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Tina V Hartert - One of the best experts on this subject based on the ideXlab platform.
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Respiratory syncytial virus Immunoprophylaxis in high-risk infants and development of childhood asthma.
The Journal of allergy and clinical immunology, 2016Co-Authors: Kecia N. Carroll, Gabriel J. Escobar, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, William D. Dupont, Ed Mitchel, Tina V HartertAbstract:Background Respiratory syncytial virus (RSV) lower respiratory tract infection is implicated in asthma development. RSV Immunoprophylaxis during infancy is efficacious in preventing RSV-related hospitalizations and has been associated with decreased wheezing in the first years of life. Objective We investigated whether greater adherence to Immunoprophylaxis in infants at high risk for severe RSV would be associated with decreased childhood asthma. Methods We conducted a retrospective cohort investigation including children born from 1996-2003 who were enrolled in Kaiser Permanente Northern California or Tennessee Medicaid and eligible to receive RSV Immunoprophylaxis. Asthma was defined at 4.5 to 6 years of age by using asthma-specific health care visits and medication fills. We classified children into Immunoprophylaxis eligibility groups and calculated adherence (percentage receipt of recommended doses). We used a set of statistical strategies (multivariable logistic regression and propensity score [PS]–adjusted and PS-matched analyses) to overcome confounding by medical complexity because infants with higher adherence (≥70%) have higher prevalence of chronic lung disease, lower birth weight, and longer nursery stays. Results By using multivariable logistic regression and PS-adjusted models in the combined group, higher adherence to RSV Immunoprophylaxis was not associated with decreased asthma. However, in PS-matched analysis, treated children with 70% or greater adherence had decreased odds of asthma compared with those with 20% or less adherence (odds ratio, 0.62; 95% CI, 0.50-0.78). Conclusions This investigation of RSV Immunoprophylaxis in high-risk children primarily found nonsignificant associations on prevention of asthma in specific preterm groups. Our findings highlight the need for larger studies and prospective cohorts and provide estimates of potential preventive effect sizes in high-risk children.
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adherence to Immunoprophylaxis regimens for respiratory syncytial virus infection in insured and medicaid populations
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants <32 weeks gestation) [6]. These recommendations, based on contemporary data [7–13], were revised in 2003 [14] and 2009 [15]. A number of studies investigated the efficacy, effectiveness, and cost-effectiveness of RSV Immunoprophylaxis with respect to hospitalization for bronchiolitis [16–24]. Our study, Prevention of RSV: Impact on Morbidity and Asthma (PRIMA), has been funded by the Agency for Healthcare Research and Quality to conduct a comprehensive evaluation of the relationships between bronchiolitis, preventive strategies for bronchiolitis, and the development of asthma in childhood. As part of this effort, we quantified the real-world use of Immunoprophylaxis in eligible and ineligible infants, because the factors associated with its use (eg, extreme prematurity) are also factors that may predispose to development of asthma. The long-term benefits of Immunoprophylaxis may be open to question (a Cochrane review is ongoing [25]), thus, not receiving Immunoprophylaxis may be safe. However, individual level data on adherence to the AAP recommendations are not widely available, nor are data available on its real-world effectiveness in large populations. Our study includes children born between 1996 and 2008, a period spanning years preceding and after the introduction of the AAP recommendations for RSV Immunoprophylaxis. In this article, we report on adherence and predictors of adherence and nonadherence to those recommendations in 2 distinct infant populations: Kaiser Permanente Northern California (KPNC) and the Tennessee Medicaid (TennCare) program.
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Adherence to Immunoprophylaxis Regimens for Respiratory Syncytial Virus Infection in Insured and Medicaid Populations.
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants
H. Cody Meissner - One of the best experts on this subject based on the ideXlab platform.
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Annual variation in respiratory syncytial virus season and decisions regarding Immunoprophylaxis with palivizumab.
