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Impact of Nirsevimab Immunization on Pediatric Hospitalization Rates: A Systematic Review and Meta-Analysis (2024)
Matteo Riccò1, Antonio Cascio2, Silvia Corrado3
1AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy.
Insights
Nirsevimab effectively prevents hospital admissions from respiratory syncytial virus (RSV) lower respiratory tract diseases (LRTDs) in infants, showing 88.40% efficacy. However, longer observation periods may reduce its effectiveness, necessitating further research for optimal public health strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract diseases (LRTDs) in infants and newborns.
- Monoclonal antibodies offer a potential preventive strategy against severe RSV outcomes.
- Nirsevimab is a novel monoclonal antibody developed for RSV prevention.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of nirsevimab in preventing RSV-LRTDs in pediatric populations.
- To evaluate nirsevimab's efficacy in preventing hospital admissions due to RSV.
- To explore the impact of observation time on nirsevimab's immunization efficacy.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and real-world studies.
- Searched PubMed, Embase, and Scopus databases until May 1, 2024.
- Included 19 series encompassing 45,238 infants.
Main Results:
- Pooled immunization efficacy of 88.40% (95% CI: 84.70-91.21) against RSV-related hospital admissions.
- Moderate heterogeneity observed (I² = 24.3%).
- Efficacy decreased with longer observation times (≥150 days), with a higher risk of breakthrough infections (RR 2.170).
Conclusions:
- Nirsevimab demonstrates significant effectiveness in preventing hospital admissions due to RSV-LRTDs.
- The duration of observation time may influence nirsevimab's protective effect.
- Further research is needed to optimize nirsevimab's use throughout the entire RSV season for public health interventions.
Abstract:
A systematic review with a meta-analysis was performed to gather available evidence on the effectiveness of monoclonal antibody nirsevimab in the prevention of lower respiratory tract diseases (LRTDs) due to respiratory syncytial virus (RSV) in children and newborns (CRD42024540669). Studies reporting on real-world experience and randomized controlled trials (RCTs) were searched for in three databases (PubMed, Embase, and Scopus) until 1 May 2024. Our analysis included five RCTs, seven real-world reports, and one official report from the health authorities. Due to the cross-reporting of RCTs and the inclusion of multiple series in a single study, the meta-analysis was performed on 45,238 infants from 19 series. The meta-analysis documented a pooled immunization efficacy of 88.40% (95% confidence interval (95% CI) from 84.70 to 91.21) on the occurrence of hospital admission due to RSV, with moderate heterogeneity (I2 24.3%, 95% CI 0.0 to 56.6). Immunization efficacy decreased with the overall length of the observation time (Spearman's r = -0.546, p = 0.016), and the risk of breakthrough infections was substantially greater in studies with observation times ≥150 days compared to studies lasting <150 days (risk ratio 2.170, 95% CI 1.860 to 2.532). However, the effect of observation time in meta-regression analysis was conflicting (β = 0.001, 95% CI -0.001 to 0.002; p = 0.092). In conclusion, the delivery of nirsevimab was quite effective in preventing hospital admissions due to LRTDs. However, further analyses of the whole RSV season are required before tailoring specific public health interventions.
