1
|
Claydon J, Popescu CR, Shaiba L, Christopherson C, Human D, Taylor R, Solimano A, Lavoie PM. Outcomes related to respiratory syncytial virus with an abbreviated palivizumab regimen in children with congenital heart disease: a descriptive analysis. CMAJ Open 2019; 7:E88-E93. [PMID: 30782771 PMCID: PMC6380901 DOI: 10.9778/cmajo.20180167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It has been hypothesized that 4 doses of palivizumab, a neutralizing monoclonal antibody against respiratory syncytial virus (RSV), administered during a fixed-date RSV season may reduce hospital admissions comparably to the standard 5-dose schedule. We report outcomes in children with congenital heart disease approved to receive this 4-dose palivizumab schedule in British Columbia. METHODS We performed a population-based descriptive cohort analysis of all 406 approved palivizumab courses over 4 seasons (2012/13 to 2015/16) in 325 children with hemodynamically significant congenital heart disease enrolled in the British Columbia RSV Immunoprophylaxis Program. The primary outcome was in-season hospital admission for potential RSV-related lower respiratory tract infection (LRTI). Secondary outcomes include timing of admission in relation to dosing. Analysis was by intention-to-treat. RESULTS Of the 406 approved palivizumab courses, 391 were administered. In 33 cases (8.4%), an additional dose was given immediately after cardiac bypass surgery. There were 17 RSV-confirmed hospital admissions (median age of children 5.9 mo [interquartile range 4-10 mo]) and 8 admissions in which the child was not tested for RSV, for a maximum of 25 potential RSV-related admissions (6.2 per 100 approvals [95% confidence interval 4.0-9.0]). Twenty-four (96%) of the 25 admissions occurred within the 4-dose palivizumab dosing period, and the remaining admission occurred 52 days after the fourth dose. Sixty-four (72%) of 89 admissions were RSV-negative; the baseline clinical characteristics of these children were not different from those of children with RSV-confirmed admissions. INTERPRETATION In infants with hemodynamically significant congenital heart disease, a 4-dose fixed-date palivizumab schedule over a 6-month season provided seasonal protection comparable to that in a clinical trial involving a standard 5-dose schedule. Because RSV was responsible for only 19% of admissions for LRTI in our cohort, it is critical to continue to emphasize other preventive measures, including family education toward proper hand hygiene, breast-feeding and limiting infectious exposures in children at high risk.
Collapse
Affiliation(s)
- Jennifer Claydon
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont
| | - Constantin R Popescu
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont
| | - Lana Shaiba
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont
| | - Cheryl Christopherson
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont
| | - Derek Human
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont
| | - Richard Taylor
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont
| | - Alfonso Solimano
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont
| | - Pascal M Lavoie
- Children's & Women's Health Centre of British Columbia (Claydon, Popescu, Christopherson, Human, Solimano, Lavoie); Divisions of Neonatology (Popescu, Shaiba, Solimano, Lavoie) and Cardiology (Human), Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute (Popescu, Human, Lavoie), Vancouver, BC; Victoria General Hospital (Taylor), Victoria, BC; University of Toronto (Shaiba), Toronto, Ont.
| |
Collapse
|
2
|
Reis J, Yamana T, Kandula S, Shaman J. Superensemble forecast of respiratory syncytial virus outbreaks at national, regional, and state levels in the United States. Epidemics 2018; 26:1-8. [PMID: 30025885 PMCID: PMC7643169 DOI: 10.1016/j.epidem.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 12/21/2022] Open
Abstract
Respiratory syncytial virus (RSV) infections peak during the winter months in the United States, yet the timing, intensity, and onset of these outbreaks vary each year. An RSV vaccine is on the cusp of being released; precise models and accurate forecasts of RSV epidemics may prove vital for planning where and when the vaccine should be deployed. Accurate forecasts with sufficient spatial and temporal resolution could also be used to support the prevention or treatment of RSV infections. Previously, we developed and validated an RSV forecast system at the regional scale in the United States. This model-inference system had considerable forecast skill, relative to the historical expectance, for outbreak peak intensity, total outbreak size, and onset, but only marginal skill for predicting the timing of the outbreak peak. Here, we use a superensemble approach to combine three forecasting methods for RSV prediction in the US at three different spatial resolutions: national, regional, and state. At the regional and state levels, we find a substantial improvement of forecast skill, relative to historical expectance, for peak intensity, timing, and onset outbreak up to two months in advance of the predicted outbreak peak. Moreover, due to the greater variability of RSV outbreaks at finer spatial scales, we find that improvement of forecast skill at the state level exceeds that at the regional and national levels. Such finer scale superensemble forecasts may be more relevant for effecting local-scale interventions, particularly in communities with a high burden of RSV infection.
Collapse
Affiliation(s)
- Julia Reis
- Biological Systems Engineering, Virginia Tech, Blacksburg, VA, United States.
| | - Teresa Yamana
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Sasikiran Kandula
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| |
Collapse
|