Pediatrics, 2004Co-Authors: H. Cody Meissner, Larry J. Anderson, Larry K. PickeringAbstract:Progress in the field of passive Immunoprophylaxis for protection of high-risk infants and children against respiratory syncytial virus (RSV) infection has achieved remarkable success. Palivizumab was licensed by the United States Food and Drug Administration (FDA) in 1998 for monthly intramuscular administration for prevention of RSV lower respiratory tract infections in high-risk infants and children. The annual rate of hospitalization due to RSV infection among infants in high-risk groups who do not receive Immunoprophylaxis varies between 10% and 20%, a figure that is ∼5 times higher than the hospitalization rate among non–high-risk infants. Results from 2 blinded, randomized, placebo-controlled trials involving 2789 infants and children with prematurity, chronic lung disease, or congenital heart disease demonstrated a reduction in RSV hospitalization rates of between 39% and 78% in different groups.1,2 Results from postlicensure, observational studies suggest that monthly Immunoprophylaxis with palivizumab may reduce rates of RSV-induced hospitalization to an even greater extent than rates reported in the well-conducted IMpact-RSV trial, which led to licensure by the FDA.3 Data confirming the safety of palivizumab have been published in a report from the FDA.4 In view of the welcome advancement in disease prevention offered by palivizumab Immunoprophylaxis against the most common cause of hospitalization in the first year of life, why does controversy surround the use of this intervention? Consideration of an intervention that has been proven effective needs to include its costs and benefits and recognize that dollars spent on this intervention may …
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Immunoprophylaxis with RespiGam.
PEDIATRICS, 2004Co-Authors: H. Cody Meissner, Margaret B. Rennels, Sarah S. Long, Larry K. PickeringAbstract:To the Editor. — Guidelines for Immunoprophylaxis with RespiGam and palivizumab for prevention of respiratory syncytial virus (RSV) infection in high-risk infants and children have been issued and updated by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases and Committee on Fetus and Newborn.1,2 Prais et al3 reported results of a survey conducted in 11 hospitals in Israel during one RSV season and noted that most of the infants admitted to the pediatric intensive care unit with a …
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Respiratory Syncytial Virus Immunoprophylaxis
Pediatric Drugs, 2000Co-Authors: Nancy N. Dougherty, H. Cody MeissnerAbstract:Objective: To better understand the spectrum of disease among hospitalised children infected with respiratory syncytial virus (RSV) and to assess the potential impact of passive Immunoprophylaxis on RSV hospitalisation rates, we analysed all patients infected with RSV who were admitted to a paediatric teaching hospital over a 3-year period. Design: We performed a retrospective chart review of all paediatric patients from whom RSV was isolated between October 1, 1994 and April 30, 1997. Results: A total of 255 children infected with RSV were hospitalised during this 3-year period. 246 (96%) patients had community acquired infections and 9 (4%) had nosocomial infections. Excluding patients with nosocomial infections, the mean length of hospital stay was 4.7 days. 70 (28%) children were admitted to the intensive care unit, 32 (13%) were intubated and there was a total of 4 deaths (1.6%). 48% of hospitalised patients were in 1 of 4 previously recognised high risk groups. Of the 52% of patients not in a defined high risk category, 42% were otherwise healthy infants (>6 weeks of age) and 10% had chronic underlying illnesses generally not associated with an increased risk of severe RSV disease. Patients not in a defined high risk category accounted for 46% of total hospital days. Conclusion: In order to reduce overall RSV hospitalisation rates and the economic burden to society, programmes for disease prevention must be directed at healthy infants as well as children in recognised high risk categories. Even if all currently eligible candidates were to have received passive Immunoprophylaxis, which yields about a 50% reduction in hospitalisation rates, the number of RSV hospitalisations in our 3-year study would have been reduced by no more than 9%. Without development and widespread use of an effective RSV vaccine, a major impact on RSV-induced hospitalisation is unlikely.
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Respiratory Syncytial Virus Immunoprophylaxis
Paediatric drugs, 2000Co-Authors: Nancy N. Dougherty, H. Cody MeissnerAbstract:Objective: To better understand the spectrum of disease among hospitalised children infected with respiratory syncytial virus (RSV) and to assess the potential impact of passive Immunoprophylaxis on RSV hospitalisation rates, we analysed all patients infected with RSV who were admitted to a paediatric teaching hospital over a 3-year period.
Kecia N. Carroll - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of Respiratory Syncytial Virus Immunoprophylaxis in Reducing Bronchiolitis Hospitalizations Among High-Risk Infants.
