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Kieffer A, Beuvelet M, Moncayo G, Chetty M, Sardesai A, Musci R, Hudson R. Disease Burden Associated with All Infants in Their First RSV Season in the UK: A Static Model of Universal Immunization with Nirsevimab Against RSV-Related Outcomes. Infect Dis Ther 2024; 13:2135-2153. [PMID: 39235703 PMCID: PMC11416453 DOI: 10.1007/s40121-024-01037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/22/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) leads to significant morbidity in newborn infants in the United Kingdom (UK). Nirsevimab, a long-acting monoclonal antibody, received approval from the European Medicines Agency and has been licensed by the Medicines and Healthcare products Regulatory Agency for preventing RSV lower respiratory tract disease (LRTD) in neonates and infants during their first RSV season. The objective of this study was to assess the potential impact of nirsevimab on RSV-associated LRTDs, related costs, and loss of quality-adjusted life years (QALYs) in infants experiencing their first RSV season. METHODS The impact of administering nirsevimab across all infant populations compared to palivizumab in the high-risk palivizumab-eligible population was assessed via a static decision-analytic model specified for a UK birth cohort experiencing their first RSV season. The RSV-related health events of interest included primary care (PC), accident and emergency (A&E) visits, hospitalizations [including hospitalizations alone and those resulting in intensive care unit (ICU) admissions], recurrent wheezing in infants who were previously hospitalized, and all-cause LRTD hospitalizations. RESULTS Under the current standard of practice (SoP), RSV was estimated to result in 329,425 RSV LRTDs annually, including 24,381 hospitalizations and ICU admissions, representing £117.8 million (2024 GBP) in costs. Comparatively, universal immunization of all infants with nirsevimab could avoid 198,886 RSV LRTDs, including 16,657 hospitalizations and ICU admissions, resulting in savings of £77.2 million in RSV treatment costs. Considering the impact on all-cause LRTD of a universal immunization strategy, nirsevimab could be valued between £243 and £274, assuming willingness-to-pay (WTP) thresholds of £20,000 and £30,000 per QALY saved, respectively. CONCLUSIONS This analysis demonstrated that the health and economic burden of RSV would be substantially reduced in all infants experiencing their first RSV season in the UK (including term, preterm, and palivizumab-eligible infants) as a result of a universal immunization strategy with nirsevimab.
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Affiliation(s)
| | | | | | - Mersha Chetty
- Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK
| | | | | | - Richard Hudson
- Sanofi, 410 Thames Valley Park Drive, Reading, Berkshire, RG6 1PT, UK.
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Akeju O, Lees EA, Amirthalingam G, Ramsay ME, Pollard AJ. Changes to the UK childhood immunisation schedule. Arch Dis Child 2024:archdischild-2023-326625. [PMID: 39326933 DOI: 10.1136/archdischild-2023-326625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/06/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Oluwasefunmi Akeju
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emily A Lees
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Fitzwilliam College, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | | | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
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Terstappen J, Hak SF, Bhan A, Bogaert D, Bont LJ, Buchholz UJ, Clark AD, Cohen C, Dagan R, Feikin DR, Graham BS, Gupta A, Haldar P, Jalang'o R, Karron RA, Kragten L, Li Y, Löwensteyn YN, Munywoki PK, Njogu R, Osterhaus A, Pollard AJ, Nazario LR, Sande C, Satav AR, Srikantiah P, Stein RT, Thacker N, Thomas R, Bayona MT, Mazur NI. The respiratory syncytial virus vaccine and monoclonal antibody landscape: the road to global access. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00455-9. [PMID: 39326422 DOI: 10.1016/s1473-3099(24)00455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 09/28/2024]
Abstract
Respiratory syncytial virus (RSV) is the second most common pathogen causing infant mortality. Additionally, RSV is a major cause of morbidity and mortality in older adults (age ≥60 years) similar to influenza. A protein-based maternal vaccine and monoclonal antibody (mAb) are now market-approved to protect infants, while an mRNA and two protein-based vaccines are approved for older adults. First-year experience protecting infants with nirsevimab in high-income countries shows a major public health benefit. It is expected that the RSV vaccine landscape will continue to develop in the coming years to protect all people globally. The vaccine and mAb landscape remain active with 30 candidates in clinical development using four approaches: protein-based, live-attenuated and chimeric vector, mRNA, and mAbs. Candidates in late-phase trials aim to protect young infants using mAbs, older infants and toddlers with live-attenuated vaccines, and children and adults using protein-based and mRNA vaccines. This Review provides an overview of RSV vaccines highlighting different target populations, antigens, and trial results. As RSV vaccines have not yet reached low-income and middle-income countries, we outline urgent next steps to minimise the vaccine delay.
