Impact of Palivizumab Guideline Revision on the Incidence of RSV in Children residing in Pediatric Long-term Care Facilities. (4th October 2017)

• Record Type: Journal Article
• Authors: Murray, Meghan; Cohen, Bevin; Larson, Elaine; Saiman, Lisa; Neu, Natalie
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S517
• Page End: S517
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1344
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Respiratory syncytial virus (RSV) is a common infection causing pathogen in children less than 2 years. RSV is especially severe in children with chronic and complex medical conditions (CMC), e.g., chronic lung disease. In August 2014, the American Academy of Pediatrics (AAP) changed the guidelines for palivizumab for RSV prophylaxis, limiting the number of eligible children. Children with CMC who reside in long-term care facilities are at increased risk for infection but may no longer meet the criteria for receipt of palivizumab. We sought to determine the effect of the change in guidelines on the rate of RSV and palivizumab prophylaxis in this population. Methods: Retrospective cohort study of 3 pediatric long-term care facilities (pLTCF) in the New York metropolitan area, 9/2012–12/2015, was performed. Rates of RSV and receipt of palivizumab were determined prior to and after August 1, 2014. Medical records were reviewed for demographic and clinical information. Poisson regression with repeated subjects was used to compare the rates of RSV pre- and post recommendation changes, when adjusting for site and age. Changes in the proportion of residents who met the 2012 eligibility criteria for palivizumab pre- and post-recommendation change were assessed using Chi square. Results: There were 720 pLTCF residents during the study period. Average age was 5.35 years, of which 40% were under 2 years of age. From 9/2012–12/2015, there were a total of 74 RSV infections, of which 51 (69%) were in residents older than 2 years. The overall rate of RSV infection was 0.19 per 1, 000 resident-days. The rate of RSV post-guideline change was 3.65 times greater than the rate of RSV prior to the 2014 season, when adjusting for study site and age (95% CI 2.23, 5.97). Fewer residents received palivizumab after the change in guideline, 0.43 to 0.27 per 1, 000 resident-days, respectively. There were no statistically significant differences in residents meeting the 2012 palivizumab criteria pre- and post-guideline change. Conclusion: The change in AAP guidelines for palivizumab prophylaxis may have significant implications in children with CMC who live in pLTCF. Further research should be conducted to examine the long-term impact of these guidelines in this population. Disclosures: All authors: No reported disclosures.