1
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Nduaguba SO, Tran PT, Winterstein AG. Model correction of diagnostic coding-based RSV incidence for children 0-4 years in the US. BMC Infect Dis 2024; 24:617. [PMID: 38907351 PMCID: PMC11191139 DOI: 10.1186/s12879-024-09474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/04/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Although administrative claims data have a high degree of completeness, not all medically attended Respiratory Syncytial Virus-associated lower respiratory tract infections (RSV-LRTIs) are tested or coded for their causative agent. We sought to determine the attribution of RSV to LRTI in claims data via modeling of temporal changes in LRTI rates against surveillance data. METHODS We estimated the weekly incidence of LRTI (inpatient, outpatient, and total) for children 0-4 years using 2011-2019 commercial insurance claims, stratified by HHS region, matched to the corresponding weekly NREVSS RSV and influenza positivity data for each region, and modelled against RSV, influenza positivity rates, and harmonic functions of time assuming negative binomial distribution. LRTI events attributable to RSV were estimated as predicted events from the full model minus predicted events with RSV positivity rate set to 0. RESULTS Approximately 42% of predicted RSV cases were coded in claims data. Across all regions, the percentage of LRTI attributable to RSV were 15-43%, 10-31%, and 10-31% of inpatient, outpatient, and combined settings, respectively. However, when compared to coded inpatient RSV-LRTI, 9 of 10 regions had improbable corrected inpatient LRTI estimates (predicted RSV/coded RSV ratio < 1). Sensitivity analysis based on separate models for PCR and antigen-based positivity showed similar results. CONCLUSIONS Underestimation based on coding in claims data may be addressed by NREVSS-based adjustment of claims-based RSV incidence. However, where setting-specific positivity rates is unavailable, we recommend modeling across settings to mirror NREVSS's positivity rates which are similarly aggregated, to avoid inaccurate adjustments.
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Affiliation(s)
- Sabina O Nduaguba
- Department of Pharmaceutical Systems and Policy, College of Pharmacy, West Virginia University, Morgantown, WV, USA
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, Florida, FL, 32611, USA
| | - Phuong T Tran
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, Florida, FL, 32611, USA
- Faculty of Pharmacy, HUTECH University, Ho Chi Minh City, Vietnam
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, Florida, FL, 32611, USA.
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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2
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Levin JC, Beam AL, Fox KP, Hayden LP. Cost Savings Without Increased Risk of Respiratory Hospitalization for Preterm Children after the 2014 Palivizumab Policy Update. Am J Perinatol 2024; 41:e133-e141. [PMID: 35523410 PMCID: PMC9969323 DOI: 10.1055/a-1845-2184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Our objective was to compare rates of hospitalizations for respiratory illnesses in preterm and full-term (FT) children for 4 years before and after the 2014 update to the American Academy of Pediatrics (AAP) respiratory syncytial virus (RSV) immunoprophylaxis guidance, which restricted eligibility among infants born at 29 to 34 weeks in the first winter and all preterm infants in the second winter after neonatal discharge. STUDY DESIGN We conducted pre-post and interrupted time series analyses on claims data from a commercial national managed care plan. We compared the number of RSV and all respiratory hospital admissions in the first and second RSV seasons after neonatal discharge among a cohort of preterm children, regardless of palivizumab status, in the 4 years before and after the implementation of the 2014 palivizumab eligibility change. A FT group was included for reference. RESULTS The cohort included 821 early preterm (EP, <29 weeks), 4,790 moderate preterm (MP, 29-34 weeks), and 130,782 FT children. Palivizumab use after the policy update decreased among MP children in the first and second RSV seasons after neonatal discharge, without any change in the odds of hospitalization with RSV or respiratory illness. For the EP group, there was no change in the rate of palivizumab or the odds of hospitalization with RSV or respiratory illness after the policy update. For the FT group, there was a slight decrease in odds of hospitalization post-2014 after the policy update. The interrupted time series did not reveal any secular trends over time in hospitalization rates among preterm children. Following the policy change, there were cost savings for MP children in the first and second RSV seasons, when accounting for the cost of hospitalizations and the cost of palivizumab. CONCLUSION Hospitalizations for RSV or respiratory illness did not increase, and cost savings were obtained after the implementation of the 2014 AAP palivizumab prophylaxis policy. KEY POINTS · Palivizumab use decreased among children born moderate preterm (29 to34 weeks) after the 2014 palivizuamb policy update.. · There was no change in odds of hospitalization with respiratory syncitial virus or respiratory illness among preterm infants after the policy update when compared to before.. · There were cost savings, when accounting for the cost of hospitalizations and the cost of palivizumab, after the policy update among children born moderate preterm..
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Affiliation(s)
- Jonathan C. Levin
- Division of Newborn Medicine, Boston Children’s
Hospital, Boston MA
- Division of Pulmonary Medicine, Boston Children’s
Hospital, Boston MA
| | - Andrew L. Beam
- Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston MA
| | - Kathe P. Fox
- Department of Biomedical Informatics, Harvard Medical
School, Boston, MA
| | - Lystra P. Hayden
- Division of Pulmonary Medicine, Boston Children’s
Hospital, Boston MA
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA
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3
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Kong AM, Winer IH, Zimmerman NM, Diakun D, Bloomfield A, Gonzales T, Fergie J, Goldstein M, Krilov LR. Increasing Rates of RSV Hospitalization among Preterm Infants: A Decade of Data. Am J Perinatol 2023; 40:1529-1536. [PMID: 34704241 PMCID: PMC10556298 DOI: 10.1055/s-0041-1736581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks of gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change. STUDY DESIGN A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November-March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change. RESULTS There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67-2.27, p <0.001; 1.70, 95% CI: 1.55-1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations. CONCLUSION We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change. KEY POINTS · Immunoprophylaxis rates decreased after the 2014 American Academy of Pediatrics guidelines update.. · Rate of RSV hospitalization increased among preterm infants after the 2014 AAP guidelines update.. · Increase in RSV hospitalization persisted for at least 5 years after AAP guidelines update..
