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Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017

OBJECTIVE: To evaluate the effectiveness of two palivizumab programmes targeting high-risk infants, defined by prematurity, diagnosis of comorbidities and geography, and assess potential disparities by neighbourhood income. DESIGN: Controlled, interrupted time series. SETTING: Ontario, Canada. PATIE...

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Autores principales: Fitzpatrick, Tiffany, McNally, James Dayre, Stukel, Therese A, Kwong, Jeffrey C, Wilton, Andrew S, Fisman, David, Guttmann, Astrid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841493/
https://www.ncbi.nlm.nih.gov/pubmed/32859612
http://dx.doi.org/10.1136/archdischild-2020-319472
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author Fitzpatrick, Tiffany
McNally, James Dayre
Stukel, Therese A
Kwong, Jeffrey C
Wilton, Andrew S
Fisman, David
Guttmann, Astrid
author_facet Fitzpatrick, Tiffany
McNally, James Dayre
Stukel, Therese A
Kwong, Jeffrey C
Wilton, Andrew S
Fisman, David
Guttmann, Astrid
author_sort Fitzpatrick, Tiffany
collection PubMed
description OBJECTIVE: To evaluate the effectiveness of two palivizumab programmes targeting high-risk infants, defined by prematurity, diagnosis of comorbidities and geography, and assess potential disparities by neighbourhood income. DESIGN: Controlled, interrupted time series. SETTING: Ontario, Canada. PATIENTS: We used linked health and demographic administrative databases to identify all children born in hospitals 1 January 1993 through 31 December 2016. Follow-up ended at the earliest of second birthday or 30 June 2017. INTERVENTION: Palivizumab-eligibility: child was born very preterm and ≤6 months old during respiratory syncytial virus (RSV) season; <24 months old with significant chronic lung or congenital heart disease; or ≤6 months, born preterm or residents of remote regions. MAIN OUTCOME: Severe RSV-related illness, defined as hospitalisation or death with a diagnosis of bronchiolitis, RSV pneumonia or RSV. RESULTS: 3 million births and 87 000 RSV-related events were identified. Over the study period, rates of severe RSV-related illness declined 65.4% among the highest risk group, eligible infants <6 months (230.6 to 79.8 admissions per 1000 child-years). Relative to changes among ineligible infants <6 months, rates dropped 10.4% (95% CI −18.6% to 39.4%) among eligible infants immediately following introduction of a national palivizumab programme in 1998. Initially, rates were considerably higher among infants from low-income neighbourhoods, but income-specific rates converged over time among eligible infants <6 months; such convergence was not seen among other children. CONCLUSIONS: Incidence of severe RSV-related illness declined over the study period. While we cannot attribute causality, the timing and magnitude of these declines suggest impact of palivizumab in reducing RSV burden and diminishing social inequities among palivizumab-eligible infants.
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spelling pubmed-78414932021-02-04 Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017 Fitzpatrick, Tiffany McNally, James Dayre Stukel, Therese A Kwong, Jeffrey C Wilton, Andrew S Fisman, David Guttmann, Astrid Arch Dis Child Original Research OBJECTIVE: To evaluate the effectiveness of two palivizumab programmes targeting high-risk infants, defined by prematurity, diagnosis of comorbidities and geography, and assess potential disparities by neighbourhood income. DESIGN: Controlled, interrupted time series. SETTING: Ontario, Canada. PATIENTS: We used linked health and demographic administrative databases to identify all children born in hospitals 1 January 1993 through 31 December 2016. Follow-up ended at the earliest of second birthday or 30 June 2017. INTERVENTION: Palivizumab-eligibility: child was born very preterm and ≤6 months old during respiratory syncytial virus (RSV) season; <24 months old with significant chronic lung or congenital heart disease; or ≤6 months, born preterm or residents of remote regions. MAIN OUTCOME: Severe RSV-related illness, defined as hospitalisation or death with a diagnosis of bronchiolitis, RSV pneumonia or RSV. RESULTS: 3 million births and 87 000 RSV-related events were identified. Over the study period, rates of severe RSV-related illness declined 65.4% among the highest risk group, eligible infants <6 months (230.6 to 79.8 admissions per 1000 child-years). Relative to changes among ineligible infants <6 months, rates dropped 10.4% (95% CI −18.6% to 39.4%) among eligible infants immediately following introduction of a national palivizumab programme in 1998. Initially, rates were considerably higher among infants from low-income neighbourhoods, but income-specific rates converged over time among eligible infants <6 months; such convergence was not seen among other children. CONCLUSIONS: Incidence of severe RSV-related illness declined over the study period. While we cannot attribute causality, the timing and magnitude of these declines suggest impact of palivizumab in reducing RSV burden and diminishing social inequities among palivizumab-eligible infants. BMJ Publishing Group 2021-02 2020-08-28 /pmc/articles/PMC7841493/ /pubmed/32859612 http://dx.doi.org/10.1136/archdischild-2020-319472 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Fitzpatrick, Tiffany
McNally, James Dayre
Stukel, Therese A
Kwong, Jeffrey C
Wilton, Andrew S
Fisman, David
Guttmann, Astrid
Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017
title Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017
title_full Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017
title_fullStr Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017
title_full_unstemmed Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017
title_short Palivizumab’s real-world effectiveness: a population-based study in Ontario, Canada, 1993–2017
title_sort palivizumab’s real-world effectiveness: a population-based study in ontario, canada, 1993–2017
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841493/
https://www.ncbi.nlm.nih.gov/pubmed/32859612
http://dx.doi.org/10.1136/archdischild-2020-319472
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