Risk Analysis of Respiratory Syncytial Virus Among Infants in the United States by Birth Month

Author:

Gantenberg Jason R12ORCID,van Aalst Robertus134ORCID,Bhuma Monika Reddy1,Limone Brendan5,Diakun David5,Smith David M5,Nelson Christopher B6ORCID,Bengtson Angela M7ORCID,Chaves Sandra S3ORCID,La Via William V6ORCID,Rizzo Christopher6,Savitz David A2ORCID,Zullo Andrew R128ORCID

Affiliation:

1. Department of Health Services, Policy and Practice, Brown University School of Public Health , Providence, Rhode Island , USA

2. Department of Epidemiology, Brown University School of Public Health , Providence, Rhode Island , USA

3. Department of Modeling, Epidemiology, and Data Science, Vaccines Medical Affairs, Sanofi , Lyon , France

4. Department of Health Sciences, University Medical Center Groningen, University of Groningen , Groningen , the Netherlands

5. Merative , Cambridge, Massachusetts , USA

6. Vaccines Medical Affairs, Sanofi , Swiftwater, Pennsylvania , USA

7. Department of Epidemiology, Emory University , Atlanta, Georgia , USA

8. Providence VA Medical Center , Providence, Rhode Island , USA

Abstract

Abstract Background Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality among US infants. A child’s calendar birth month determines their age at first exposure(s) to RSV. We estimated birth month-specific risk of medically attended (MA) RSV lower respiratory tract infection (LRTI) among infants during their first RSV season and first year of life (FYOL). Methods We analyzed infants born in the USA between July 2016 and February 2020 using three insurance claims databases (two commercial, one Medicaid). We classified infants’ first MA RSV LRTI episode by the highest level of care incurred (outpatient, emergency department, or inpatient), employing specific and sensitive diagnostic coding algorithms to define index RSV diagnoses. In our main analysis, we focused on infants’ first RSV season. In our secondary analysis, we compared the risk of MA RSV LRTI during infants’ first RSV season to that of their FYOL. Results Infants born from May through September generally had the highest risk of first-season MA RSV LRTI—approximately 6–10% under the specific RSV index diagnosis definition and 16–26% under the sensitive. Infants born between October and December had the highest risk of RSV-related hospitalization during their first season. The proportion of MA RSV LRTI events classified as inpatient ranged from 9% to 54% (specific) and 5% to 33% (sensitive) across birth month and comorbidity group. Through the FYOL, the overall risk of MA RSV LRTI is comparable across birth months within each claims database (6–11% under the specific definition, 17–30% under the sensitive), with additional cases progressing to care at outpatient or ED settings. Conclusions Our data support recent national recommendations for the use of nirsevimab in the USA. For infants born at the tail end of an RSV season who do not receive nirsevimab, a dose administered prior to the onset of their second RSV season could reduce the incidence of outpatient- and ED-related events.

Publisher

Oxford University Press (OUP)

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