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The Effectiveness of the Palivizumab Programme in Reducing the Risk of Paediatric Asthma: A Population-Based Study in
Kimberley A Foley1,2, Sarah A Buchan3,4,5,6,7, Dayre McNally8
1Department of Primary Care and Public Health, Imperial College London, London, UK.
Insights
Ontario's palivizumab program showed declining asthma rates, with the most significant drops in children ineligible for the respiratory syncytial virus (RSV) treatment. The study suggests broader RSV prevention could further reduce childhood asthma.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Epidemiology
Background:
- Palivizumab, a respiratory syncytial virus (RSV) prevention medication, was publicly funded in Canada starting in 1998.
- Early-life RSV infections are linked to an increased risk of developing childhood asthma.
- This study investigates the potential indirect effect of palivizumab on pediatric asthma rates.
Purpose of the Study:
- To assess the effectiveness of Ontario's palivizumab program in reducing the incidence of pediatric asthma.
- To analyze asthma trends in relation to palivizumab eligibility criteria.
- To explore socio-demographic factors influencing asthma incidence and palivizumab's impact.
Main Methods:
- Utilized linked, population-based administrative databases for children born in Ontario (1993-2013).
- Employed controlled interrupted time-series analysis to evaluate asthma incidence changes before and after palivizumab introduction.
- Categorized children by palivizumab eligibility: clearly eligible, possibly eligible, or ineligible.
Main Results:
- Nearly 3 million children were analyzed; 14.6% were diagnosed with asthma by age 7.
- Overall asthma incidence declined significantly, with the largest decrease observed in palivizumab-ineligible children.
- Possibly eligible children showed a modest additional annual decline of 2.0% in asthma incidence post-palivizumab introduction.
- Socio-demographic disparities in asthma were noted, with incidence higher among children of teenage mothers; this gap narrowed post-palivizumab, especially in possibly eligible groups.
Conclusions:
- While asthma incidence decreased over 20 years, the reduction was less pronounced in children clearly eligible for palivizumab compared to ineligible children.
- Exploratory findings suggest palivizumab may have reduced social inequities in asthma, particularly among possibly eligible children.
- Population-based RSV immunization programs with broader eligibility could potentially lead to greater asthma reductions by decreasing severe RSV disease.
Background:
Palivizumab was introduced in Canada in 1998 as a publicly funded programme to reduce respiratory syncytial virus (RSV) disease in high-risk children. Severe early-life RSV infections are associated with increased asthma risk. Thus, palivizumab may also indirectly reduce paediatric asthma.
Objective:
To evaluate the effectiveness of Ontario, Canada's palivizumab programme in decreasing paediatric asthma.
Methods:
We used multiple linked population-based administrative databases to identify all children born in Ontario between 1993 and 2013, with follow-up through March 2020. Our primary outcome was physician-diagnosed asthma by age 7. Controlled interrupted time-series analysis was used to compare changes in annual asthma incidence (by birth year) before and after palivizumab's introduction, according to programme eligibility (clearly, possibly, or ineligible). Socio-demographic differences were explored via stratification.
Results:
Nearly 3 million children were included in this study, including 406,596 (14.6%) diagnosed with asthma by age 7. Asthma incidence substantially declined over the study period, with the greatest declines among palivizumab-ineligible children (35.3%, 95% confidence interval [CI] 28.3, 42.6, versus 18.1%, 95% CI 13.9, 22.9 among clearly eligible children). However, relative to ineligible children, post-palivizumab declines were most apparent among possibly eligible children, with an additional annual decline of 2.0% (95% CI 0.3, 3.7) in asthma. Socio demographic differences in asthma incidence and post-palivizumab declines were noted. Particularly, incidence was higher among children born to teenage mothers than among those aged 19+ years; this gap narrowed over time, especially among possibly eligible children.
Conclusions:
Asthma incidence declined over this 20-year study; however, smaller declines were observed among children clearly eligible for palivizumab relative to ineligible children. However, exploratory evidence was suggestive of reduced social inequities in asthma post-palivizumab, particularly among possibly eligible children. Larger reductions in asthma might be realized with the introduction of population-based RSV immunization programmes through broader programme eligibility and reductions in severe RSV disease.
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