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Affiliation(s)
- Amanda M. Kong
- IBM Watson Health, Life Sciences Division, Cambridge, Massachusetts
| | | | | | - David Diakun
- IBM Watson Health, Life Sciences Division, Cambridge, Massachusetts
| | - Adam Bloomfield
- Swedish Orphan Biovitrum Sobi, NA, Medical Affairs, Waltham, Massachusetts
| | - Tara Gonzales
- Swedish Orphan Biovitrum Sobi, NA, Medical Affairs, Waltham, Massachusetts
| | - Jaime Fergie
- Infectious Diseases Service, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, California
| | - Leonard R. Krilov
- Department of Pediatrics, NYU Langone Hospital—Long Island, and the NYU Long Island School of Medicine, Mineola, New York
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4
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Packnett ER, Winer IH, Oladapo A, Wojdyla M. Risk of RSV-related hospitalization is associated with gestational age in preterm (born at 29-34 wGA) infants without outpatient palivizumab administration. Hum Vaccin Immunother 2023; 19:2252289. [PMID: 37828711 PMCID: PMC10578184 DOI: 10.1080/21645515.2023.2252289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023] Open
Abstract
Palivizumab has been shown to decrease RSV-related hospitalization (RSVH) risk and reduce RSVH severity. American Academy of Pediatrics (AAP) guidance on administration of palivizumab has changed over time; in 2014, palivizumab was no longer recommended in preterm infants born at 29 weeks gestational age (wGA) or later. This study's objective was to describe RSVH risk and severity in preterm infants (29-34 wGA) without comorbidities relative to healthy term infants and to each other by gestational age. Using the MarketScan Multi-State Medicaid and Commercial Databases, infants born from July 1, 2014 to June 30, 2019, at 29-34 wGA (preterm) and >37 wGA (term) were identified. During RSV seasons (November to March) from 2014 to 2020, claims incurred by infants while they were <6 months old were evaluated for RSVH and RSVH characteristics. This study included 63,351 preterm infants and 1,076,389 term infants without outpatient palivizumab administration. Rate of RSVH was higher in infants with lower wGA at birth and ranged 3.32-5.72 per 100 infant-seasons in Medicaid-insured infants and 3.21-4.84 in commercially insured infants. Relative risk of RSVH was 5-8 times higher in Medicaid-insured preterm infants and 3-5 times higher in commercially insured preterm infants compared to term infants. ICU admissions and mechanical ventilation were more common during RSVH in preterm infants relative to term infants. RSV-related outpatient healthcare utilization was also 2-3 times higher in preterm infants born at 31-34 wGA. Increased utilization of palivizumab among infants born at 29-34 wGA may decrease RSVH rates and result in less severe course in preterm infants with RSVH.
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5
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Manzoni P, Baraldi E, Luna MS, Tzialla C. Real-World Studies of Respiratory Syncytial Virus Hospitalizations among Moderate/Late Preterm Infants Exposed to Passive Immunoprophylaxis with Palivizumab. Am J Perinatol 2022; 39:S7-S13. [PMID: 36307092 DOI: 10.1055/s-0042-1757279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article aims to assess the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-associated hospitalization (RSVH) rates in otherwise healthy moderate/late preterm infants and discuss the role of palivizumab in preventing acute and long-term outcomes. We identified studies in the PubMed and Embase databases that reported patient-level data on (1) exposure to palivizumab in preterm infants born between 29 and 35 weeks of gestational age (or subsets within this range) ≤ 2 years of chronological age, and (2) the outcome of RSVH. Six studies assessed RSVH in infants this gestational age who had been exposed or not to palivizumab and reported patient-level data. Exposure was associated with a reduction in RSVH rates that was comparable to the reduction seen in controlled clinical trials (weighed mean 4.0-fold reduction). RSV immunoprophylaxis in preterm infants within 29 to 35 weeks of gestational age is associated with a considerably lower burden of RSVH. KEY POINTS: · RSV is the leading cause of lower respiratory tract infection hospitalization in infants.. · Palivizumab prevents RSVH in a real-world scenario.. · Immunoprophylaxis should be used in high-risk infants..
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Affiliation(s)
- Paolo Manzoni
- Department of Maternal Infant Medicine, Degli Infermi Hospital, Biella, Italy.,University of Torino, Turin, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Manuel Sánchez Luna
- Neonatology Division and NICU, University Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, Italy
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6
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Packnett ER, Winer IH, Larkin H, Oladapo A, Gonzales T, Wojdyla M, Goldstein M, Smith VC. RSV-related hospitalization and outpatient palivizumab use in very preterm (born at <29 wGA) infants: 2003-2020. Hum Vaccin Immunother 2022; 18:2140533. [PMID: 36412253 PMCID: PMC9746385 DOI: 10.1080/21645515.2022.2140533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of bronchiolitis and pneumonia in children under one year and a leading cause of infant hospitalization. Palivizumab was approved by the FDA in 1998 as RSV immunoprophylaxis to prevent severe RSV disease in children with specific health conditions and those born at <35 weeks gestational age (wGA). This study compared RSV-related hospitalization (RSVH) and RSVH characteristics in very preterm (<29 wGA) and term (>37 wGA) infants. Using the MarketScan Commercial and Multi-State Medicaid administrative claims databases, infants born between 7/1/2003 and 6/30/2020 were identified and classified as very preterm or term. Infants with evidence of health conditions, such as congenital heart disease and cystic fibrosis, were excluded. During 2003-2020 RSV seasons (November to March), claims incurred by infants while they were <12 months old were evaluated for outpatient administration of palivizumab and RSVH. The study included 40,123 very preterm infants and 4,421,942 term infants. Rate of RSVH in very preterm infants ranged 1.5-3.8 per 100 infant-seasons in commercially insured infants and 3.5-8.4 in Medicaid insured infants and were inversely related to wGA at birth. Relative risk of RSVH in very preterm was 3-4 times higher, and ICU admissions and mechanical ventilation were more common during RSVH in very preterm infants relative to term infants. However, these outcomes were less common or less severe in very preterm infants who received outpatient palivizumab administration, despite evidence of higher baseline risk of RSVH in these infants.
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Affiliation(s)
| | | | - Heather Larkin
- Real World Data Research & Analytics, Merative, Cambridge, MA, USA
| | | | | | | | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Vincent C. Smith
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
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7
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Reichert H, Suh M, Jiang X, Movva N, Bylsma LC, Fryzek JP, Nelson CB. Mortality Associated With Respiratory Syncytial Virus, Bronchiolitis, and Influenza Among Infants in the United States: A Birth Cohort Study From 1999 to 2018. J Infect Dis 2022; 226:S246-S254. [PMID: 35968877 PMCID: PMC9377030 DOI: 10.1093/infdis/jiac127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Infant mortality due to respiratory syncytial virus (RSV) in the United States is not well understood. METHODS From 1999 to 2018, RSV, bronchiolitis, and influenza deaths were described for infants <1 year using linked birth/death datasets from the National Vital Statistics System. Mortality was described overall and by infant birth and death characteristics. Bronchiolitis was included as the plausible upper limit of RSV, while influenza served as a comparator. RESULTS Total infant deaths were 561 RSV, 1603 bronchiolitis, and 504 influenza, and rates were 6.9 (95% confidence interval [CI], 6.4-7.5), 19.8 (95% CI, 18.9-20.8), and 6.2 (95% CI, 5.7-6.8) per 1 000 000 live births, respectively. The highest RSV rates were observed among <29 weeks' gestational age infants (103.5; 95% CI, 81.8-129.1), American Indian/Alaskan Native (20.3; 95% CI, 11.6-33.0), and Medicaid-insured (7.3; 95% CI, 5.9-8.9). However, RSV mortality burden was greatest in full-term (53.7%), white (44.9%), and Medicaid-insured (61.7%) infants. Deaths outside the inpatient setting were 21% and 54% for RSV and bronchiolitis; more Medicaid- (58%) and other/unknown-insured (69%) infants with bronchiolitis died outside of the inpatient setting, compared to privately insured infants (48%) (P = .0327). CONCLUSIONS These national estimates emphasize the importance of considering all infants across all healthcare settings when describing RSV mortality.
