scholarly journals Respiratory syncytial virus hospitalizations in US preterm infants after the 2014 change in immunoprophylaxis guidance by the American Academy of Pediatrics

2020 ◽  
Vol 40 (8) ◽  
pp. 1135-1144
Author(s):  
Leonard R. Krilov ◽  
Evan J. Anderson
Keyword(s):  
Respiratory Syncytial Virus ◽  
American Academy ◽  
Preterm Infants ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus

scholarly journals 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

2018 ◽  
Vol 35 (14) ◽  
pp. 1433-1442 ◽  
Author(s):  
Mitchell Goldstein ◽  
Leonard Krilov ◽  
Jaime Fergie ◽  
Kimmie McLaurin ◽  
Sally Wade ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
American Academy ◽  
Preterm Infants ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Before And After ◽  
Syncytial Virus ◽  
Using Data ◽  
Rate Ratios ◽  
Calculated Difference

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.

scholarly journals Impact of the 2014 American Academy of Pediatrics Immunoprophylaxis Policy on the Rate, Severity, and Cost of Respiratory Syncytial Virus Hospitalizations among Preterm Infants

2019 ◽  
Vol 37 (02) ◽  
pp. 174-183 ◽  
Author(s):  
Leonard R. Krilov ◽  
Jaime Fergie ◽  
Mitchell Goldstein ◽  
Lance Brannman
Keyword(s):  
Respiratory Syncytial Virus ◽  
American Academy ◽  
Preterm Infants ◽  
Policy Change ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Administrative Claims ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus

Objective This study examined the rate, severity, and cost of respiratory syncytial virus (RSV) hospitalizations among preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after a 2014 change in the American Academy of Pediatrics policy for RSV immunoprophylaxis. Study Design Preterm (29–34 wGA) and term infants born from July 2011 to March 2017 and aged < 6 months were identified in a U.S. commercial administrative claims database. RSV hospitalization (RSVH) rate ratios, severity, and costs were evaluated for the 2011 to 2014 and 2014 to 2017 RSV seasons. Postpolicy changes in RSVH risks for preterm versus term infants were assessed with difference-in-difference (DID) modeling to control for patient characteristics and temporal trends. Results In the DID analysis, prematurity-associated RSVH risk was 55% greater in 2014 to 2017 versus 2011 to 2014 (relative risk = 1.55, 95% confidence interval: 1.10–2.17, p = 0.011). RSVH severity increased among preterm infants after 2014 and was highest among those aged < 3 months. Differences in mean RSVH costs for preterm infants in 2014 to 2017 versus 2011 to 2014 were not statistically significant. Conclusion RSVH risk for preterm versus term infants increased after the policy change, confirming previous national analyses. RSVHs after the policy change were more severe, particularly among younger preterm infants.

scholarly journals Impact of the 2014 American Academy of Pediatrics recommendation and of the resulting limited financial coverage by the Italian Medicines Agency for palivizumab prophylaxis on the RSV-associated hospitalizations in preterm infants during the 2016–2017 epidemic season: a systematic review of seven Italian reports

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Renato Cutrera ◽  
Andrea Wolfler ◽  
Simonetta Picone ◽  
Giovanni A. Rossi ◽  
Giuliana Gualberti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
American Academy ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Pediatric Intensive Care ◽  
Pediatric Intensive Care Units ◽  
Epidemic Season ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus

Abstract Background The only pharmacologic prophylaxis against respiratory syncytial virus (RSV) infection in preterm infants is the humanized monoclonal antibody palivizumab. After the 2014 modification of the American Academy of Pediatrics (AAP) recommendations, the Italian Medicines Agency (AIFA) limited the financial coverage for palivizumab prescriptions to otherwise healthy preterm infants with < 29 weeks of gestational age (wGA) aged < 12 months at the beginning of the 2016–2017 RSV season. However, due to the effect on disease severity and hospitalizations following this limitation, shown by several Italian clinical studies, in November 2017 AIFA reinstated the financial coverage for these infants. In this systematic review, we critically summarize the data that show the importance of palivizumab prophylaxis. Methods Data from six Italian pediatric institutes and the Italian Network of Pediatric Intensive Care Units (TIPNet) were retrieved from the literature and considered. The epidemiologic information for infants 29–36 wGA, aged < 12 months and admitted for viral-induced acute lower respiratory tract infection were retrospectively reviewed. RSV-associated hospitalizations were compared between the season with running limitation, i.e. 2016–2017, versus 2 seasons before (2014–2015 and 2015–2016) and one season after (2017–2018) the AIFA limitation. Results During the 2016–2017 RSV epidemic season, when the AIFA limited the financial coverage of palivizumab prophylaxis based on the 2014 AAP recommendation, the study reports on a higher incidences of RSV bronchiolitis and greater respiratory function impairment. During this season, we also found an increase in hospitalizations and admissions to the Pediatric Intensive Care Units and longer hospital stays, incurring higher healthcare costs. During the 2016–2017 epidemic season, an overall increase in the number of RSV bronchiolitis cases was also observed in infants born full term, suggesting that the decreased prophylaxis in preterm infants may have caused a wider infection diffusion in groups of infants not considered to be at risk. Conclusions The Italian results support the use of palivizumab prophylaxis for otherwise healthy preterm (29–36 wGA) infants aged < 6 months at the beginning of the RSV season.

