Pub Date : 2024-09-17DOI: 10.1016/S2352-4642(24)00189-5
Jonathan Green
{"title":"Pathological demand avoidance: further research is required","authors":"Jonathan Green","doi":"10.1016/S2352-4642(24)00189-5","DOIUrl":"10.1016/S2352-4642(24)00189-5","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 10","pages":"Page e12"},"PeriodicalIF":19.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1016/S2352-4642(24)00188-3
Sabrina H Y Eliason MD , Anton R Miller MD , W Ben Gibbard MD , Gurpreet Salh MD , Nancy Lanphear MD
Alcohol is a known teratogen and prenatal alcohol exposure remains a major ongoing public health concern. Fetal alcohol spectrum disorder has become the diagnosis for describing individuals who have been affected by prenatal alcohol exposure. In this Viewpoint, we raise major concerns about its continued use as a diagnostic term in how it perpetuates a misleading and outdated narrative about child development and maternal health. We argue that the term fetal alcohol spectrum disorder has contributed to a culture of racism and discrimination for many who are diagnosed with it. The term fetal alcohol spectrum disorder fails to capture the progress made in our collective understanding of neurodevelopment through advancements in the field of genetics and in understanding the effects of trauma and adversity. We call for urgent international collaborative action to review the use of it as a diagnostic term and, more broadly, to reconsider the practice of diagnosing disabilities as medical illnesses. We suggest that this practice fails to recognise that outcomes of functioning and participation in individuals are not only the results of health conditions, but are also the products of complex interactions and experiences of individuals within the families and societies in which they live.
{"title":"Asking difficult questions about fetal alcohol spectrum disorder in the context of the child, the mother, and the systems in which they live","authors":"Sabrina H Y Eliason MD , Anton R Miller MD , W Ben Gibbard MD , Gurpreet Salh MD , Nancy Lanphear MD","doi":"10.1016/S2352-4642(24)00188-3","DOIUrl":"10.1016/S2352-4642(24)00188-3","url":null,"abstract":"<div><div>Alcohol is a known teratogen and prenatal alcohol exposure remains a major ongoing public health concern. Fetal alcohol spectrum disorder has become the diagnosis for describing individuals who have been affected by prenatal alcohol exposure. In this Viewpoint, we raise major concerns about its continued use as a diagnostic term in how it perpetuates a misleading and outdated narrative about child development and maternal health. We argue that the term fetal alcohol spectrum disorder has contributed to a culture of racism and discrimination for many who are diagnosed with it. The term fetal alcohol spectrum disorder fails to capture the progress made in our collective understanding of neurodevelopment through advancements in the field of genetics and in understanding the effects of trauma and adversity. We call for urgent international collaborative action to review the use of it as a diagnostic term and, more broadly, to reconsider the practice of diagnosing disabilities as medical illnesses. We suggest that this practice fails to recognise that outcomes of functioning and participation in individuals are not only the results of health conditions, but are also the products of complex interactions and experiences of individuals within the families and societies in which they live.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 11","pages":"Pages 835-842"},"PeriodicalIF":19.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1016/S2352-4642(24)00235-9
Satvika Chalasani , Lauren Rumble , Prerna Banati , Sheri Bastien , Jose Roberto Luna , Suzanne Petroni
{"title":"Adolescents and the International Conference on Population and Development at 30","authors":"Satvika Chalasani , Lauren Rumble , Prerna Banati , Sheri Bastien , Jose Roberto Luna , Suzanne Petroni","doi":"10.1016/S2352-4642(24)00235-9","DOIUrl":"10.1016/S2352-4642(24)00235-9","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 12","pages":"Pages 851-853"},"PeriodicalIF":19.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/S2352-4642(24)00167-6
Justine Kahn MD , Ruta Brazauskas PhD , Stephanie Bo-Subait MPH , David Buchbinder MD , Betty K Hamilton MD , Hélène Schoemans MD , Allistair A Abraham MD , Vaibhav Agrawal MD , Prof Jeffery J Auletta MD , Sherif M Badawy MD , Amer Beitinjaneh MD , Neel S Bhatt MBBS , Larisa Broglie MD , Prof Miguel Angel Diaz Perez MD , Nosha Farhadfar MD , Prof Cesar O Freytes MD , Prof Robert Peter Gale MD , Prof Siddhartha Ganguly MD , Prof Robert J Hayashi MD , Prof Peiman Hematti MD , Rachel Phelan MD