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Affiliation(s)
- Heidi Reichert
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Mina Suh
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Xiaohui Jiang
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Naimisha Movva
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Lauren C Bylsma
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
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8
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Tran PT, Nduaguba SO, Diaby V, Choi Y, Winterstein AG. RSV testing practice and positivity by patient demographics in the United States: integrated analyses of MarketScan and NREVSS databases. BMC Infect Dis 2022; 22:681. [PMID: 35941563 PMCID: PMC9360654 DOI: 10.1186/s12879-022-07659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Background RSV-incidence estimates obtained from routinely-collected healthcare data (e.g., MarketScan) are commonly adjusted for under-reporting using test positivity reported in national Surveillance Systems (NREVSS). However, NREVSS lacks detail on patient-level characteristics and the validity of applying a single positivity estimate across diverse patient groups is uncertain. We aimed to describe testing practices and test positivity across subgroups of private health insurance enrollees in the US and illustrate the possible magnitude of misclassification when using NREVSS to correct for RSV under ascertainment. Methods Using billing records, we determined distributions of RSV-test claims and test positivity among a national sample of private insurance enrollees. Tests were considered positive if they coincided with an RSV-diagnosis. We illustrated the influence of positivity variation across sub-populations when accounting for untested acute respiratory infections. Results Most tests were for children (age 0–4: 65.8%) and outpatient encounters (78.3%). Test positivity varied across age (0–4: 19.8%, 5–17: 1.8%, adults: 0.7%), regions (7.6–16.1%), settings (inpatient 4.7%, outpatient 14.2%), and test indication (5.0–35.9%). When compared to age, setting or indication-specific positivity, bias due to using NREVSS positivity to correct for untested ARIs ranged from − 76% to 3556%. Conclusions RSV-test positivity depends on the characteristics of patients for whom those tests were ordered. NREVSS-based correction for RSV-under-ascertainment underestimates the true incidence among children and overestimate rates among adults. Demographic-specific detail on testing practice and positivity can improve the accuracy of RSV-incidence estimates. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07659-x.
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Affiliation(s)
- Phuong T Tran
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611-0496, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.,Faculty of Pharmacy, HUTECH University, Ho Chi Minh City, Vietnam
| | - Sabina O Nduaguba
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611-0496, USA.,Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia, Morgantown, WV, USA.,West Virginia University Cancer Institute, Morgantown, WV, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611-0496, USA.,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.,Global Value and Real-World Evidence, Otsuka America Pharmaceutical, Inc., Princeton, NJ, USA
| | - Yoonyoung Choi
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611-0496, USA. .,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA. .,Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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9
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Clark RH, Tolia VN, Ahmad KA. Palivizumab Use in the NICU: 1999-2020. Pediatrics 2022; 150:188307. [PMID: 35730329 DOI: 10.1542/peds.2021-055607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the relationship between changes in American Academy of Pediatrics (AAP) guidance and palivizumab use for infants admitted to the NICU. We hypothesized that each change in guidance would be associated with a change in palivizumab usage. METHODS This is a retrospective repeated cross-sectional study of palivizumab usage in defined subgroups of infants discharged between 1999 and 2020 using the Pediatrix Clinical Data Warehouse. RESULTS Palivizumab utilization increased in all groups between 1999 and 2003 and remained stable until 2013. Large changes in palivizumab use occurred between 2013 and 2015 followed by slower changes from 2016 to 2020. The largest decrease was in infants born between 29 0/7 and 31 6/7 weeks' gestational age without chronic lung disease (decreased from 87% to 21%; P < .001). The second largest absolute decrease was infants born at 32 0/7 to 34 6/7 weeks' gestational age without chronic lung disease and no major anomalies (decreased from 52% to 6%; P < .001). The decrease in term infants with major congenital heart problem was smaller (25 to 17%; P < .001). Even in the most vulnerable infants born between 22 0/7 and 28 6/7 estimated gestational age, palivizumab use declined (88% in 2013 to 74% in 2020; P < .001). CONCLUSIONS Early AAP guidelines had minor impacts on palivizumab use in infants discharged from the hospital from the NICU. The 2014 guidelines resulted in major changes in palivizumab use and extended into populations for which the AAP guidance remained unchanged.
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Affiliation(s)
- R Hunter Clark
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | - Veeral N Tolia
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, Florida.,Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, Texas.,Pediatrix Medical Group, Dallas, Texas
| | - Kaashif A Ahmad
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, Florida.,Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.,Pediatrix Neonatology of San Antonio, San Antonio, Texas.,Pediatrix Neonatology of Houston, Houston, Texas
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10
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Reingold ELB, Bennion M, Meyer MN. Immunizations in Children With Chronic Diseases: A State of the Science Review With Implications for Practice Change. J Pediatr Health Care 2022; 36:368-375. [PMID: 35120778 DOI: 10.1016/j.pedhc.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/01/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Chronic diseases afflict more than 25% of America's children, and it has been reported that some children with chronic illness are underimmunized, compounding their risks of complications from vaccine-preventable infections. METHOD To better assess vaccination rates in this population, we systematically reviewed PubMed and CINAHL. Publications were included if specific to immunization rates in U.S. children aged < 18 years and were published between 2010 and 2020. A total of 18 studies were reviewed. RESULTS Compared with healthy children, children with chronic illnesses have significantly lower vaccination rates, and they face higher risks if they contract a preventable disease. DISCUSSION Barriers to on-time vaccinations included inadequate education for both parents and providers and misconceptions from nonmedical sources. In addition, lack of provider comfort serves to lower vaccination rates of children with chronic illness. This topic requires further research and discussion until all children are protected from preventable illness.
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11
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Affiliation(s)
- Mina Suh
- Correspondence: Mina Suh, MPH, EpidStrategies, A Division of ToxStrategies, Inc. 27001 La Paz Road, Suite 260 Mission Viejo, CA 92691 ()
| | - Naimisha Movva
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Lauren C Bylsma
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
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12
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Ozkan H, Celebi S, Koksal N, Hacımustafaoğlu M, Koc E, Tezer H, Cetinkaya M, Cebeci B, Erdeve O, Ozdemir H. Risk Factors for Respiratory Syncytial Virus Infections in Moderate/Late Premature Infants in Turkey: A Prospective Multicenter Epidemiological Study. Am J Perinatol 2021; 38:1540-1546. [PMID: 32659789 DOI: 10.1055/s-0040-1713928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Respiratory syncytial virus (RSV) is one of the most prevalent causes of lower respiratory tract infection (LRTI). The primary objective of this study is to provide the risk modelling of confirmed RSV infection in children who were born preterm at 29 to 35 weeks of gestational age and presented with LRTI. STUDY DESIGN This prospective, multicenter study was performed between October 2015 and March 2017. Premature infants born with gestational age between 29 and 35 weeks that were ≤2 years of age at the beginning of the RSV season and admitted to the hospital with clinical findings of LRTI during the season were included. RSV-positive and -negative infants were compared in terms of demographic features, risk factors, and requirement of hospitalization. RESULTS RSV positive group was lower than RSV negative group and ratio of ≤3 months age at admission was significant higher in RSV (+) group. RSV-positive infants were found to be significantly born during or 3 months prior to RSV season. The rate and duration of hospitalization and need for mechanical ventilation were significantly higher in RSV positive infants. The rate and duration of hospitalization in RSV positive patients was related to the chronological age. CONCLUSION This study showed that preterm infants with RSV-associated LRTI significantly needed more hospitalization, intensive care admission, and mechanical ventilation. In addition need of hospitalization and duration of hospitalization were significant higher in ≤3 months of age. Therefore, we suggest the importance of palivizumab prophylaxis in infants ≤ 3 months chronological age, especially during the RSV season.
