharmacy dispensing data for 43 out of 153 hospitals in England. Infants born between 2010 and 2016 were considered eligible for palivizumab if their medical records indicated chronic lung disease (CLD), congenital heart disease (CHD) or severe immunodeficiency (SCID), and they met additional criteria based on gestational age at birth and age at start of the RSV season (beginning of October). We calculated the proportion of infants who received at least one dose of palivizumab in their first RSV season, and modelled the odds of treatment according to multiple child characteristics using logistic regression models. We identified 3712 eligible children, of whom 2479 (67%) had complete information on all risk factors. Palivizumab was prescribed to 832 of eligible children (34%). Being born at <30 weeks' gestation, aged <6months at the start of RSV season, and having two or more of CLD, CHD or SCID were associated with higher odds of treatment. In England, palivizumab is not prescribed to the majority of children who are eligible to receive it. Doctors managing these infants may be unfamiliar with the eligibility criteria or constrained by other considerations, such as cost.

Can we improve the targeting of respiratory syncytial virus (RSV) prophylaxis in infants born 32–35 weeks’ gestational age with more informed use of risk factors?

Objective: To evaluate the key risk factors for respiratory syncytial virus (RSV) hospitalisation in 32–35 weeks’ gestational age (wGA) infants.Methods: Published risk factors were assessed for predictive accuracy (area under the receiver operating characteristic curve [ROC AUC]) and for number needed to treat (NNT).Results: Key risk factors included: proximity of birth to the RSV season; having siblings; crowding at home; day care; smoking; breast feeding; small for GA; male gender; and familial wheezing/eczema. Proximity of birth to the RSV season appeared the most predictive. Risk factors models from Europe and Canada were found to have a high level of predictive accuracy (ROC AUC both >0.75; NNT for European model 9.5). A model optimised for three risk factors (birth ±10 weeks from start of RSV season, number of siblings ≥2 years and breast feeding for ≤2 months) had a similar level of prediction (ROC AUC: 0.776; NNT: 10.2). An example two-risk factor model (day care attendance and living with ≥2 siblings <5 years old) had a lower level of predictive accuracy (ROC AUC: 0.55; NNT: 26).Conclusions: An optimised combination of risk factors has the potential to improve the identification of 32–35 wGA infants at heightened risk of RSV hospitalisation.

The 2009 COID Recommendations for RSV Prophylaxis: Issues of Efficacy, Cost, and Evidence-Based Medicine

The American Academy of Pediatrics (AAP) Committee on Infectious Disease (COID) recently published its updated recommendations for palivizumab prophylaxis for infants at high risk for severe respiratory syncytial virus (RSV) infection.1 Comparison of these guidelines with those published in 20062 reveals changes that would significantly decrease the number of premature infants who would be considered for palivizumab prophylaxis. The most notable changes in the 2009 guidelines are the indications for prophylaxis in premature infants 32 to 35 weeks' gestational age (GA). These changes included: 1. decreasing the chronological age (CA) for infants 32 to 35 weeks' GA for whom palivizumab would be considered from 6 months to 90 days of age at the start of RSV season (in addition, these infants should have at least 1 more risk factor [ie, day care attendance and/or have sibling(s) <5 years of age]); and 2. continuing palivizumab in these infants only until they reach a CA of ≥90 days (ie, a total of 1–3 doses based on date of birth). We believe that some aspects of the new guidelines extend beyond the available evidence-based data and merit discussion. ![Graphic][1] For further study of the AAP's policy on RSV treatments, download “RSV: Prevention of Disease”. This complementary issue of PREP® Audio is being offered exclusively to Pediatrics subscribers and AAP members. This is a must hear for all pediatricians! Current evidence indicates that young CA (infants born within 3 months before or during the RSV season) is an independent risk factor for RSV hospitalization during that RSV season.3 Law et al4 also documented that infants 33 to 35 weeks' GA born between November and January were at increased risk for RSV hospitalization throughout that season. Although they noted higher RSV-related hospitalization rates in 33- to 36-week-GA infants at a CA of … Address correspondence to Leonard R. Krilov, MD, Winthrop University Hospital, 120 Mineola Blvd, Suite 210, Mineola, NY 11501. E-mail: lkrilov{at}winthrop.org [1]: /embed/inline-graphic-1.gif

Utilidad predictiva de ingreso por infección por virus respiratorio sincitial de diferentes asociaciones de factores de riesgo en prematuros de 32 a 35 semanas de gestación en España

Aim The aim of the study was to evaluate the risk factor associations for respiratory syncytial virus (RSV) hospitalization in preterm infants from 32 to 35 weeks gestation, treated during two consecutive RSV seasons in Spain. Patients and methods A database (FLIP-2) was used after excluding the infants who received prophylactic palivizumab. A total of 193 RSV+ admissions and 4568 non-hospitalized children were studied. The risk factors analyzed were: chronological age <=10 weeks at start of RSV season or to be born during the first 10 weeks of the season; school-age siblings or daycare attendance; mother smoking during pregnancy; male gender; breastfeeding <=2 months; >=4 adults at home; history of wheezing; small for gestational age; >=2 smokers at home. Results Logistic regression model included the first four previously mentioned risk factors as independently significant variables, with R 2 of 0.062 and area under curve of 0.687 ( P<0.001). Predictive values for a child with the four risk factors were: sensitivity 6.2%, specificity 98.6%, predictive positive value 16.2%, negative predictive value 96.1%, accuracy 94.9%, positive likelihood ratio 4.581, and negative likelihood ratio 0.951. Positive likelihood ratio for a child with the two major risk factors is 2.657. Conclusions Usefulness of different risk factor associations to predict hospitalization for respiratory syncytial virus infection in preterm infants 32 to 35 weeks gestation in Spain is low, although similar to other models.