American journal of epidemiology, 2018Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Edward F. Mitchel, Chantel D. Sloan, William D. DupontAbstract:We sought to determine the real-world effectiveness of respiratory syncytial virus (RSV) Immunoprophylaxis in a population-based cohort to inform policy. The study population included infants born during 1996-2008 and enrolled in the Kaiser Permanente Northern California integrated health-care delivery system. During the RSV season (November-March), the date of RSV Immunoprophylaxis administration and the following 30 days were defined as RSV Immunoprophylaxis protected period(s), and all other days were defined as unprotected period(s). Numbers of bronchiolitis hospitalizations were determined using International Classification of Diseases, Ninth Revision, codes during RSV season. We used a proportional hazards model to estimate risk of bronchiolitis hospitalization when comparing infants' protected period(s) with unprotected period(s). Infants who had ever received RSV Immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.68, 95% confidence interval: 0.46, 1.00) when protected periods were compared with unprotected periods. Infants with chronic lung disease (CLD) had a 52% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.48, 95% confidence interval: 0.25, 0.94) when protected periods were compared with unprotected periods. Under the new 2014 American Academy of Pediatrics (AAP) guidelines, 48% of infants eligible for RSV Immunoprophylaxis on the basis of AAP guidelines in place at birth would no longer be eligible, but nearly all infants with CLD would remain eligible. RSV Immunoprophylaxis is effective in decreasing hospitalization. This association is greatest for infants with CLD, a group still recommended for receipt of RSV Immunoprophylaxis under the new AAP guidelines.
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Respiratory syncytial virus Immunoprophylaxis in high-risk infants and development of childhood asthma.
The Journal of allergy and clinical immunology, 2016Co-Authors: Kecia N. Carroll, Gabriel J. Escobar, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, William D. Dupont, Ed Mitchel, Tina V HartertAbstract:Background Respiratory syncytial virus (RSV) lower respiratory tract infection is implicated in asthma development. RSV Immunoprophylaxis during infancy is efficacious in preventing RSV-related hospitalizations and has been associated with decreased wheezing in the first years of life. Objective We investigated whether greater adherence to Immunoprophylaxis in infants at high risk for severe RSV would be associated with decreased childhood asthma. Methods We conducted a retrospective cohort investigation including children born from 1996-2003 who were enrolled in Kaiser Permanente Northern California or Tennessee Medicaid and eligible to receive RSV Immunoprophylaxis. Asthma was defined at 4.5 to 6 years of age by using asthma-specific health care visits and medication fills. We classified children into Immunoprophylaxis eligibility groups and calculated adherence (percentage receipt of recommended doses). We used a set of statistical strategies (multivariable logistic regression and propensity score [PS]–adjusted and PS-matched analyses) to overcome confounding by medical complexity because infants with higher adherence (≥70%) have higher prevalence of chronic lung disease, lower birth weight, and longer nursery stays. Results By using multivariable logistic regression and PS-adjusted models in the combined group, higher adherence to RSV Immunoprophylaxis was not associated with decreased asthma. However, in PS-matched analysis, treated children with 70% or greater adherence had decreased odds of asthma compared with those with 20% or less adherence (odds ratio, 0.62; 95% CI, 0.50-0.78). Conclusions This investigation of RSV Immunoprophylaxis in high-risk children primarily found nonsignificant associations on prevention of asthma in specific preterm groups. Our findings highlight the need for larger studies and prospective cohorts and provide estimates of potential preventive effect sizes in high-risk children.
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adherence to Immunoprophylaxis regimens for respiratory syncytial virus infection in insured and medicaid populations
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants <32 weeks gestation) [6]. These recommendations, based on contemporary data [7–13], were revised in 2003 [14] and 2009 [15]. A number of studies investigated the efficacy, effectiveness, and cost-effectiveness of RSV Immunoprophylaxis with respect to hospitalization for bronchiolitis [16–24]. Our study, Prevention of RSV: Impact on Morbidity and Asthma (PRIMA), has been funded by the Agency for Healthcare Research and Quality to conduct a comprehensive evaluation of the relationships between bronchiolitis, preventive strategies for bronchiolitis, and the development of asthma in childhood. As part of this effort, we quantified the real-world use of Immunoprophylaxis in eligible and ineligible infants, because the factors associated with its use (eg, extreme prematurity) are also factors that may predispose to development of asthma. The long-term benefits of Immunoprophylaxis may be open to question (a Cochrane review is ongoing [25]), thus, not receiving Immunoprophylaxis may be safe. However, individual level data on adherence to the AAP recommendations are not widely available, nor are data available on its real-world effectiveness in large populations. Our study includes children born between 1996 and 2008, a period spanning years preceding and after the introduction of the AAP recommendations for RSV Immunoprophylaxis. In this article, we report on adherence and predictors of adherence and nonadherence to those recommendations in 2 distinct infant populations: Kaiser Permanente Northern California (KPNC) and the Tennessee Medicaid (TennCare) program.