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Affiliation(s)
- Jonne Terstappen
- Department of Paediatric Infectious Disease & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sarah F Hak
- Department of Paediatric Infectious Disease & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anant Bhan
- Yenepoya Medical College & Centre for Ethics, Yenepoya University, Mangalore, India
| | - Debby Bogaert
- Paediatric Medicine, University of Edinburgh, Edinburgh, UK
| | - Louis J Bont
- Department of Paediatric Infectious Disease & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; ReSViNET Foundation, Zeist, Netherlands
| | - Ursula J Buchholz
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andrew D Clark
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cheryl Cohen
- Center for Respiratory Diseases and Meningitis, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ron Dagan
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Daniel R Feikin
- Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - Barney S Graham
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Anuradha Gupta
- Global Immunization, Sabin Vaccine Institute, Washington, DC, USA
| | - Pradeep Haldar
- Government of India, Ministry of Health and Family Welfare, Delhi, India
| | - Rose Jalang'o
- National Vaccines and Immunization Program, Ministry of Health, Nairobi, Kenya
| | - Ruth A Karron
- Boomberg School of Public Health Department of International Health, Johns Hopkins Bloomberg Baltimore, MD, USA
| | | | - You Li
- Centre for Global Health, University of Edinburgh, Edinburgh, UK; School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yvette N Löwensteyn
- Department of Paediatric Infectious Disease & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Rosemary Njogu
- Department of International Health, Jhpiego, Nairobi, Kenya
| | - Ab Osterhaus
- Center of Infection Medicine and Zoonosis Research, University of Veterinary Medicine, Hannover, Germany
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, UK
| | | | - Charles Sande
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ashish R Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Melghat, India
| | - Padmini Srikantiah
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Renato T Stein
- Pneumologia Pediátrica, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Naveen Thacker
- International Pediatric Association, Webster Groves, MI, USA; Child Health Foundation, Mumbai, India
| | | | | | - Natalie I Mazur
- Department of Paediatric Infectious Disease & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
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Xu H, Aparicio C, Wats A, Araujo BL, Pitzer VE, Warren JL, Shapiro ED, Niccolai LM, Weinberger DM, Oliveira CR. Real-World Effectiveness of Nirsevimab Against Respiratory Syncytial Virus: A Test-Negative Case-Control Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.12.24313545. [PMID: 39314944 PMCID: PMC11419242 DOI: 10.1101/2024.09.12.24313545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
IMPORTANCE Nirsevimab, a long-acting monoclonal antibody, has demonstrated efficacy against RSV-related lower respiratory tract infections (LRTIs) in clinical trials. Post-licensure monitoring is essential to confirm these benefits in real-world settings. OBJECTIVE To evaluate the real-world effectiveness of nirsevimab against medically attended RSV infections in infants and to assess how effectiveness varies by disease severity, dosage, and time since immunization. DESIGN SETTING AND PARTICIPANTS This test-negative case-control study used inpatient, outpatient, and emergency room data from the Yale New Haven Health System. Nirsevimab-eligible infants who were tested for RSV using polymerase chain reaction between October 1, 2023 and May 9, 2024 were included. Cases were infants with confirmed RSV infections; controls were those who tested negative. EXPOSURE Nirsevimab immunization, verified through state immunization registries. MAIN OUTCOMES AND MEASURES Effectiveness was estimated using multivariable logistic regression, adjusting for age, calendar month, and individual risk factors. Separate models examined effectiveness by clinical setting, disease severity, dose, and time since immunization. Broader outcomes, including all-cause LRTI and LRTI-related hospitalization, were also analyzed, with stratification by early and late respiratory seasons. RESULTS The analytic sample included 3,090 infants (median age 6.7 months, IQR 3.6-9.7), with 680 (22.0%) RSV-positive and 2,410 (78.0%) RSV-negative. 21 (3.1%) RSV-positive and 309 (12.8%) RSV-negative infants received nirsevimab. Effectiveness against RSV infection was 68.4% (95% CI, 50.3%-80.8%). Effectiveness was 61.6% (95% CI, 35.6%-78.6%) for outpatient visits and 80.5% (95% CI, 52.0%-93.5%) for hospitalizations. The highest effectiveness, 84.6% (95% CI, 58.7%-95.6%), was observed against severe RSV outcomes requiring ICU admission or high-flow oxygen. Although effectiveness against RSV infections declined over time, it remained significant at 55% (95% credible interval, 16%-75%) at 14 weeks post-immunization. Protective effectiveness was also observed against all-cause LRTI and LRTI-related hospitalizations during peak RSV season (49.4% [95% CI, 10.7%-72.9%] and 79.1% [95% CI, 27.6%-94.9%], respectively). However, from February to May, when RSV positivity was low, effectiveness against these broader outcomes was negligible. CONCLUSIONS AND RELEVANCE Nirsevimab provided substantial protection against RSV-related outcomes for at least three months. These findings support the continued use of nirsevimab and provide evidence that may help build public confidence in the immunization program.
