Effectiveness of Palivizumab against Respiratory Syncytial Virus: Cohort and Case Series Analysis

Hannah C. Moore, Nicholas de Klerk, Peter C. Richmond, Parveen Fathima, Ruomei Xu, Anthony D. Keil, Thomas L. Snelling, Tobias Strunk

    Research output: Contribution to journalArticle

    Abstract

    Objective: To measure the real-world effectiveness of palivizumab immunoprophylaxis against respiratory syncytial virus (RSV)-confirmed infection before age 2 years in a population-cohort of high-risk infants.

    Study design: Palivizumab is funded for high-risk infants in Western Australia. We used probabilistically linked administrative data encompassing RSV laboratory-confirmed infections, hospital admissions, and palivizumab dispensing records for a cohort of 24 329 high-risk infants admitted to neonatal intensive care units, born 2002-2013 with follow-up to 2015. We used a traditional cohort method with Cox proportional hazards regression and a self-controlled case series analysis to assess effectiveness of palivizumab in reducing RSV-confirmed infection by number of doses.

    Results: From the cohort of 24 329 infants, 271 (1.1%) received at least 1 dose of palivizumab and 1506 (6.2%) had at least 1 RSV-confirmed infection before age 2 years. Using the traditional cohort approach, we found no protective association of palivizumab receipt with RSV detection (adjusted hazard ratio = 0.99 [95% CI 0.5, 1.9] for 1 dose). However, using a self-controlled case series to eliminate confounding by indication, a protective association was seen with a 74% lower RSV incidence (relative incidence = 0.26; 95% CI 0.11, 0.67) following any dose of palivizumab compared with control (nonexposed) periods.

    Conclusions: After accounting for confounding by indication through a self-controlled analysis, palivizumab appeared effective for reducing virologically confirmed RSV in this high-risk cohort.

    Original languageEnglish
    Pages (from-to)1-8
    Number of pages8
    JournalJournal of Pediatrics
    Volume214
    Issue numberNovember
    Early online date1 Aug 2019
    DOIs
    Publication statusPublished - Nov 2019

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  • Cite this

    Moore, H. C., de Klerk, N., Richmond, P. C., Fathima, P., Xu, R., Keil, A. D., Snelling, T. L., & Strunk, T. (2019). Effectiveness of Palivizumab against Respiratory Syncytial Virus: Cohort and Case Series Analysis. Journal of Pediatrics, 214(November), 1-8. https://doi.org/10.1016/j.jpeds.2019.06.058