Evaluation of RSV hospitalizations in high-risk infants who received nirsevimab vs. palivizumab Authors: Allison Lopez, Courtney Campbell, Erica Gray, Katelyn Gibson
Background Respiratory syncytial virus (RSV) is a common acute respiratory infection that can cause mild cold-like symptoms in most infants, but some high-risk infants, such as those born prematurely or with chronic lung or congenital heart disease, can develop severe disease requiring hospitalization. Prophylaxis is the most effective way to prevent severe RSV infection. Palivizumab and nirsevimab are monoclonal antibodies that provide passive immunity by preventing RSV from entering healthy cells. Palivizumab requires monthly dosing during RSV season, while nirsevimab is given as a single dose for the entire season. Our institution recently switched from palivizumab to nirsevimab following updated ACIP, CDC, and AAP guidance. There is established data supporting palivizumab use in high-risk infants, but limited evidence exists for nirsevimab in this population. This study aims to compare RSV-related hospitalizations in high-risk infants receiving nirsevimab versus palivizumab to inform RSV prophylaxis use at our institution.
Methods This is a single-center retrospective chart review of high-risk infants who received palivizumab or nirsevimab for RSV prophylaxis during the 2022-2023 or 2024-2025 season, respectively. High-risk infants include those born prematurely and those with chronic lung disease or significant congenital heart disease. Infants were included if they met institutional criteria for RSV prophylaxis and received at least one dose of nirsevimab or palivizumab. The primary outcome was the number of hospitalizations with confirmed RSV infection. Secondary outcomes included risk factors for severe RSV, number and timing of prophylactic doses, timing of hospitalization relative to dosing, and the number of confirmed RSV cases in Georgia. The purpose of this study was to evaluate whether a single dose of nirsevimab is sufficient for high-risk infants throughout the RSV season through comparison of hospitalization rates between infants receiving palivizumab versus nirsevimab.
Results A total of 146 patients were included in this study, with 82 patients receiving nirsevimab and 64 patients receiving palivizumab. The patients in the two groups were similar regarding baseline characteristics, and the majority of patients were African American. Of the patients included, four were hospitalized with confirmed RSV infection. Three of these patients had received nirsevimab and one had received palivizumab. There was no significant difference seen in the primary outcome comparing hospitalizations in the nirsevimab group and the palivizumab group (P = 0.63).
Conclusions This single-center retrospective chart review demonstrates that the use of nirsevimab for RSV prophylaxis does not increase the risk of hospitalization in high-risk infants compared to palivizumab. No statistically significant difference was seen between nirsevimab and palivizumab in terms of RSV-related hospitalizations. The results of this study support continued utilization of nirsevimab for RSV prophylaxis in high-risk infants.
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