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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Appropriateness of age thresholds for respiratory syncytial virus immunoprophylaxis in moderate-preterm infants: a
Almut G Winterstein1, Caitlin A Knox, Paul Kubilis
1Department of Epidemiology, University of Florida, Gainesville2Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville.
Insights
Moderate-preterm infants have double the risk of respiratory syncytial virus (RSV) hospitalization. Their risk equals that of healthy term infants around 4-5 months of age, supporting earlier prophylaxis recommendations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Respiratory syncytial virus (RSV) prophylaxis recommendations for moderate-preterm infants are debated.
- Preterm infants face a higher risk of RSV hospitalization compared to term infants.
Purpose of the Study:
- To determine the specific age when moderate-preterm infants' RSV hospitalization risk diminishes to that of low-risk term infants.
- To inform age-based thresholds for RSV immunoprophylaxis in moderate-preterm populations.
Main Methods:
- Retrospective cohort study utilizing Florida and Texas Medicaid data (1999-2004).
- Analysis included 247,566 infants aged 0-12 months, comparing moderate-preterm (32-34 weeks GA) and term infants (37-41 weeks GA).
- Discrete time survival analysis modeled RSV hospitalization trends and identified risk equivalence points.
Main Results:
- Moderate-preterm infants exhibited doubled RSV hospitalization risk (OR 2.41 in FL, OR 1.94 in TX).
- RSV hospitalization risk for moderate-preterm infants approximated that of 1-month-old term infants at approximately 4.2 months in Florida and 4.5 months in Texas.
- These findings were observed in a large cohort with over 5000 RSV hospitalizations.
Conclusions:
- The study supports more restrictive age thresholds for RSV immunoprophylaxis in moderate-preterm infants.
- Moderate-preterm infants' elevated RSV hospitalization risk persists until approximately 4-5 months of corrected age.
- Further research is needed on age-dependent RSV risk in other infant populations.
Abstract:
IMPORTANCE Recommendations concerning the appropriate age threshold for respiratory syncytial virus (RSV) prophylaxis in moderate-preterm infants are highly debated. OBJECTIVE To determine the age at which moderate-preterm infants' risk of RSV hospitalization has decreased to the risk observed in low-risk term infants. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of Florida and Texas Medicaid fee-for-service billing records matched to birth certificates from Medicaid beneficiaries aged 0 to 12 months with a sibling younger than 5 years and without other indications for RSV prophylaxis between January 1, 1999, and December 31, 2004. EXPOSURES For each state, we used discrete time survival analysis to develop age trend models for RSV hospitalizations for 2 groups: moderate-preterm infants (32-34 weeks' gestational age) and term infants (37-41 weeks' gestational age). MAIN OUTCOMES AND MEASURES Age at which preterm infants' risk of RSV hospitalization equaled the risk for term infants at age 1 month. RESULTS Our cohort included 247,566 eligible infants with 5322 RSV hospitalizations. Preterm status doubled the risk for RSV hospitalization in both Florida (odds ratio = 2.41; 95% CI, 1.85-3.12) and Texas (odds ratio = 1.94; 95% CI, 1.64-2.30). Preterm infants' risk of RSV hospitalization was similar to that for 1-month-old term infants at ages 4.2 months (95% CI, 2.5-5.7) in Florida and 4.5 months (95% CI, 2.8-6.4) in Texas. CONCLUSIONS AND RELEVANCE The age at which moderate-preterm infants showed RSV hospitalization risk similar to their healthy term counterparts supports the more restrictive age thresholds in RSV immunoprophylaxis recommendations. Further studies are warranted to investigate the age-dependent risk of RSV hospitalization in other RSV risk groups.
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