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Impact of RSV Preventive Strategies on Hospitalizations for Bronchiolitis in Infants
Marine Tarizzo1, Julie Mesinèle1, Blandine Prevost1
1Inserm U938, Centre de Recherche Saint-Antoine (CRSA), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Trousseau, Service de Pneumologie Pédiatrique, Sorbonne Université, Paris, France.
Insights
France
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Respiratory syncytial virus (RSV) is a primary cause of infant bronchiolitis and hospitalizations.
- France introduced nirsevimab and maternal RSV vaccination to mitigate RSV burden.
- The study evaluates the impact of these preventive strategies on infant bronchiolitis.
Purpose of the Study:
- To assess the effect of new RSV preventive strategies on clinical severity.
- To analyze changes in viral epidemiology of bronchiolitis in hospitalized infants.
- To compare outcomes between pre- and post-intervention periods.
Main Methods:
- Retrospective study at Armand Trousseau University Hospital (2021-2025).
- Inclusion of infants under 12 months hospitalized for first bronchiolitis episode.
- Comparison of clinical and virological data pre- and post-intervention, with subgroup analysis for nirsevimab use.
Main Results:
- Post-intervention infants showed reduced oxygen therapy needs and shorter hospital stays.
- Nirsevimab recipients had significantly lower RSV and co-infection rates.
- Increased detection of human metapneumovirus observed post-intervention.
Conclusions:
- RSV preventive strategies reduced hospital burden and disease severity.
- Shifts in viral epidemiology were noted, with increased human metapneumovirus.
- Continued implementation of RSV immunoprophylaxis and surveillance are recommended.
Introduction:
Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and hospitalization in infants. Since 2023, France has implemented two preventive strategies aimed at reducing RSV burden: long-acting monoclonal antibody nirsevimab and RSV vaccine for pregnant women, the latter becoming available from September 2024. This study aimed to assess the impact of RSV preventive strategies on the clinical severity and viral epidemiology of bronchiolitis in hospitalized infants.
Material And Methods:
We conducted a retrospective study at Armand Trousseau University Hospital, including infants under 12 months hospitalized for a first episode of bronchiolitis between October and March during four winter seasons (2021-2025). Clinical and virological data were compared between the pre-intervention (2021-2023) and post-intervention (2023-2025) periods. Subgroup analyses were performed based on RSV infection and prophylaxis status.
Results:
A total of 509 infants were included (292 pre-intervention, 217 post-intervention). Post-intervention infants were older (median, 3.2 vs. 1.9 months, p = 0.001), required less oxygen therapy (58.5% vs. 70.9%, p < 0.001), and had shorter hospital stays (median, 3.0 vs. 5.0 days, p < 0.001). Compared with untreated infants (n = 140), those who received nirsevimab (n = 67) had significantly lower rates of RSV infection and viral co-infections (OR: 0.15 (95%CI: 0.08-0.29), p < 0.001; and 40.4% vs. 25.0%, p = 0.035), while human metapneumovirus was detected more frequently (OR: 11.00 (95%CI: 3.50-34.55), p < 0.001).
Discussion And Conclusion:
During the period following the introduction of RSV preventive strategies, a reduced hospital burden, milder clinical courses, and shifts in viral epidemiology were observed. These findings support the continued implementation of RSV immunoprophylaxis and underscore the importance of ongoing surveillance to monitor its long-term impact.
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