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CC BY-NC-ND 4.0 · Am J Perinatol 2022; 39(15): 1668-1677
DOI: 10.1055/s-0041-1725146
Original Article

Respiratory Syncytial Virus Immunoprophylaxis with Palivizumab: 12-Year Observational Study of Usage and Outcomes in Canada

Ian Mitchell 
1   Department of Paediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
,
Abby Li
2   Medical Outcomes and Research in Economics, Sunnybrook Health Sciences, Centre, Toronto, Ontario, Canada
,
Candice L. Bjornson
1   Department of Paediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
,
Krista L. Lanctot
2   Medical Outcomes and Research in Economics, Sunnybrook Health Sciences, Centre, Toronto, Ontario, Canada
,
Bosco A. Paes 
3   Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
,
the CARESS investigators › Author Affiliations Funding The Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab (CARESS) is funded by an investigator-initiated grant from AbbVie Corporation (A05-130).
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Abstract

Objective This study aimed to evaluate palivizumab (PVZ) use, trends in indications, and outcomes of respiratory illness hospitalizations (RIH) and respiratory syncytial virus hospitalizations (RSVH).

Study Design It involves a large, Canadian prospective (2005–2017) observational multicenter study of children at high risk for RSV infection.

Results A total of 25,003 infants (56.3% male) were enrolled at 32 sites; 109,579 PVZ injections were administered. Indications included: prematurity (63.3%); “miscellaneous” (17.8%); hemodynamically significant congenital heart disease (10.5%); bronchopulmonary dysplasia/chronic lung disease (8.4%). The “miscellaneous” group increased over time (4.4% in 2005–2006 to 22.5% in 2016–2017) and included: trisomy 21, airway anomalies, pulmonary disorders, cystic fibrosis, neurological impairments, immunocompromised, cardiac aged >2 years, multiple conditions, and a residual “unclassified” group. Adherence measured by expected versus actual doses plus correct interdose interval was 64.7%. A total of 2,054 RIH occurred (6.9%); 198 (9.6%) required intubation. Three hundred thirty-seven hospitalized children were RSV-positive (overall RSVH 1.6%). Risk factors for RSVH included having siblings, attending daycare, family history of atopy, smoking exposure, and crowded household. Infants with 5 risk factors were 9.0 times (95% CI or confidence interval 4.4–18.2; p < 0.0005) more likely to have RSVH than infants without risk factors. Three adverse events occurred; none were fatal.

Conclusion Results are relevant to both clinicians and decision-makers. We confirmed the safety of PVZ. Use of PVZ increased steadily for children with miscellaneous conditions and medical complexity. Medical and social factors pose a risk for severe RIH and RSVH with accompanying burden of illness. A vaccine that protects against RSV is urgently required.

Key Points

  • Main indications were prematurity (63.3%); “miscellaneous” (17.8%); hemodynamically significant congenital heart disease (10.5%); bronchopulmonary dysplasia/chronic lung disease (8.4%).

  • The proportion of children in the “miscellaneous” group, comprised of those with trisomy 21, airway anomalies, pulmonary disorders, cystic fibrosis, neurological impairments, immunocompromised, cardiac aged >2 years, multiple conditions, and a residual “unclassified” group, increased over time (4.4% in 2005–2006 to 22.5% in 2016–2017).

  • Respiratory illness-related hospitalization occurred in 2,054 children (6.9%); 198 (9.6%) required intubation. Three hundred thirty-seven hospitalized children were RSV-positive (overall RSVH: 1.6%).

Keywords

RSV infection - palivizumab - prematurity - bronchopulmonary dysplasia - chronic lung disease - hemodynamically significant congenital heart disease - children with medical complexity

Registration

ClinicalTrials.gov Identifier: NCT00420966.




Publication History

Received: 10 July 2020

Accepted: 19 January 2021

Article published online:
03 March 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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