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Affiliation(s)
- Hilal Ozkan
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Solmaz Celebi
- Department of Pediatric Infection, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Nilgun Koksal
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | - Esin Koc
- Department of Neonatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hasan Tezer
- Department of Pediatric Infection, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Merih Cetinkaya
- Department of Neonatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Burcu Cebeci
- Department of Neonatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Omer Erdeve
- Department of Pediatric Infection, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infection, Faculty of Medicine, Ankara University, Ankara, Turkey
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13
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Goldstein M, Krilov LR, Fergie J, Brannman L, Wade SW, Kong AM, Ambrose CS. Unintended Consequences Following the 2014 American Academy of Pediatrics Policy Change for Palivizumab Prophylaxis among Infants Born at Less than 29 Weeks' Gestation. Am J Perinatol 2021; 38:e201-e206. [PMID: 32299107 PMCID: PMC8397527 DOI: 10.1055/s-0040-1709127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this study is to compare outpatient respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and relative RSV hospitalization (RSVH) rates for infants <29 weeks' gestational age (wGA) versus term infants before and after the 2014 American Academy of Pediatrics (AAP) policy change. STUDY DESIGN Infants were identified in the MarketScan Commercial and Multi-State Medicaid databases. Outpatient RSV IP receipt and relative <29 wGA/term hospitalization risks in 2012 to 2014 and 2014 to 2016 were assessed using rate ratios and a difference-in-difference model. RESULTS Outpatient RSV IP receipt by infants <29 wGA and aged <3 months in the Commercial and Medicaid populations and those aged 3 to <6 months in the Medicaid population declined after 2014. Relative RSVH risks for infants <29 wGA were numerically greater after 2014, with infants aged <3 months and Medicaid infants experiencing the greatest increases. Difference-in-difference results indicated a significantly increased relative risk of RSVH for infants <29 wGA versus term (both cohorts aged 0 to <6 months) in the Medicaid-insured population (1.68, p = 0.0054). A nonsignificant increase of similar magnitude occurred in the commercially insured population (1.57, p = 0.2867). CONCLUSION The 2014 policy change was associated with a decrease in RSV IP use and an increase in RSVH risk among otherwise healthy infants <29 wGA.
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Affiliation(s)
- Mitchell Goldstein
- Division of Neonatology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, California,Address for correspondence Mitchell Goldstein, MD Division of Neonatology, Department of Pediatrics, Loma Linda University Children's Hospital11175 Campus Street, Suite #11121, Loma Linda, CA 92354
| | - Leonard R. Krilov
- Division of Pediatric Infectious Disease, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Lance Brannman
- Biopharmaceutical Medical Department, AstraZeneca, Gaithersburg, Maryland
| | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Amanda M. Kong
- Life Sciences Department, IBM Watson Health, Cambridge, Massachusetts
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14
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Shmueli E, Goldberg O, Mei-Zahav M, Stafler P, Bar-On O, Levine H, Steuer G, Mussaffi H, Gendler Y, Blau H, Prais D. Risk factors for respiratory syncytial virus bronchiolitis hospitalizations in children with chronic diseases. Pediatr Pulmonol 2021; 56:2204-2211. [PMID: 33913611 DOI: 10.1002/ppul.25435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) bronchiolitis is the most common lower respiratory tract disorder causing hospitalization in infants. Due to decreased hospitalization rates of premature infants following Palivizumab immune prophylaxis, the proportion of infants with chronic diseases not eligible for Palivizumab has increased. AIM To characterize infants hospitalized during 2014-2018 with RSV bronchiolitis, to compare between those with and without chronic conditions, and to identify risk factors for severe disease. METHODS This retrospective study analyzed demographic and clinical data of patients younger than 2 years admitted with bronchiolitis during four consecutive RSV seasons. RESULTS Of 1124 hospitalizations due to RSV bronchiolitis, 244 (22%) were in infants with chronic diseases. Although 20/1124 qualified for RSV prophylaxis, only eight received immune prophylaxis. Compared to otherwise healthy infants, children with chronic diseases had longer hospitalizations, median 4.8 days (interquartile range [IQR]: 3.4-8.3) versus 3.7 days (IQR: 2.7-5.1), p < .001; and higher pediatric intensive care unit (PICU) and readmission rates (9% vs. 4.5%, p = .007% and 3% vs. 1%, p = .055, respectively). Children with Down's syndrome comprised 2% of all hospitalizations, but 8% of PICU admissions; their median length of hospitalization was 10.7 days (IQR: 6.6-17.6). Respiratory tract malformations were present in 2% of hospitalizations, and comprised 4% of PICU admissions. CONCLUSION Among infants admitted with RSV bronchiolitis, those with chronic diseases had longer hospitalizations and higher rates of transfer to the PICU. Children with multiple comorbidities, and especially those with Down's syndrome, are at particularly high risk for severe hospitalization and may benefit from RSV immune prophylaxis.
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Affiliation(s)
- Einat Shmueli
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Goldberg
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meir Mei-Zahav
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Bar-On
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Hagit Levine
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Steuer
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Huda Mussaffi
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Gendler
- Department of Nursing, Ariel University, Ariel, Israel
| | - Hannah Blau
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Fergie J, Goldstein M, Krilov LR, Wade SW, Kong AM, Brannman L. Update on respiratory syncytial virus hospitalizations among U.S. preterm and term infants before and after the 2014 American Academy of Pediatrics policy on immunoprophylaxis: 2011-2017. Hum Vaccin Immunother 2021; 17:1536-1545. [PMID: 33090914 PMCID: PMC8078654 DOI: 10.1080/21645515.2020.1822134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/04/2020] [Indexed: 10/26/2022] Open
Abstract
Palivizumab is the only licensed respiratory syncytial virus (RSV) immunoprophylaxis (IP) available to prevent severe RSV disease in high-risk pediatric populations, including infants born at 29-34 weeks' gestational age (wGA). In 2014, the American Academy of Pediatrics (AAP) stopped recommending RSV IP use for otherwise healthy 29-34 wGA infants and stated that 29-34 wGA infants and term infants have similar RSV hospitalization (RSVH) rates. This study aimed to compare RSV IP use and RSVH rates in 29-34 wGA infants and term infants during the 3 RSV seasons before and after the 2014 AAP policy change. RSV IP use in otherwise healthy infants 29-30, 31-32, and 33-34 wGA was estimated from pharmacy or outpatient medical claims for palivizumab. RSVH rates in the first 6 months of life were calculated per 100 infant-seasons. RSVH rate ratios were used to compare preterm infants and term infants before and after the policy change. Across infant cohorts (29-34 wGA) and chronologic age groups (<3 months and 3-<6 months), absolute decreases in RSV IP use between the combined 2011-2014 seasons and 2014-2017 seasons ranged from 7% to 38% and from 68% to 97%, respectively. Compared with 2011-2014, the RSVH risk increased 2.09-fold (P< .001) and 1.76-fold (P< .001) in 2014-2017 for infants born at 29-34 wGA and aged <6 months with commercial and Medicaid insurance, respectively. Overall, RSV IP use declined in the RSV seasons following the 2014 RSV IP policy change, and RSVH increased among 29-34 wGA infants aged <6 months.
