Reduced-Dose Schedule of Prophylaxis Based on Local Data Provides Near-Optimal Protection Against Respiratory Syncytial Virus. - PubMed - NCBI

Reduced-Dose Schedule of Prophylaxis Based on Local Data Provides Near-Optimal Protection Against Respiratory Syncytial Virus. - PubMed - NCBI

Clin Infect Dis. 2015 Aug 15;61(4):506-14. doi: 10.1093/cid/civ331. Epub 2015 Apr 22.

Reduced-Dose Schedule of Prophylaxis Based on Local Data Provides Near-Optimal Protection Against Respiratory Syncytial Virus.

Weinberger DM1, Warren JL2, Steiner CA3, Charu V4, Viboud C4, Pitzer VE1.

Author information

Abstract

BACKGROUND:

Respiratory syncytial virus (RSV) is a major cause of respiratory infections among young children and can lead to severe disease among some infants. Infants at high risk for severe RSV infection receive monthly injections of a prophylactic monoclonal antibody during the RSV season based on national guidelines. We considered whether a reduced-dose schedule tailored to the local RSV season in the continental United States would provide adequate protection.

METHODS:

Hospitalization data for 1942 counties across 38 states from 1997 to 2009 were obtained from the State Inpatient Databases (Agency for Healthcare Research and Quality). We assessed the timing of RSV epidemics at the county and state levels using a 2-stage hierarchical Bayesian change point model. We used a simple summation approach to estimate the fraction of RSV cases that occur during the window of protection provided by initiating RSV prophylaxis during different weeks of the year.

RESULTS:

The timing of RSV epidemic onset varied significantly at the local level. Nevertheless, the national recommendations for initiation of prophylaxis provided near-optimal coverage of the RSV season in most of the continental United States. Reducing from 5 to 4 monthly doses (with a later initiation) provides near-optimal coverage (<5% decrease in coverage) in most settings. Earlier optimal dates for initiating 4 doses of prophylaxis were associated with being farther south and east, higher population density, and having a higher percentage of the population that was black or Hispanic.

CONCLUSIONS:

A 4-dose schedule of prophylactic injections timed with local RSV epidemics could provide protection comparable to 5 doses and could be considered as a way to improve the cost-effectiveness of prophylaxis.

© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS:

RSV; palivizumab; prophylaxis; respiratory syncytial virus; spatial variation

Comment in

• Editorial Commentary: Can a Reduced-Dose Prophylaxis Schedule Provide Adequate Coverage Against Respiratory Syncytial Virus Infection? [Clin Infect Dis. 2015]

PMID:

 

25904370

 

[PubMed - in process] 

PMCID:

 

PMC4542596

 [Available on 2016-08-15]