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Adherence to Immunoprophylaxis Regimens for Respiratory Syncytial Virus Infection in Insured and Medicaid Populations.
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants
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Adherence to guidelines for respiratory syncytial virus Immunoprophylaxis among infants with prematurity or chronic lung disease in three United States counties.
The Pediatric infectious disease journal, 2012Co-Authors: Kecia N. Carroll, Marie R. Griffin, Kathryn M. Edwards, Asad Ali, Yuwei Zhu, Marika K. Iwane, Peter G. Szilagyi, Mary Allen Staat, Timothy P. Stevens, Caroline B. HallAbstract:Among infants with prematurity and/or chronic lung disease for whom respiratory syncytial virus Immunoprophylaxis is recommended, we examined adherence in infants enrolled during healthcare visits for acute respiratory illness in 3 US counties from 2001 to 2007. Immunoprophylaxis among infants who met national criteria for prophylaxis increased from 33% to 83% over the 6-year period; 17% (11/65) of infants who received Immunoprophylaxis did not meet eligibility criteria.
Gabriel J. Escobar - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of Respiratory Syncytial Virus Immunoprophylaxis in Reducing Bronchiolitis Hospitalizations Among High-Risk Infants.
American journal of epidemiology, 2018Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Edward F. Mitchel, Chantel D. Sloan, William D. DupontAbstract:We sought to determine the real-world effectiveness of respiratory syncytial virus (RSV) Immunoprophylaxis in a population-based cohort to inform policy. The study population included infants born during 1996-2008 and enrolled in the Kaiser Permanente Northern California integrated health-care delivery system. During the RSV season (November-March), the date of RSV Immunoprophylaxis administration and the following 30 days were defined as RSV Immunoprophylaxis protected period(s), and all other days were defined as unprotected period(s). Numbers of bronchiolitis hospitalizations were determined using International Classification of Diseases, Ninth Revision, codes during RSV season. We used a proportional hazards model to estimate risk of bronchiolitis hospitalization when comparing infants' protected period(s) with unprotected period(s). Infants who had ever received RSV Immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.68, 95% confidence interval: 0.46, 1.00) when protected periods were compared with unprotected periods. Infants with chronic lung disease (CLD) had a 52% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.48, 95% confidence interval: 0.25, 0.94) when protected periods were compared with unprotected periods. Under the new 2014 American Academy of Pediatrics (AAP) guidelines, 48% of infants eligible for RSV Immunoprophylaxis on the basis of AAP guidelines in place at birth would no longer be eligible, but nearly all infants with CLD would remain eligible. RSV Immunoprophylaxis is effective in decreasing hospitalization. This association is greatest for infants with CLD, a group still recommended for receipt of RSV Immunoprophylaxis under the new AAP guidelines.
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Respiratory syncytial virus Immunoprophylaxis in high-risk infants and development of childhood asthma.
The Journal of allergy and clinical immunology, 2016Co-Authors: Kecia N. Carroll, Gabriel J. Escobar, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, William D. Dupont, Ed Mitchel, Tina V HartertAbstract:Background Respiratory syncytial virus (RSV) lower respiratory tract infection is implicated in asthma development. RSV Immunoprophylaxis during infancy is efficacious in preventing RSV-related hospitalizations and has been associated with decreased wheezing in the first years of life. Objective We investigated whether greater adherence to Immunoprophylaxis in infants at high risk for severe RSV would be associated with decreased childhood asthma. Methods We conducted a retrospective cohort investigation including children born from 1996-2003 who were enrolled in Kaiser Permanente Northern California or Tennessee Medicaid and eligible to receive RSV Immunoprophylaxis. Asthma was defined at 4.5 to 6 years of age by using asthma-specific health care visits and medication fills. We classified children into Immunoprophylaxis eligibility groups and calculated adherence (percentage receipt of recommended doses). We used a set of statistical strategies (multivariable logistic regression and propensity score [PS]–adjusted and PS-matched analyses) to overcome confounding by medical complexity because infants with higher adherence (≥70%) have higher prevalence of chronic lung disease, lower birth weight, and longer nursery stays. Results By using multivariable logistic regression and PS-adjusted models in the combined group, higher adherence to RSV Immunoprophylaxis was not associated with decreased asthma. However, in PS-matched analysis, treated children with 70% or greater adherence had decreased odds of asthma compared with those with 20% or less adherence (odds ratio, 0.62; 95% CI, 0.50-0.78). Conclusions This investigation of RSV Immunoprophylaxis in high-risk children primarily found nonsignificant associations on prevention of asthma in specific preterm groups. Our findings highlight the need for larger studies and prospective cohorts and provide estimates of potential preventive effect sizes in high-risk children.
