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An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Impact of universal immunization program with monoclonal antibody nirsevimab on reducing the burden of serious
Carme Alejandre1,2, Daniel Penela-Sánchez3,4, Judit Alsina5
1Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, Barcelona, 08950, Spain.
Insights
Universal nirsevimab immunization significantly reduced pediatric intensive care unit admissions for respiratory syncytial virus (RSV) bronchiolitis. The study found fewer admissions and shorter hospital stays post-immunization.
Area of Science:
- Pediatric infectious diseases
- Immunology
- Public health
Background:
- Bronchiolitis is a common viral lower respiratory tract infection in infants, causing significant pediatric intensive care unit (PICU) admissions.
- Respiratory Syncytial Virus (RSV) is a primary cause of bronchiolitis, leading to healthcare system strain globally.
- Universal nirsevimab immunization for infants began in Spain in October 2023, with clinical trials showing high RSV protection, but real-world PICU data was lacking.
Purpose of the Study:
- To evaluate the impact of nirsevimab immunization on PICU admissions for bronchiolitis.
- To analyze changes in epidemiological, clinical, and microbiological characteristics before and after nirsevimab implementation.
- To assess the real-world effectiveness of nirsevimab in preventing severe RSV bronchiolitis requiring PICU care.
Main Methods:
- A prospective, descriptive, observational study of severe bronchiolitis patients admitted to a PICU.
- Inclusion of patients from September 2010 to February 2024, comparing pre-nirsevimab (pre-N) and post-nirsevimab (post-N) periods.
- Collection of demographic, clinical data, and viral etiological diagnosis.
Main Results:
- 1531 patients were included; 73 in the post-N period, with 67% immunized.
- Significantly lower total PICU admissions, admission ratios, and RSV etiology were observed in the post-N period.
- Patients in the post-N period were older at admission and had a shorter length of hospital stay.
Conclusions:
- Nirsevimab immunization demonstrated a significant impact on reducing PICU admissions for RSV bronchiolitis.
- The study indicates a decrease in the number of admissions and length of stay in PICUs following nirsevimab implementation.
- Nirsevimab appears effective in mitigating the burden of severe RSV bronchiolitis in infants requiring intensive care.
Abstract:
RSV bronchiolitis remains the leading cause of hospitalization in children under 1 year of age. It is estimated that 2-6% of cases will be hospitalized on pediatric intensive care units (PICUs). In October 2023, a universal immunization program with the monoclonal antibody nirsevimab was implemented in Catalonia. The aim of the study was to analyze the impact of the nirsevimab immunization on the burden of bronchiolitis admitted to a PICU and resulting changes in epidemiological, clinical, and microbiological characteristics comparing the pre-nirsevimab (pre-N) with the post-nirsevimab (post-N) period. This was a prospective, descriptive, and observational study. Patients with severe bronchiolitis admitted to reference children's hospital PICU, between September 2010 and February 2024 were included. Demographic and clinical data were collected and viral laboratory etiological diagnosis was carried out. 1531 patients were recruited, 1458 in the pre-N seasons and 73 after its introduction (58% males, median age 52 days), of which 67% were immunized with nirsevimab. The total number of PICU bronchiolitis admissions, the ratio, and the RSV etiology were significantly lower in the post-N period (p = 0.03, p < 0.001, and p = 0.039, respectively). Significant higher age at admission (p < 0.001) and lower hospital length of stay (p < 0.001) was observed comparing pre-N vs. post-N period.
Conclusion:
Nirsevimab appears to have an important impact on reducing the number and length of stay of PICU admissions due to RSV bronchiolitis.
What Is Known:
• Bronchiolitis is the most common viral infection of the lower respiratory tract in infants. • It represents 13% of the total pediatric intensive care admissions, typically during winter. This is one of the causes that produces a collapse in the health care systems all around the world.
What Is New:
• In October 2023, universal immunization with monoclonal antibody nirsevimab of all children under 6 months of age was started in the majority of autonomous communities in Spain. • Recent publications from the nirsevimab clinical trials have evidenced a high RSV protective effect, but data on its effect on real life patients who require pediatric intensive care unit admission are missing.
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