Impact of nirsevimab immunization on pediatric RSV-related hospitalizations in Luxembourg

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Respiratory syncytial virus (RSV) is one of the leading causes of hospitalization in young children worldwide, and each year, RSV infection kills an estimated 101,000 children under 5 years of age. From the end of 2022, the use of a long-acting monoclonal antibody (nirsevimab) in children as a means of passive immunization against RSV is permitted in the European Union and the European Economic Area (EU/EEA). However, only a few countries in the EU/EEA have started using nirsevimab before the RSV season 2023/24.

They are published in quick communication Euro surveillance, Ernst et al. describe the first experience in Luxembourg recommending one-dose nirsevimab prophylaxis for all infants born in 2023 and a recommended catch-up vaccination for infants younger than two years of age at high risk of severe illness. A national immunization campaign began in fall 2023 that reached an estimated 84% of newborns in 2023 (1,277 doses/1,524 births).

In addition to the estimated coverage of nisvemib vaccination among newborns in Luxembourg until mid-December 2023, Ernst et al. The possible effects of this vaccination in children under 5 years of age have been looked at. To do this, they compared data on RSV-related pediatric hospitalizations at the National Pediatric Hospital of Luxembourg in 2022 and 2023, i.e. before and after the national nirsevimab vaccination recommendation.

Promising first signs: fewer hospitalizations, changes in age structure and less severe morbidity

The authors could show a decrease in hospitalizations related to RSV infection, including a distinct decrease (69%) in children under six months of age (232 confirmed cases in 2022 and 72 cases in 2023). Among the broad age group of children younger than 5 years, a total of 241 children were hospitalized with a laboratory-confirmed RSV infection in 2023, compared with 389 cases in 2022 (a 38% decrease).

According to data available in Luxembourg, the authors also noted a change in the age structure of children hospitalized due to RSV infection: the average age of hospitalized children went from slightly less than 8 months in 2022 to more than 14 months in 2023, meaning that children were generally older when they were hospitalized. Ernst et al. This has been attributed to “an effect of the administration strategy shortly after birth. Most hospitalized infants have not yet received a nisvemumab vaccine.” […]”

Also, the data shows a decreasing severity in children hospitalized in 2023 Children were hospitalized for about 3 days in 2023, up from about 5 days in 2022, and the number of children admitted to intensive care units dropped from 28. 2022 to 9 most vulnerable (under six months) ages in 2023.

The authors concluded that this “suggests that niracevimab prophylaxis reduced severe RSV infections, particularly in infants <6 months of age, resulting in reduced health care strain" - while acknowledging that their comparisons at this time only looked at two consecutive seasons and covered did not Full 2023/24 RSV season yet.


Journal Reference:

Ernst, C., etc. (2024). Impact of niracevimab prophylaxis on pediatric respiratory syncytial virus (RSV)-related hospitalizations during the initial 2023/24 season in Luxembourg. Euro surveillance.

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