<div><h3>Background</h3><p>Continued advances in haematopoietic cell transplantation (HCT) for children with non-malignant diseases (NMDs) have led to a growing population of survivors in whom late occurring toxic effects remain a challenge. We investigated the incidence of and risk factors for post-transplant toxicities in a contemporary cohort of children and adolescents undergoing HCT for NMDs.</p></div><div><h3>Methods</h3><p>In this retrospective cohort study, we extracted data from the Center for International Blood and Marrow Transplantation Research (CIBMTR) database to analyse timing and incidence of effects and risk factors associated with late effects of HCT for treatment of NMDs at age 21 years or younger. Late effects of interest were avascular necrosis, cataracts, congestive heart failure, myocardial infarction, diabetes, gonadal dysfunction, growth hormone deficiency, hypothyroidism, renal failure requiring dialysis, and neurological events (stroke and seizure). Cumulative incidence of each late effect was calculated at 5 years and 7 years after HCT. Risk factors were evaluated in Cox proportional hazards regression analyses. Main exposures were primary NMD, age, sex, ethnicity and race, insurance, donor and graft type, myoablative conditioning, total-body irradiation exposure, graft-versus-host disease (GVHD), and transplant year. Primary outcomes were rates, cumulative incidence probability (95% CI), and risk-factors for organ-specific late effects.</p></div><div><h3>Findings</h3><p>Between Jan 1, 2000, and Dec 31, 2017, 7785 patients aged 21 years or younger underwent HCT. 1995 patients were ineligible or did not consent to be included. 5790 patients from 171 centres were included in the analysis. 3505 (60·5%) of 5790 patients were male and 2285 (39·5%) were female. 2106 (36·4%) patients were White, 771 (13·3%) were Hispanic, and 773 (12·7%) were Black. 1790 (30·9%) patients were non-USA residents. Median age at HCT was 5·5 years (range 0·0–21·0). 1127 (19%) of 5790 patients had one late effect, and 381 (7%) had at least two. At 7 years post-HCT, the cumulative incidence probability was 1·9 (95% CI 1·5–2·3) for cataracts, 4·9 (4·3–5·6) for diabetes, 2·6 (2·1–3·1) for gonadal dysfunction, 3·2 (2·7–3·8) for hypothyroidism, 5·0 (4·4–5·7) for growth disturbance, 8·1 (7·4–8·9) for renal failure, 1·6 (1·3–2·0) for avascular necrosis, 0·6 (0·4–0·8) for congestive heart failure, 0·2 (0·1–0·3) for myocardial infarction, and 9·4 (8·6–10·2) for neurological effects. Age 10 years or older at HCT, unrelated donor source, total-body irradiation, and GVHD were identified as risk factors for long-term effects.</p></div><div><h3>Interpretation</h3><p>The findings highlight the need for, and access to, multidisciplinary and lifelong follow-up for children undergoing HCT for NMDs. As more children undergo treatment with cellular therapies for non-malignant conditions, further analyses of post-transplant data could increasingly guide treatment deci
{"title":"Late effects after allogeneic haematopoietic cell transplantation in children and adolescents with non-malignant disorders: a retrospective cohort study","authors":"Justine Kahn MD , Ruta Brazauskas PhD , Stephanie Bo-Subait MPH , David Buchbinder MD , Betty K Hamilton MD , Hélène Schoemans MD , Allistair A Abraham MD , Vaibhav Agrawal MD , Prof Jeffery J Auletta MD , Sherif M Badawy MD , Amer Beitinjaneh MD , Neel S Bhatt MBBS , Larisa Broglie MD , Prof Miguel Angel Diaz Perez MD , Nosha Farhadfar MD , Prof Cesar O Freytes MD , Prof Robert Peter Gale MD , Prof Siddhartha Ganguly MD , Prof Robert J Hayashi MD , Prof Peiman Hematti MD , Rachel Phelan MD","doi":"10.1016/S2352-4642(24)00167-6","DOIUrl":"10.1016/S2352-4642(24)00167-6","url":null,"abstract":"<div><h3>Background</h3><p>Continued advances in haematopoietic cell transplantation (HCT) for children with non-malignant diseases (NMDs) have led to a growing population of survivors in whom late occurring toxic effects remain a challenge. We investigated the incidence of and risk factors for post-transplant toxicities in a contemporary cohort of children and adolescents undergoing HCT for NMDs.</p></div><div><h3>Methods</h3><p>In this retrospective cohort study, we extracted data from the Center for International Blood and Marrow Transplantation Research (CIBMTR) database to analyse timing and incidence of effects and risk factors associated with late effects of HCT for treatment of NMDs at age 21 years or younger. Late effects of interest were avascular necrosis, cataracts, congestive heart failure, myocardial infarction, diabetes, gonadal dysfunction, growth hormone deficiency, hypothyroidism, renal failure requiring dialysis, and neurological events (stroke and seizure). Cumulative incidence of each late effect was calculated at 5 years and 7 years after HCT. Risk factors were evaluated in Cox proportional hazards regression analyses. Main exposures were primary NMD, age, sex, ethnicity and race, insurance, donor and graft type, myoablative conditioning, total-body irradiation exposure, graft-versus-host disease (GVHD), and transplant year. Primary outcomes were rates, cumulative incidence probability (95% CI), and risk-factors for organ-specific late effects.