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Am J Epidemiol. 2018 Jul 1;187(7):1490-1500. doi: 10.1093/aje/kwy008.

Effectiveness of Respiratory Syncytial Virus Immunoprophylaxis in Reducing Bronchiolitis Hospitalizations Among High-Risk Infants.

Author information

1
Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
2
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Department of Inpatient Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California.
4
Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland, California.
5
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
6
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
7
Department of Health Science, College of Life Sciences, Brigham Young University, Provo, Utah.

Abstract

We sought to determine the real-world effectiveness of respiratory syncytial virus (RSV) immunoprophylaxis in a population-based cohort to inform policy. The study population included infants born during 1996-2008 and enrolled in the Kaiser Permanente Northern California integrated health-care delivery system. During the RSV season (November-March), the date of RSV immunoprophylaxis administration and the following 30 days were defined as RSV immunoprophylaxis protected period(s), and all other days were defined as unprotected period(s). Numbers of bronchiolitis hospitalizations were determined using International Classification of Diseases, Ninth Revision, codes during RSV season. We used a proportional hazards model to estimate risk of bronchiolitis hospitalization when comparing infants' protected period(s) with unprotected period(s). Infants who had ever received RSV immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.68, 95% confidence interval: 0.46, 1.00) when protected periods were compared with unprotected periods. Infants with chronic lung disease (CLD) had a 52% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.48, 95% confidence interval: 0.25, 0.94) when protected periods were compared with unprotected periods. Under the new 2014 American Academy of Pediatrics (AAP) guidelines, 48% of infants eligible for RSV immunoprophylaxis on the basis of AAP guidelines in place at birth would no longer be eligible, but nearly all infants with CLD would remain eligible. RSV immunoprophylaxis is effective in decreasing hospitalization. This association is greatest for infants with CLD, a group still recommended for receipt of RSV immunoprophylaxis under the new AAP guidelines.

PMID:
29351636
PMCID:
PMC6030843
DOI:
10.1093/aje/kwy008
[Indexed for MEDLINE]
Free PMC Article

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