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Affiliation(s)
- Jaime Fergie
- Infectious Diseases Service, Driscoll Children’s Hospital, Corpus Christi, TX, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - Leonard R. Krilov
- Department of Pediatrics, NYU Winthrop Hospital and the NYU Long Island School of Medicine, Mineola, NY, USA
| | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, UT, USA
| | - Amanda M. Kong
- Department of Life Sciences, IBM Watson Health, Cambridge, MA, USA
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16
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Sierra CM, Park A, Eum E, Garcia G, Lopez M, Daniel SN, Bahjri K, Parbuoni KA. Adherence to the 2014 American Academy of Pediatrics palivizumab prophylaxis recommendations. Pediatr Pulmonol 2021; 56:1121-1126. [PMID: 33314771 DOI: 10.1002/ppul.25225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/28/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION This study aims to describe adherence rates to the 2014 American Academy of Pediatrics (AAP) Committee on Infectious Disease guidance document recommending which patients should receive palivizumab for prophylaxis against respiratory syncytial virus (RSV). METHODS A retrospective, single-center analysis of patients who received at least one dose of palivizumab between October 1, 2012, and March 1, 2017 was conducted. Data collected included demographics, medical history, palivizumab administration regimens, and incidence of RSV infection. RESULTS Data were collected on 457 patients who received palivizumab over five RSV seasons. Approximately half of the patients (45% and 55%, respectively) received palivizumab according to the AAP recommendations in place at the time (2012 or 2014 recommendations, respectively). One percent of patients had a breakthrough RSV infection after receiving at least one dose of palivizumab. There was no significant difference in the number of breakthrough infections before and after the 2014 recommendations were released (3 vs. 2). CONCLUSIONS Approximately half of the patients received prophylaxis in accordance with the 2014 AAP recommendations and infrequently suffered from a breakthrough RSV infection.
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Affiliation(s)
- Caroline M Sierra
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Alice Park
- Rite-Aid Pharmacy, Rancho Cucamonga, California, USA
| | - Eunsi Eum
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Giselle Garcia
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Mireya Lopez
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | | | - Khaled Bahjri
- Loma Linda University School of Pharmacy, Loma Linda, California, USA
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17
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Taylor RS, Baker MH. Palivizumab Prophylaxis for infants 29 to 32 weeks gestation at birth: A 10-year audit from Vancouver Island using BC Guidelines. Paediatr Child Health 2021; 26:e110-e114. [PMID: 36381679 PMCID: PMC9642346 DOI: 10.1093/pch/pxz151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/27/2019] [Indexed: 09/08/2024] Open
Abstract
Background After initially recommending palivizumab (PVZ), a monoclonal antibody against respiratory syncytial virus (RSV) for all infants 29 to 32 weeks at birth if <6 months age at season start, the American Academy of Pediatrics (AAP) and Canadian Paediatric Society (CPS) guidelines were revised. British Columbia was the only jurisdiction in North America to restrict eligibility for this group to those with additional risk factors, long before the change in national recommendations. Objectives To determine the risk for first season RSV admission for 29 to 32-week gestational age (GA) infants admitted to Victoria Neonatal Intensive Care Unit (NICU) that either received or were denied PVZ prophylaxis. Methods Descriptive cohort study of infants eligible for prophylaxis according to earlier CPS guidelines. Instead, BC guidelines for prophylaxis were applied and data for Vancouver Island infants were collected over 10 consecutive RSV seasons. Results We followed 423 infants. Three hundred and thirty-six (79%) did not receive prophylaxis, of which 10 (3.0%; 95% confidence interval [CI] 1.4% to 5.4%) had an RSV hospitalization before the end of April during their first RSV season versus 3 admissions from 87 (3.5%; 95% CI 0.7% to 10%) infants who received prophylaxis. Conclusions Our risk factor approach to RSV prophylaxis for infants born at 29 to 32 weeks GA resulted in a low (average incidence=3.1%) rate of RSV hospitalization. Our approach would offer considerable cost savings to RSV prophylaxis programs that continue to offer routine prophylaxis beyond 28/29 weeks GA at birth.
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Affiliation(s)
- Richard S Taylor
- University of Victoria, Victoria, British Columbia
- NICU, Victoria General Hospital, Victoria, British Columbia
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18
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Domachowske JB, Anderson EJ, Goldstein M. The Future of Respiratory Syncytial Virus Disease Prevention and Treatment. Infect Dis Ther 2021; 10:47-60. [PMID: 33656652 PMCID: PMC7926075 DOI: 10.1007/s40121-020-00383-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/31/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in infants, young children, and older or immunocompromised adults. Although aerosolized ribavirin was licensed for RSV treatment on the basis of data demonstrating a reduced need for supplemental oxygen, ribavirin use is limited because of issues with efficacy, safety, and cost. Currently, the treatment of RSV is primarily supportive. New antiviral treatments for RSV are in the early stages of development, but it will be years until any of these may be licensed by the US Food and Drug Administration (FDA). Palivizumab, an RSV monoclonal antibody [immunoprophylaxis (IP)], has demonstrated effectiveness in disease prevention and is the only licensed IP for RSV disease in specific high-risk pediatric populations. Although its efficacy is well established, some challenges that may interfere with its clinical use include cost, need for monthly injections, and changing policy for use by the American Academy of Pediatrics (AAP). Preventing RSV disease would be possible through RSV vaccine development (e.g., live-attenuated, vector-based subunit, or particle-based). Alternatively, new long-acting monoclonal antibodies have demonstrated promising results in early clinical trials. Despite scientific advances, until new agents become available, palivizumab should continue to be used to reduce RSV disease burden in high-risk patients for whom it is indicated.
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Affiliation(s)
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA.