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Affiliation(s)
- Hanmeng Xu
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Camilla Aparicio
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, CT, USA
| | - Aanchal Wats
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, CT, USA
| | - Barbara L. Araujo
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, CT, USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Eugene D. Shapiro
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, CT, USA
| | - Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Carlos R. Oliveira
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Section of Health Informatics, Yale School of Public Health, New Haven, CT, USA
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Papazisis G, Topalidou X. Maternal Vaccination for the Prevention of Infantile RSV Disease: An Overview of the Authorized, In-Progress, and Rejected Vaccine Candidates. Vaccines (Basel) 2024; 12:980. [PMID: 39340012 PMCID: PMC11435746 DOI: 10.3390/vaccines12090980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 09/30/2024] Open
Abstract
Respiratory Syncytial Virus (RSV) continues to pose a significant challenge, contributing to elevated hospitalization rates among children up to 5 years old, with a disproportionate burden on newborns and infants under 6 months old. The unique characteristics of the young immune system make it prone to altered responses to infections and vaccinations, requiring a tailored approach to disease prevention. The recent approval of the maternal RSV vaccine (brand name ABRYSVO) represents a pivotal advancement in preventive strategies among newborns and infants, marking a milestone in RSV research as the first market-approved maternal vaccine. The present review examines clinical trial data on both recent and previous vaccine candidates, as well as the licensed vaccine, focusing on the prevention of RSV disease in newborns and young infants through the passive acquisition of antibodies following maternal immunization. Additionally, it evaluates the safety profile of these vaccines.
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Affiliation(s)
- Georgios Papazisis
- Clinical Research Unit, Special Unit for Biomedical Research and Education & Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Oti VB, Idris A, McMillan NAJ. Intranasal antivirals against respiratory syncytial virus: the current therapeutic development landscape. Expert Rev Anti Infect Ther 2024:1-11. [PMID: 38973346 DOI: 10.1080/14787210.2024.2378185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/05/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes bronchiolitis and other respiratory issues in immunocompromised individuals, the elderly, and children. After six decades of research, we have only recently seen the approval of two RSV vaccines, Arexvy and Abrysvo. Direct-acting antivirals against RSV have been more difficult to develop with ribavirin and palivizumab giving very modest reductions in hospitalizations and no differences in mortality. Recently, nirsevimab was licensed and has proven to be much more effective when given prophylactically. These are delivered intravenously (IV) and intramuscularly (IM), but an intranasal (IN) antiviral has several advantages in terms of ease of use, lower resource need, and acting at the site of infection. AREAS COVERED In this paper, we review the available literature on the current pre-clinical research landscape of anti-RSV therapeutics tested for IN delivery. EXPERT OPINION As RSV is a respiratory virus that infects both the upper and lower respiratory tracts, efforts are focused on developing a therapeutic that can be delivered via the nasal route. The rationale is to directly target the replicating virus with an obvious respiratory tract tropism. This approach will not only pave the way for a nasal delivery approach aimed at reducing respiratory viral illness but also controlling aerosol virus transmission.
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Affiliation(s)
- Victor Baba Oti
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia
| | - Adi Idris
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Nigel A J McMillan
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia
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Günther F, Sandmann FG. RSV immunisation in infants: weighing the options. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100867. [PMID: 38476744 PMCID: PMC10928288 DOI: 10.1016/j.lanepe.2024.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Felix Günther
- Immunisation Unit – Team Vaccine/VPD Modelling, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Frank G. Sandmann
- Immunisation Unit – Team Vaccine/VPD Modelling, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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