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adherence to Immunoprophylaxis regimens for respiratory syncytial virus infection in insured and medicaid populations
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants <32 weeks gestation) [6]. These recommendations, based on contemporary data [7–13], were revised in 2003 [14] and 2009 [15]. A number of studies investigated the efficacy, effectiveness, and cost-effectiveness of RSV Immunoprophylaxis with respect to hospitalization for bronchiolitis [16–24]. Our study, Prevention of RSV: Impact on Morbidity and Asthma (PRIMA), has been funded by the Agency for Healthcare Research and Quality to conduct a comprehensive evaluation of the relationships between bronchiolitis, preventive strategies for bronchiolitis, and the development of asthma in childhood. As part of this effort, we quantified the real-world use of Immunoprophylaxis in eligible and ineligible infants, because the factors associated with its use (eg, extreme prematurity) are also factors that may predispose to development of asthma. The long-term benefits of Immunoprophylaxis may be open to question (a Cochrane review is ongoing [25]), thus, not receiving Immunoprophylaxis may be safe. However, individual level data on adherence to the AAP recommendations are not widely available, nor are data available on its real-world effectiveness in large populations. Our study includes children born between 1996 and 2008, a period spanning years preceding and after the introduction of the AAP recommendations for RSV Immunoprophylaxis. In this article, we report on adherence and predictors of adherence and nonadherence to those recommendations in 2 distinct infant populations: Kaiser Permanente Northern California (KPNC) and the Tennessee Medicaid (TennCare) program.
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Adherence to Immunoprophylaxis Regimens for Respiratory Syncytial Virus Infection in Insured and Medicaid Populations.
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants
Chantel D. Sloan - One of the best experts on this subject based on the ideXlab platform.
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Effectiveness of Respiratory Syncytial Virus Immunoprophylaxis in Reducing Bronchiolitis Hospitalizations Among High-Risk Infants.
American journal of epidemiology, 2018Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Edward F. Mitchel, Chantel D. Sloan, William D. DupontAbstract:We sought to determine the real-world effectiveness of respiratory syncytial virus (RSV) Immunoprophylaxis in a population-based cohort to inform policy. The study population included infants born during 1996-2008 and enrolled in the Kaiser Permanente Northern California integrated health-care delivery system. During the RSV season (November-March), the date of RSV Immunoprophylaxis administration and the following 30 days were defined as RSV Immunoprophylaxis protected period(s), and all other days were defined as unprotected period(s). Numbers of bronchiolitis hospitalizations were determined using International Classification of Diseases, Ninth Revision, codes during RSV season. We used a proportional hazards model to estimate risk of bronchiolitis hospitalization when comparing infants' protected period(s) with unprotected period(s). Infants who had ever received RSV Immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.68, 95% confidence interval: 0.46, 1.00) when protected periods were compared with unprotected periods. Infants with chronic lung disease (CLD) had a 52% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.48, 95% confidence interval: 0.25, 0.94) when protected periods were compared with unprotected periods. Under the new 2014 American Academy of Pediatrics (AAP) guidelines, 48% of infants eligible for RSV Immunoprophylaxis on the basis of AAP guidelines in place at birth would no longer be eligible, but nearly all infants with CLD would remain eligible. RSV Immunoprophylaxis is effective in decreasing hospitalization. This association is greatest for infants with CLD, a group still recommended for receipt of RSV Immunoprophylaxis under the new AAP guidelines.