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19
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Krilov LR, Forbes ML, Goldstein M, Wadhawan R, Stewart DL. Severity and Cost of RSV Hospitalization Among US Preterm Infants Following the 2014 American Academy of Pediatrics Policy Change. Infect Dis Ther 2021; 10:27-34. [PMID: 33656650 PMCID: PMC8017024 DOI: 10.1007/s40121-020-00389-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
The American Academy of Pediatrics (AAP) Committee on Infectious Diseases (COID) periodically publishes recommendations for respiratory syncytial virus (RSV) immunoprophylaxis (IP) use in pediatric patients considered to be at highest risk for severe RSV infection. In 2014, for the first time, the AAP COID stopped recommending the use of RSV IP for otherwise healthy infants born at 29 weeks’ gestational age (wGA) or later, stating that RSV hospitalization (RSVH) rates in this population are similar to those of term infants. Subsequently, epidemiological studies in the US at national and regional levels provided evidence of the impact of the policy change in 29–34 wGA infants. The results of these studies demonstrated a significant decrease in IP use after 2014 that was associated with an increased rate of RSVH in 29–34 wGA infants and an increase in morbidities. RSVH-related morbidities included pediatric intensive care unit (ICU) admissions, an increased need for mechanical ventilation, and an increase in the length of stay. After the change in recommendations, the costs of RSVH also rose among 29–34 wGA infants. The severity of the illness and expenses associated with RSVH were generally higher among 29–34 wGA infants of younger chronologic age compared with older preterm infants. Overall, these studies underscore that 29–34 wGA infants continue to be a high-risk pediatric population that could benefit from the protection provided by RSV IP. On the basis of these data, in 2018, the National Perinatal Association developed guidelines that recommended RSV IP for all ≤ 32 wGA infants and 32–35 wGA infants with additional risk factors. Re-evaluation of the AAP COID policy is warranted in light of these observations.
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Affiliation(s)
- Leonard R Krilov
- Department of Pediatrics, NYU Langone Hospital - Long Island and the NYU Long Island School of Medicine, Mineola, NY, USA.
| | - Michael L Forbes
- Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Rajan Wadhawan
- Department of Pediatrics, AdventHealth for Children, Orlando, FL, USA
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's Hospital and University of Louisville Hospital, Louisville, KY, USA
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20
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Impact of the 2014 American Academy of Pediatrics Policy on RSV Hospitalization in Preterm Infants in the United States. Infect Dis Ther 2021; 10:17-26. [PMID: 33656649 PMCID: PMC8017053 DOI: 10.1007/s40121-020-00388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/25/2022] Open
Abstract
Despite being a leading cause of hospitalization due to lower respiratory tract infections, the treatment of respiratory syncytial virus (RSV) infection is primarily supportive. Palivizumab is the only licensed immunoprophylaxis (IP) available for preventing severe RSV infection in high-risk populations including ≤ 35 weeks' gestational age (wGA) infants and children with chronic lung disease of prematurity or congenital heart disease. The American Academy of Pediatrics (AAP) has published its IP recommendations since the approval of palivizumab. In 2014, the AAP stopped recommending RSV IP in 29-34 wGA infants without comorbidities and stated that RSV hospitalization (RSVH) risk in otherwise healthy ≥ 29 wGA infants and term infants was similar. Since then, experts in the field have debated the appropriateness of the 2014 policy change, and several real-world evidence studies at the national and regional levels in the US have examined the impact of the AAP policy on 29-34 wGA infants. Overall, these studies showed a significant decline in RSV IP use and a concurrent increase in RSVH risk among 29-34 wGA infants relative to term infants in the seasons after the 2014 policy change. A similar decrease in IP use and increase in RSVH risk was also observed among < 29 wGA infants relative to term infants after the 2014 policy change. This decrease could be an unintended consequence as < 29 wGA infants are an in-policy population recommended to receive RSV IP. According to the National Perinatal Association, strong evidence exists to support the use of RSV IP in all ≤ 32 wGA and 32-35 wGA infants with risk factors such as attending day care, having ≥ 1 school-aged siblings, twin or greater multiple gestation, younger age, and exposure to parental smoking. Until new preventive and treatment options become available, palivizumab can help prevent and mitigate RSV disease burden among high-risk preterm infants.
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21
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Staebler S, Blake S. Respiratory Syncytial Virus Disease: Immunoprophylaxis Policy Review and Public Health Concerns in Preterm and Young Infants. Policy Polit Nurs Pract 2021; 22:41-50. [PMID: 33050785 PMCID: PMC7802052 DOI: 10.1177/1527154420965543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Globally, respiratory syncytial virus (RSV) is a leading cause of hospitalization due to severe respiratory infections in infants of all gestational ages and children aged 5 years and younger, and it is associated with a substantial health care burden. Approximately, 1% to 3% of infants younger than 1 year are hospitalized with severe RSV disease in the United States. With no specific treatment or vaccine, palivizumab is the only licensed immunoprophylaxis for the prevention of severe RSV disease in high-risk pediatric populations, including infants born at or before 35 weeks' gestational age (wGA). In the United States, the American Academy of Pediatrics (AAP) periodically publishes its recommendation for the use of RSV immunoprophylaxis, which is largely followed by health care professionals and payers. In 2014, the AAP Committee on Infectious Diseases stopped recommending RSV immunoprophylaxis for otherwise healthy infants born at or after 29 wGA and stated that the RSV hospitalization rates in infants 29 to 34 wGA and full-term infants were similar. Several studies have demonstrated that a significant decline in palivizumab use following the AAP 2014 recommendations was accompanied by increases in rates of RSV hospitalization and disease severity and hospital costs in infants 29 to 34 wGA versus full-term infants. Despite the growing evidence demonstrating high RSV morbidity in infants 29 to 34 wGA, the AAP reaffirmed its 2014 policy in 2019. This article will discuss the critical roles and strategies of advocacy groups and nurses in providing the maximum protection with RSV immunoprophylaxis to all high-risk and label-eligible preterm infants.
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Affiliation(s)
- Suzanne Staebler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Stephanie Blake
- Department of Pediatrics, Division of Neonatology, Duke University Medical Center, Durham, North Carolina, United States
- School of Nursing, Duke University, Durham, North Carolina, United States
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22
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Chirikov VV, Simões EAF, Kuznik A, Kwon Y, Botteman M. Economic-Burden Trajectories in Commercially Insured US Infants With Respiratory Syncytial Virus Infection. J Infect Dis 2021; 221:1244-1255. [PMID: 30982895 DOI: 10.1093/infdis/jiz160] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study evaluates the long-term respiratory syncytial virus (RSV) burden among preterm and full-term infants in the United States. METHODS Infants with birth hospitalization claims and ≥24 months of continuous enrollment were retrospectively identified in the Truven MarketScan Commercial Claims and Encounters database for the period 1 January 2004-30 September 2015. Infants with RSV infection in the first year of life (n = 38 473) were matched to controls (n = 76 825), and remaining imbalances in the number of individuals in each group were adjusted using propensity score methods. All-cause, respiratory-related, and asthma/wheezing-related 5-year average cumulative costs were measured. RESULTS Early premature (n = 213), premature (n = 397), late premature (n = 4446), and full-term (n = 33 417) RSV-infected infants were matched to 424, 791, 8875, and 66 735 controls, respectively. After 2 years since RSV diagnosis, all-cause cumulative costs for RSV-infected infants as compared to those for controls increased by $22 081 (95% confidence interval [CI], -$5800-$42 543) for early premature infants, by $14 034 (95% CI, $5095- $22 973) for premature infants, by $10 164 (95% CI, $8835-$11 493) for late premature infants, and by $5404 (95% CI, $5110-$5698) for full-term infants. The 5-year RSV burden increased to $39 490 (95% CI, $18 217-$60 764), $23 160 (95% CI, $13 002-$33 317),$13 755 (95% CI, $12 097-$15 414), and $6631 (95% CI, $6060-$7202), respectively. The RSV burden was higher when stratified by inpatient and outpatient setting and respiratory-related and asthma/wheezing-related costs. CONCLUSIONS The RSV burden extends across cost domains and prematurity, with the greatest burden incurred by the second year of follow-up. Findings are useful in determining the cost-effectiveness of RSV therapies in development.
