Impact of the Revised Guidelines for Respiratory Syncytial Virus (RSV) Prophylaxis: Morbidity Persists After Two Seasons!

Abstract

Background. Palivizumab is FDA-approved for prevention of serious RSV lower respiratory tract infection (LRTI) in children at high-risk of RSV disease. On July 2014, the American Academy of Pediatrics updated and restricted the use of palivizumab. We showed that the implementation of the revised guideline at Nationwide Children's Hospital (NCH) in the 2014-15 RSV season resulted in higher number of RSV hospi-talizations, increased morbidity and hospital charges among preterm (PT) infants of 29-34 weeks' gestation (wGA) who were no longer eligible for palivizumab prophylaxis. Our objective was to determine the impact of the revised guideline on RSV hospi-talization, outcomes, and hospital charges in 29-34 wGA infants in the 2nd RSV season after its implementation. Methods. Children <24 months (n = 617) hospitalized with RSV LRTI during the 2015-16 RSV season (S3) were identified by review of the virology laboratory reports of all +RSV tests at NCH and by discharge ICD-9 codes for bronchiolitis. Electronic health records were reviewed for demographic and clinical data, and RSV disease severity (duration of hospitalization, need for oxygen or mechanical ventilation, and PICU admission) was assessed for infants of 29-34 wGA, and compared with previously reported rates in the season before (S1, 2013-14) and the season after (S2, 2014-15) the implementation of the updated guideline. Results. During S3, 9% (58/617) of all RSV hospitalizations were in infants born at 29-34 wGA, compared with 8% (47/582) in S1 and 10% (72/700) in S2 (table). Outcomes did not differ between S2 and S3. Median charges increased significantly (S1: $19,686; S2: $31,247; S3: $35,411; p = 0.01). Conclusion. Two years after implementation of the revised guideline for palivizu-mab prophylaxis, the morbidity of RSV disease among 29-34 wGA infants remains substantial and increased significantly from the 2013-14 RSV season when its use was less restrictive. [Figure Presented] Disclosures. P. J. Sanchez, AbbVie, Inc: Scientific Advisor, Speaker honorarium; A. Mejias, Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Research grant. Alios: Consultant, Consulting fee. Abbvie: CME lecture, Speaker honorarium. Novartis: CME lecture, Speaker honorarium. Gilead: Grant Investigator, Grant recipient.