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Respiratory syncytial virus Immunoprophylaxis in high-risk infants and development of childhood asthma.
The Journal of allergy and clinical immunology, 2016Co-Authors: Kecia N. Carroll, Gabriel J. Escobar, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, William D. Dupont, Ed Mitchel, Tina V HartertAbstract:Background Respiratory syncytial virus (RSV) lower respiratory tract infection is implicated in asthma development. RSV Immunoprophylaxis during infancy is efficacious in preventing RSV-related hospitalizations and has been associated with decreased wheezing in the first years of life. Objective We investigated whether greater adherence to Immunoprophylaxis in infants at high risk for severe RSV would be associated with decreased childhood asthma. Methods We conducted a retrospective cohort investigation including children born from 1996-2003 who were enrolled in Kaiser Permanente Northern California or Tennessee Medicaid and eligible to receive RSV Immunoprophylaxis. Asthma was defined at 4.5 to 6 years of age by using asthma-specific health care visits and medication fills. We classified children into Immunoprophylaxis eligibility groups and calculated adherence (percentage receipt of recommended doses). We used a set of statistical strategies (multivariable logistic regression and propensity score [PS]–adjusted and PS-matched analyses) to overcome confounding by medical complexity because infants with higher adherence (≥70%) have higher prevalence of chronic lung disease, lower birth weight, and longer nursery stays. Results By using multivariable logistic regression and PS-adjusted models in the combined group, higher adherence to RSV Immunoprophylaxis was not associated with decreased asthma. However, in PS-matched analysis, treated children with 70% or greater adherence had decreased odds of asthma compared with those with 20% or less adherence (odds ratio, 0.62; 95% CI, 0.50-0.78). Conclusions This investigation of RSV Immunoprophylaxis in high-risk children primarily found nonsignificant associations on prevention of asthma in specific preterm groups. Our findings highlight the need for larger studies and prospective cohorts and provide estimates of potential preventive effect sizes in high-risk children.
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adherence to Immunoprophylaxis regimens for respiratory syncytial virus infection in insured and medicaid populations
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants <32 weeks gestation) [6]. These recommendations, based on contemporary data [7–13], were revised in 2003 [14] and 2009 [15]. A number of studies investigated the efficacy, effectiveness, and cost-effectiveness of RSV Immunoprophylaxis with respect to hospitalization for bronchiolitis [16–24]. Our study, Prevention of RSV: Impact on Morbidity and Asthma (PRIMA), has been funded by the Agency for Healthcare Research and Quality to conduct a comprehensive evaluation of the relationships between bronchiolitis, preventive strategies for bronchiolitis, and the development of asthma in childhood. As part of this effort, we quantified the real-world use of Immunoprophylaxis in eligible and ineligible infants, because the factors associated with its use (eg, extreme prematurity) are also factors that may predispose to development of asthma. The long-term benefits of Immunoprophylaxis may be open to question (a Cochrane review is ongoing [25]), thus, not receiving Immunoprophylaxis may be safe. However, individual level data on adherence to the AAP recommendations are not widely available, nor are data available on its real-world effectiveness in large populations. Our study includes children born between 1996 and 2008, a period spanning years preceding and after the introduction of the AAP recommendations for RSV Immunoprophylaxis. In this article, we report on adherence and predictors of adherence and nonadherence to those recommendations in 2 distinct infant populations: Kaiser Permanente Northern California (KPNC) and the Tennessee Medicaid (TennCare) program.
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Adherence to Immunoprophylaxis Regimens for Respiratory Syncytial Virus Infection in Insured and Medicaid Populations.
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Gabriel J. Escobar, Kecia N. Carroll, Tebeb Gebretsadik, Eileen M. Walsh, Chantel D. Sloan, Ed Mitchel, Tina V HartertAbstract:Infection with respiratory syncytial virus (RSV) is common, with infection rates approaching 100% by age 3 years [1]. Attempts at developing an RSV vaccine have been unsuccessful [2–5]. Given the absence of viable treatment options, the only currently available option for decreasing morbidity among high risk infants is Immunoprophylaxis. In 1997, the American Academy of Pediatrics (AAP) first issued recommendations for RSV Immunoprophylaxis, recommending RSV immunoglobulin, and in 1998 recommending palivizumab administration, to selected infants at high risk (eg, premature infants
