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Original Investigation |

Appropriateness of Age Thresholds for Respiratory Syncytial Virus Immunoprophylaxis in Moderate-Preterm Infants:  A Cohort Study

Almut G. Winterstein, RPh, PhD1,2; Caitlin A. Knox, MPH2; Paul Kubilis, MS2; Christian Hampp, PhD3
[+] Author Affiliations
1Department of Epidemiology, University of Florida, Gainesville
2Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
3Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
JAMA Pediatr. 2013;167(12):1118-1124. doi:10.1001/jamapediatrics.2013.2636.
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Importance  Recommendations concerning the appropriate age threshold for respiratory syncytial virus (RSV) prophylaxis in moderate-preterm infants are highly debated.

Objective  To determine the age at which moderate-preterm infants’ risk of RSV hospitalization has decreased to the risk observed in low-risk term infants.

Design, Setting, and Participants  Retrospective cohort study of Florida and Texas Medicaid fee-for-service billing records matched to birth certificates from Medicaid beneficiaries aged 0 to 12 months with a sibling younger than 5 years and without other indications for RSV prophylaxis between January 1, 1999, and December 31, 2004.

Exposures  For each state, we used discrete time survival analysis to develop age trend models for RSV hospitalizations for 2 groups: moderate-preterm infants (32-34 weeks’ gestational age) and term infants (37-41 weeks’ gestational age).

Main Outcomes and Measures  Age at which preterm infants’ risk of RSV hospitalization equaled the risk for term infants at age 1 month.

Results  Our cohort included 247 566 eligible infants with 5322 RSV hospitalizations. Preterm status doubled the risk for RSV hospitalization in both Florida (odds ratio = 2.41; 95% CI, 1.85-3.12) and Texas (odds ratio = 1.94; 95% CI, 1.64-2.30). Preterm infants’ risk of RSV hospitalization was similar to that for 1-month-old term infants at ages 4.2 months (95% CI, 2.5-5.7) in Florida and 4.5 months (95% CI, 2.8-6.4) in Texas.

Conclusions and Relevance  The age at which moderate-preterm infants showed RSV hospitalization risk similar to their healthy term counterparts supports the more restrictive age thresholds in RSV immunoprophylaxis recommendations. Further studies are warranted to investigate the age-dependent risk of RSV hospitalization in other RSV risk groups.

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Age Effect on Seasonal Respiratory Syncytial Virus Hospitalization Rates in Term and Preterm Infants

Respiratory syncytial virus (RSV) hospitalization rates and 95% CIs averaged across covariates (sex, race, plurality, palivizumab use, season months, and seasons) for infants from Florida (A) and Texas (B) with siblings, estimated from the discrete survival model. The risk level for 1-month-old term infants (horizontal gray reference lines) is shown, and the estimated age (with 95% CI [black horizontal error bars]) at which the risk for moderate-preterm infants has decreased to the risk level for 1-month-old term infants is indicated (vertical reference lines) (ages 4.2 months in Florida [A] and 4.5 months in Texas [B]).

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