Tool could pinpoint infants at highest risk for RSV
Click Here to Manage Email Alerts
Key takeaways:
- Researchers studied data from nearly 430,000 children to find factors related to RSV illness.
- What they found could help pediatricians prioritize young children for RSV prevention.
A new tool could help pediatricians identify infants most at risk for severe respiratory syncytial virus, according to research published in Open Forum Infectious Diseases.
“We know that 50% of infant hospitalizations for RSV are among term healthy infants who are not considered high risk for RSV and have not qualified for RSV immunoprophylaxis in the past,” Tina V. Hartert, MD, MPH, director of the Vanderbilt University Center for Asthma and Environmental Sciences Research, told Healio. “We wanted to develop a tool to identify all high-risk infants.”
Given the shortage and cost of the RSV monoclonal antibody nirsevimab, Hartert said they were interested in creating a tool to “identify the infants at highest risk of the most severe outcomes, need for hospital intensive care unit admission, in order to inform allocation of a limited resource to those most likely to benefit.”
They studied the de-identified patient records of 429,365 children insured by the Tennessee Medicaid Program from 1995 and 2007, including infants who did not receive RSV immunoprophylaxis in the first year of life, and considered factors including birth month, birth weight and whether an infant has siblings to determine who was most at risk for severe RSV illness and could benefit from nirsevimab.
“For this tool we wanted to use data that would be readily available at birth and could eventually be automated by pulling data directly from electronic health records shortly following birth,” Hartert said.
The tool included 19 variables, such as birth month, birth weight, whether the infant had older siblings and whether they had certain health conditions.
“It’s important to note that we developed this predictive model using one dataset, but as with all predictive models, it requires validation in other datasets or populations.”
Among all children, 0.2% had a severe RSV lower respiratory tract infection requiring ICU admission, with a median age at admission of 66 days (interquartile range, 37 to 120 days).
The tool developed by Hartert and colleagues demonstrated “good predictive accuracy” to estimate an infant’s risk for severe RSV requiting ICU admission (area under the curve, 0.78; 95% CI, 0.77-0.8). It identified infants who did not qualify for the RSV treatment palivizumab, based on AAP guidelines, but it had higher predicted risk levels than infants who qualified (27% of noneligible infants with greater than 0.16% predicted probabilities [lower quartile for eligible infants]).
“This is a reminder that more than 50% of RSV hospitalizations during infancy are among term, previously healthy infants,” Hartert said. “This tool may help to identify infants at highest risk of the most severe outcomes, including death, allowing allocation of limited resources such as nirsevimab, and motivating vaccine-hesitant parents of infants who are at high risk to understand the importance of RSV immunization for their infant.”
In addition to validating the tool, Hartert said they would like to determine if it could be useful in low- and middle-income countries, “where over 90% of all RSV-associated child deaths occur.”
“Timely identification of high-risk infants is key to prevention,” Hartert said “This is a tool to identify them, and we now have highly effective RSV prevention products.”
References:
Hartert TV, et al. Open Forum Infect Dis. 2024;doi:10.1093/ofid/ofae077.
New tool helps identify babies at high-risk for RSV. https://www.eurekalert.org/news-releases/1042602. Published Apr. 25, 2024. Accessed Apr. 29, 2024.
Collapse
Read more about
Click Here to Manage Email Alerts