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Respiratory syncytial virus prophylaxis in Down syndrome: A prospective cohort study

Ian Mitchell, Hao Yi, Alexander Kiss, Abby Li, Krista Lanctot, Louis Bont, Beatrijs Bloemers, Michel Weijerman, Chantal Broers, Bosco Paes
European Respiratory Journal 2014 44: P1260; DOI:
Ian Mitchell
1Paediatrics, University of Calgary, Calgary, AB, Canada
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Hao Yi
2Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Alexander Kiss
2Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Abby Li
2Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Krista Lanctot
2Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Louis Bont
3Department of Pediatrics, Division of Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
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Beatrijs Bloemers
3Department of Pediatrics, Division of Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
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Michel Weijerman
3Department of Pediatrics, Division of Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
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Chantal Broers
3Department of Pediatrics, Division of Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
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Bosco Paes
4Paediatrics, Division of Neonatology, McMaster University, Hamilton, ON, Canada
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Abstract

Background/Objective: Down syndrome (DS) children are at significant risk for respiratory tract (RTI) and respiratory syncytial virus (RSV) infection and hospitalization. We compared hospitalization rates for RTI in DS children aged < 2 years given palivizumab in the RSV season versus a previously published, similar untreated DS birth cohort.

Methods: 532 prophylaxed DS children were from the Canadian palivizumab registry (CARESS) between 2005-2012. The untreated group comprised 233 DS children derived from a Dutch, nation-wide birth cohort from 2003-2005. Events during the RSV seasons were counted. Demographics and risk factors were compared using t-test or chi-square where appropriate. Poisson regression analysis was performed to compare incidence rate ratios [95% CI] for both RTI and confirmed RSV hospitalization between the groups while controlling for observation length and known risk factors for severe RSV infection.

Results: In total, 31 (23 untreated, 8 treated) RSV-related hospitalizations were documented. The adjusted risk of RSV-related hospitalizations was higher in untreated subjects compa

red to palivizumab recipients (incidence rate ratio 3.63 [95% CI: 1.52-8.67], p=0.004). The adjusted risk for hospitalization for all respiratory tract infection (147 events; 73 untreated, 74 treated) was similar (incidence rate ratio untreated versus palivizumab 1.11 [0.80 – 1.55], p=0.53).

Conclusions: These results suggest that palivizumab is associated with a 3.6-fold reduction in the incidence rate ratio for RSV-related hospitalization in DS children aged <2 years. A randomized trial is needed to determine the efficacy of RSV immunoprophylaxis in this specific high risk patient population.

  • Bronchiolitis
  • Vaccination
  • Infants
  • © 2014 ERS
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Respiratory syncytial virus prophylaxis in Down syndrome: A prospective cohort study
Ian Mitchell, Hao Yi, Alexander Kiss, Abby Li, Krista Lanctot, Louis Bont, Beatrijs Bloemers, Michel Weijerman, Chantal Broers, Bosco Paes
European Respiratory Journal Sep 2014, 44 (Suppl 58) P1260;

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Respiratory syncytial virus prophylaxis in Down syndrome: A prospective cohort study
Ian Mitchell, Hao Yi, Alexander Kiss, Abby Li, Krista Lanctot, Louis Bont, Beatrijs Bloemers, Michel Weijerman, Chantal Broers, Bosco Paes
European Respiratory Journal Sep 2014, 44 (Suppl 58) P1260;
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