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Affiliation(s)
| | - Eric A F Simões
- Department of Pediatrics, University of Colorado School of Medicine.,Department of Epidemiology, Center for Global Health, Colorado School of Public Health.,Section of Infectious Disease, Children's Hospital Colorado, Aurora
| | - Andreas Kuznik
- Health Economics and Outcomes Research, Regeneron, Tarrytown, New York
| | - Youngmin Kwon
- Real World Evidence, Pharmerit International, Bethesda, Maryland
| | - Marc Botteman
- Real World Evidence, Pharmerit International, Bethesda, Maryland
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23
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Krilov LR, Anderson EJ. Respiratory syncytial virus hospitalizations in US preterm infants after the 2014 change in immunoprophylaxis guidance by the American Academy of Pediatrics. J Perinatol 2020; 40:1135-1144. [PMID: 32499597 PMCID: PMC7271636 DOI: 10.1038/s41372-020-0689-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/03/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022]
Abstract
Palivizumab is the only licensed and effective immunoprophylaxis (IP) available to prevent respiratory syncytial virus (RSV) infection in high-risk infants including infants born at ≤35 weeks' gestational age (wGA). In 2014, the American Academy of Pediatrics stopped recommending IP for otherwise healthy 29-34 wGA infants, stating that their risk of RSV hospitalization (RSVH) was similar to term infants. Recent studies have demonstrated a significant decline in IP use after 2014 that was accompanied by an increased risk of RSVH in 29-34 wGA infants vs term infants. Severity and healthcare utilization of RSVH were high among 29-34 wGA infants. In 2018, the National Perinatal Association developed guidelines advocating IP use in all ≤32 wGA infants and 32-35 wGA infants with additional risk factors. Risk factor predictive models can identify infants who are at risk for RSVH and promote cost-effective use of palivizumab until new methods of RSV prevention become available.
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Affiliation(s)
- Leonard R Krilov
- Department of Pediatrics, NYU Winthrop Hospital and NYU Long Island School of Medicine, Mineola, NY, USA.
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, USA
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24
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Fergie J, Suh M, Jiang X, Fryzek JP, Gonzales T. Respiratory Syncytial Virus and All-Cause Bronchiolitis Hospitalizations Among Preterm Infants Using the Pediatric Health Information System (PHIS). J Infect Dis 2020; 225:1197-1204. [PMID: 32691037 PMCID: PMC8974836 DOI: 10.1093/infdis/jiaa435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Background In 2014, the American Academy of Pediatrics stopped recommending palivizumab to otherwise healthy 29–34 weeks’ gestational age (wGA) infants aged <12 months at respiratory syncytial virus (RSV) season start. Here, we compare the burden of RSV hospitalizations (RSVH) and all-cause bronchiolitis hospitalizations (BH) before and after 2014 among otherwise healthy 29–34 wGA infants hospitalized at ≤6 months of age. Methods A historical, observational cohort study was conducted to evaluate RSVH and BH in 29–34 wGA infants during the 2010–2017 RSV seasons using encounter data from 51 United States children’s hospitals that comprise the Pediatric Health Information System. Results The overall cohort included 67 570 RSVH out of 96 281 patients with BH. wGA was known for 22 937 RSVH and 33 289 BH. For 29–34 wGA infants, there were 8.7% and 14.2% RSVH before and after 2014, respectively (P < .0001). Intensive care unit admissions increased for RSVH (from 54.5% to 64.2%; P = .0002) and BH (from 46.7% to 54.5%; P = .0005) after controlling for sex, race, comorbidity, and cluster. The total cost of care increased for RSVH from $37 million to nearly $60 million. Conclusions RSVH, BH, and their severity increased among 29–34 wGA infants in the 3 RSV seasons following 2014.
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Affiliation(s)
- Jaime Fergie
- Department of Pediatrics, Driscoll Children’s Hospital, Corpus Christi, Texas, USA
| | - Mina Suh
- EpidStrategies, Rockville, Maryland, USA
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Greenberg D, Dagan R, Shany E, Ben-Shimol S, Givon-Lavi N. Health Care Resource Utilization of Late Premature Versus Term Infants With Bronchiolitis. Clin Pediatr (Phila) 2020; 59:778-786. [PMID: 32400172 DOI: 10.1177/0009922820920012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is controversial whether it is cost-beneficial for late preterm infants to receive respiratory syncytial virus prophylaxis. This study compares community and hospital health care resource utilization (HCRU) of late premature infants (33-36 weeks gestational age) with term infants (>36 weeks gestational age) hospitalized with bronchiolitis. This was a retrospective, population-based, observational study spanning a 9-year period (2004-2012). HCRU data were obtained from the Health Maintenance Organization "Clalit" and included duration of hospitalization, physician visits, laboratory tests, and treatments. Compared with term infants, late preterm infants had significantly longer duration of hospitalization and higher admission rates to pediatric intensive care unit. They also had higher rates of mean outpatients clinic visits, total outpatient clinic and specialist visits, blood chemistry, and virology testing. HCRU of term infants with bronchiolitis was also substantial, indicating that they also can greatly benefit from respiratory syncytial virus prophylaxis. These findings can guide stakeholders in decisions concerning the prevention of bronchiolitis and will be useful in performing further cost-benefit analysis.
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Affiliation(s)
- David Greenberg
- Soroka University Medical Center, Beer-Sheva, Israel.,Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron Dagan
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eilon Shany
- Soroka University Medical Center, Beer-Sheva, Israel.,Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Soroka University Medical Center, Beer-Sheva, Israel.,Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- Soroka University Medical Center, Beer-Sheva, Israel.,Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kenmoe S, Kengne-Nde C, Modiyinji AF, La Rosa G, Njouom R. Comparison of health care resource utilization among preterm and term infants hospitalized with Human Respiratory Syncytial Virus infections: A systematic review and meta-analysis of retrospective cohort studies. PLoS One 2020; 15:e0229357. [PMID: 32084214 PMCID: PMC7034889 DOI: 10.1371/journal.pone.0229357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/04/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Data on the variation in the medical resource utilization rate of Human Respiratory Syncytial Virus (HRSV) infected children by gestational age have recently been made available. This review aimed to determine whether prematurity is independently associated with the use of medical resources in hospitalized children for HRSV infections. METHODS We conducted this systematic review on cohort studies published on the medical resources use in preterm and full-term patients hospitalized for confirmed HRSV infections. We searched PubMed, Embase, and Global Index medicus for eligible studies. The standardized mean difference (SMD) and Risk Ratio (RR) with their 95% confidence intervals (95% CI) were estimated as summary statistics with random effects meta-analysis. The overall results were adjusted to the common confounders by stratified analyses. RESULTS A total of 14 articles (20 studies) were included. Compared to full-term, preterm hospitalized with HRSV infections had more frequent intensive care unit admission (RR = 2.6, 95% CI = 1.9-3.5), increased length of stay in hospital (SMD = 0.6, 95% CI = 0.5-0.8) and intensive care unit (SMD = 0.6, 95% CI = 0.4-0.8) and increased case fatality rate (RR = 6.9, 95% CI = 2.0-23.8). Mechanical ventilation utilization was more frequent in preterm children ≤ 2 years (RR = 15.5, 95% CI = 8.9-26.4) and those who did not receive prophylaxis against HRSV (RR = 15.9, 95% CI = 9.1-27.9)] than in full-term children. No differences were identified in the frequency of emergency department visits, oxygen utilization, and the age at the first HRSV episode between preterm and full-term infants. CONCLUSIONS Regardless of gestational age, preterm infants hospitalized for HRSV infections, especially those ≤ 2 years, have an increased frequency of use of health resources and poor outcomes compared to full-term infants. HRSV vaccine development programs for pregnant women should be accelerated. CLINICAL TRIALS REGISTRATION Review registration PROSPERO, CRD42019124375.