scholarly journals 740. Impact of the 2014 American Academy of Pediatrics Guidance on Respiratory Syncytial Virus Hospitalization Rates for Preterm Infants <29 Weeks Gestational Age at Birth: 2012–2016

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S265-S266
Author(s):  
Mitchell Goldstein ◽  
Leonard R Krilov ◽  
Jaime Fergie ◽  
Lance Brannman ◽  
Christopher S Ambrose ◽  
...  
Keyword(s):  
American Academy ◽  
Preterm Infants ◽  
Gestational Age ◽  
Research Support ◽  
Term Infants ◽  
Medical Claims ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus ◽  
Rate Ratios ◽  
Research Grant

Abstract Background In 2014, the American Academy of Pediatrics stopped recommending RSV immunoprophylaxis (RSV IP) for otherwise healthy infants 29–34 weeks gestational age (wGA), while continuing to recommend RSV IP for infants born at &lt;29 wGA. The decline in RSV IP and associated increase in RSV hospitalizations (RSVH) among infants 29–34 wGA have been described previously, but potential effects of the 2014 guidance change on preterm infants &lt;29 wGA are unknown. This study compared 2012–2014 and 2014–2016 outpatient RSV IP use as well as RSVH rates relative to term infants among otherwise healthy &lt;29 wGA infants. Methods Infants born from July 1, 2011 to June 30, 2016 were followed from birth hospitalization discharge through their first year of life in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. DRG and ICD codes identified term and &lt;29 wGA infants at birth. RSV IP receipt was derived from pharmacy and outpatient medical claims (inpatient RSV IP data were unavailable). RSVH were derived from inpatient medical claims. RSVH IP use and RSVH were assessed across three chronologic age (CA) groups: &lt;3 months, 3–&lt;6 months, and 6–&lt;12 months. RSVH rate ratios for 2012–2014 and 2014–2016 were calculated for &lt;29 wGA infants using healthy term infants 0–&lt;12 months of age as a reference category. Results Outpatient RSV IP receipt fell after 2014 for &lt;29 wGA infants across all CA categories, with the greatest decline observed among infants &lt;3 months CA (Table 1). Greater RSVH rates for &lt;29 wGA infants relative to term infants were observed after 2014 (Figures 1 and 2), with infants &lt;3 months CA experiencing the greatest percentage increases in relative RSVH risks. Conclusion Outpatient RSV IP decreased and RSVH relative to term infants increased among otherwise healthy &lt;29 wGA infants following the 2014 policy change, even though RSV IP continued to be recommended. The effects were greatest for infants &lt;3 months CA and those insured by Medicaid. Funded by AstraZeneca Disclosures M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. L. Brannman, AstraZeneca: Employee, Salary and Stocks. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting contracted by Truven: Consultant, Consulting fee. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary.

Concerned About Ribavirin Recommendations

PEDIATRICS ◽  
1994 ◽  
Vol 94 (1) ◽  
pp. 132-133
Author(s):  
John F. Pope ◽  
James B. Besunder ◽  
Mary L. Kumar ◽  
Dennis M. Super
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Syncytial Virus ◽  
Infectious Diseases ◽  
American Academy ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus ◽  
New Guidelines ◽  
Ventilated Patients

The Committee on Infectious Diseases of the American Academy of Pediatrics recently published new guidelines for using ribavirin in treating respiratory syncytial virus (RSV).1 In updating previous guidelines, the Committee, based on the study by Smith et al,2 added the recommendation that all RSV-infected patients who require mechanical ventilation should receive ribavirin. We believe the Committee's broad recommendation for using this drug in mechanically ventilated patients is premature. We have concerns about the Smith study that call into question their conclusions regarding the efficacy of ribavirin in mechanically ventilated children.

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