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Nirsevimab Implementation and Primary Management of Lower Respiratory Tract Infections in Infants in Spain: A
María Medina Muñoz1,2, Soledad Gallego Campillo3, Yolanda Martín Peinador3
1Department of Pediatrics, Centro de Salud Montesa, Primary Care, C/Montesa 38, 28006, Madrid, Spain. mariamedina90@gmail.com.
Insights
Nirsevimab did not alter lower respiratory tract infection (LRTI) severity in infants. However, its introduction led to more primary care visits for LRTI diagnosis and follow-up.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Lower respiratory tract infections (LRTIs) are a significant cause of pediatric primary care visits.
- Evaluating the impact of novel immunoprophylaxis like nirsevimab on LRTI course is crucial for public health strategies.
- Understanding risk factors associated with LRTIs remains important for targeted prevention.
Purpose of the Study:
- To assess the clinical course of LRTIs in infants before and after nirsevimab introduction.
- To identify changes in LRTI management and healthcare utilization post-nirsevimab.
- To determine risk factors for LRTI occurrence in infants.
Main Methods:
- A quasi-experimental, before-and-after study design.
- Comparison of two infant cohorts (2017-2018 vs. 2023-2024) during their first year of life.
- Analysis of clinical, epidemiological, and healthcare-related variables, including nirsevimab uptake.
Main Results:
- Nirsevimab was administered to 91.0% of infants in the post-introduction period.
- No significant difference in overall LRTI incidence (26.3% vs. 23.9%) or clinical severity was observed.
- Primary care diagnoses and follow-up for LRTIs significantly increased (+35.3% and +28.4%, respectively) post-nirsevimab introduction.
Conclusions:
- Nirsevimab introduction did not impact the severity of infant LRTIs.
- A notable increase in primary care management of LRTI cases was observed following nirsevimab implementation.
- Male sex, daycare attendance, siblings, passive smoking, and lack of nirsevimab were associated with LRTI occurrence.
Objective:
Lower respiratory tract infections (LRTIs) are a common cause of primary care visits in infants. This study was done to evaluate the course of LRTIs before-and-after the introduction of nirsevimab and to identify the associated risk factors.
Methods:
This was a quasi-experimental, before-and-after study, comparing two cohorts of infants followed during their first year of life, before (April-December 2017-2018) and after (April-December 2023-2024) following the introduction of nirsevimab. Clinical, epidemiological, and healthcare-related variables were analyzed.
Results:
A total of 729 infants were included (n = 327 in 2017-2018; n = 402 in 2023-2024); 91.0% of infants in the second period received nirsevimab. The overall incidence of LRTIs did not differ between the two periods (26.3% vs. 23.9%; P = 0.453). Following the introduction of nirsevimab, diagnoses and follow-up in primary care increased (+ 35.3% and + 28.4%, respectively; both P < 0.001). No differences were observed in clinical severity (P = 0.301), emergency department referrals (P = 1.000), pharmacological treatment (P = 0.791), recurrences (P = 0.110), or hospitalizations (P = 1.000). In multivariable analysis, LRTI occurrence was independently associated with male sex, daycare attendance, school-aged siblings, passive smoking exposure, and lack of nirsevimab immunoprophylaxis.
Conclusions:
The introduction of nirsevimab did not affect the severity of LRTI and was accompanied by a greater proportion of cases managed in primary care.
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