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Affiliation(s)
- Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Cyprien Kengne-Nde
- National AIDS Control Committee, Epidemiological Surveillance, Evaluation and Research Unit, Yaoundé, Cameroon
| | - Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Department of Animals Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
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Expert consensus on palivizumab use for respiratory syncytial virus in developed countries. Paediatr Respir Rev 2020; 33:35-44. [PMID: 31060948 DOI: 10.1016/j.prrv.2018.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/16/2018] [Accepted: 12/11/2018] [Indexed: 11/24/2022]
Abstract
Respiratory syncytial virus (RSV) infection is a leading cause of hospitalisation in early childhood and palivizumab is the only licensed intervention for prevention. Palivizumab guidelines should reflect the latest evidence, in addition to cost-effectiveness and healthcare budgetary considerations. RSV experts from Europe, Canada and Israel undertook a systematic review of the evidence over the last 5 years and developed recommendations regarding prophylaxis in industrialised countries. Almost 400 publications were reviewed. This group recommended palivizumab for: preterm infants (<29 and ≤31 weeks gestational age [wGA] and ≤9 and ≤6 months of age, respectively; high-risk 32-35wGA), former preterm children ≤24 months with chronic lung disease/bronchopulmonary dysplasia, children ≤24 months with significant congenital heart disease; and other high-risk populations, such as children ≤24 months with Down syndrome, pulmonary/neuromuscular disorders, immunocompromised, and cystic fibrosis. Up to 5 monthly doses should be administered over the RSV season. It is our impression that the adoption of these guidelines would help reduce the burden of RSV.
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An update of the recommendations of the spanish neonatology society for the use of paivizumab as prophylaxis for severe infections due to syncytial respiratory virus in high risk infants. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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29
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[An update of the recommendations of the Spanish Neonatology Society for the use of palivizumab as prophylaxis for severe infections due to syncytial respiratory virus in high risk infants]. An Pediatr (Barc) 2019; 91:348-350. [PMID: 31585838 DOI: 10.1016/j.anpedi.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 11/21/2022] Open
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Goldstein M, Krilov LR, Fergie J, McLaurin KK, Wade SW, Diakun D, Lenhart GM, Bloomfield A, Kong AM. Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012-2016. Am J Perinatol 2018; 35:1433-1442. [PMID: 29920638 PMCID: PMC6260117 DOI: 10.1055/s-0038-1660466] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. STUDY DESIGN Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November-March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference-in-difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. RESULTS In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 (P<0.0001 for commercial and Medicaid samples). CONCLUSION In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.
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Affiliation(s)
- Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California,Address for correspondence Mitchell Goldstein, MD Loma Linda University Children's Hospital11175 Campus Street, Loma Linda, CA 92354
| | - Leonard R. Krilov
- Pediatric Infectious Diseases, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
| | | | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - David Diakun
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | | | | | - Amanda M. Kong
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
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Abstract
Administrative healthcare databases are created from records of service utilization and payments for payer or hospital billing purposes. Such databases contain large amounts of information on the diagnoses, procedures, resource utilization, and costs or charges of thousands or even millions of patients. However, the patient populations included and data elements available vary widely by database, resulting in different strengths, limitations, and potential uses for each. Therefore, selection of an administrative database should be guided by the research question of interest. This review discusses important considerations when selecting an administrative healthcare database to use to answer a research question and describes key characteristics of the administrative databases most frequently used for pediatric surgical research.
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Affiliation(s)
- Calista M Harbaugh
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer N Cooper
- The Research Institute at Nationwide Children's Hospital and the Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
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Noor A, Krilov LR. Respiratory syncytial virus vaccine: where are we now and what comes next? Expert Opin Biol Ther 2018; 18:1247-1256. [PMID: 30426788 DOI: 10.1080/14712598.2018.1544239] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and elderly and to date, there is no safe or effective vaccine against RSV. AREAS COVERED This review provides a roadmap to RSV vaccine development. It is a journey spanning over more than half a century from the initial disappointment with inactivated formalin vaccine to the current advancements in vaccine technology. We highlight the important aspects of RSV structural biology and protective immune response. We include discussion of newer fusion glycoprotein immune targets and current vaccine candidates. We used Pub Med and Medline resources for literature search. EXPERT OPINION A resurgence of information on the burden related to RSV infection coupled with the newer understanding of the molecular mechanism of RSV infection has reignited a tremendous activity in RSV vaccine discovery. The vaccine pipeline is diverse and target populations are varied, thus making the goal of a safe and effective RSV vaccine in the future within reach.
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Affiliation(s)
- Asif Noor
- a Department of Pediatrics, Children's Medical Center , NYU Winthrop Hospital , Mineola , NY , USA
| | - Leonard R Krilov
- a Department of Pediatrics, Children's Medical Center , NYU Winthrop Hospital , Mineola , NY , USA.,b Department of Pediatrics, Stony Brook School of Medicine , State University of New York , Stony Brook , NY , USA
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Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Montella S, Tchana B, Valerio G, Verrotti A, Valenzise M, Bernasconi S, Corsello G. Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics. Ital J Pediatr 2018; 44:82. [PMID: 30016966 PMCID: PMC6050676 DOI: 10.1186/s13052-018-0524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022] Open
Abstract
This review provides an overview of a remarkable number of significant studies in pediatrics that have been published over the past year in the Italian Journal of Pediatrics. We have selected information from papers presented in the Journal that deal with allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology. The relevant epidemiologic findings, and developments in prevention, diagnosis and treatment of the last year have been discussed and placed in context. We think that advances achieved in 2017 will help readers to make the future of patients better.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bertrand Tchana
- Cardiologia Pediatrica, Azienda Ospedaliera-Universitaria, Parma, Italy
| | - Giuliana Valerio
- Pediatria, Dipartimento di Scienze Motorie e del Benessere, Università di Napoli Parthenope, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Mariella Valenzise
- UOC Clinica Pediatrica AOU G, Martino Università di Messina, Messina, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
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