</p></div><div><h3>Findings</h3><p>Between Jan 1, 2000, and Dec 31, 2017, 7785 patients aged 21 years or younger underwent HCT. 1995 patients were ineligible or did not consent to be included. 5790 patients from 171 centres were included in the analysis. 3505 (60·5%) of 5790 patients were male and 2285 (39·5%) were female. 2106 (36·4%) patients were White, 771 (13·3%) were Hispanic, and 773 (12·7%) were Black. 1790 (30·9%) patients were non-USA residents. Median age at HCT was 5·5 years (range 0·0–21·0). 1127 (19%) of 5790 patients had one late effect, and 381 (7%) had at least two. At 7 years post-HCT, the cumulative incidence probability was 1·9 (95% CI 1·5–2·3) for cataracts, 4·9 (4·3–5·6) for diabetes, 2·6 (2·1–3·1) for gonadal dysfunction, 3·2 (2·7–3·8) for hypothyroidism, 5·0 (4·4–5·7) for growth disturbance, 8·1 (7·4–8·9) for renal failure, 1·6 (1·3–2·0) for avascular necrosis, 0·6 (0·4–0·8) for congestive heart failure, 0·2 (0·1–0·3) for myocardial infarction, and 9·4 (8·6–10·2) for neurological effects. Age 10 years or older at HCT, unrelated donor source, total-body irradiation, and GVHD were identified as risk factors for long-term effects.</p></div><div><h3>Interpretation</h3><p>The findings highlight the need for, and access to, multidisciplinary and lifelong follow-up for children undergoing HCT for NMDs. As more children undergo treatment with cellular therapies for non-malignant conditions, further analyses of post-transplant data could increasingly guide treatment deci","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 10","pages":"Pages 740-750"},"PeriodicalIF":19.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1016/S2352-4642(24)00168-8
Hasan Hashem
{"title":"Echoes of healing: late effects of HCT for non-malignant disease in childhood","authors":"Hasan Hashem","doi":"10.1016/S2352-4642(24)00168-8","DOIUrl":"10.1016/S2352-4642(24)00168-8","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 10","pages":"Pages 709-711"},"PeriodicalIF":19.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1016/S2352-4642(24)00143-3
Antoine Brault PhD , Isabelle Pontais PhD , Vincent Enouf PhD , Christine Debeuret PharmD , Emma Bloch MSc , Juliette Paireau PhD , Prof Marie-Anne Rameix-Welti PhD , Michael White PhD , Gaëlle Baudemont MsC , Prof Bruno Lina PhD , Isabelle Parent du Châtelet MD , Jean-Sébastien Casalegno MD , Sophie Vaux PharmD , Prof Simon Cauchemez PhD
<div><h3>Background</h3><p>Respiratory syncytial virus (RSV) is a major cause of hospitalisations and deaths among infants worldwide. France was one of the first countries to implement a national programme (beginning on Sept 15, 2023) for administration of nirsevimab, a single-dose long-acting monoclonal antibody treatment, to infants born on or after Feb 6, 2023, to prevent lower respiratory tract infection caused by RSV. We aimed to estimate the effectiveness of nirsevimab and the number of hospitalisations averted in children younger than 24 months in real-world settings.</p></div><div><h3>Methods</h3><p>In this modelling study, we developed an age-structured deterministic model characterising RSV transmission as well as plausible scenarios for the administration of nirsevimab doses based on maternity ward and community pharmacy supply data. We retrospectively estimated nirsevimab effectiveness in infants younger than 24 months during the 2023–24 RSV season in France (excluding overseas territories) and the number of averted hospitalisations for RSV bronchiolitis occurring after emergency department visits, by calibrating the model to hospital and virological surveillance data from Aug 21, 2017, to Feb 4, 2024, alongside serological data from a previous cross-sectional study. To assess the robustness of our estimates, we conducted sensitivity analyses in which we modified our assumptions about the number of doses administered, the reconstruction of the number of RSV-associated hospitalisations for bronchiolitis, the duration of maternal and post-infection immunity to RSV, and the number of contacts in children aged 0–2 months.</p></div><div><h3>Findings</h3><p>We estimated that nirsevimab administration prevented 5800 (95% credible interval 3700–7800) RSV-associated hospitalisations for bronchiolitis after emergency department visits among children younger than 24 months, including 4200 (2900–5600) hospitalisations among those aged 0–2 months, between Sept 15, 2023 (the date nirsevimab was introduced), and Feb 4, 2024—a 23% (16–30) reduction in the total number of hospitalisations and a 35% (25–44) reduction in the 0–2 months age group, compared with the scenario without administration. In our baseline scenario, in which we estimated that 215 000 doses of nirsevimab were administered by Jan 31, 2024, the estimated effectiveness against RSV-associated hospitalisations for bronchiolitis was 73% (61–84), corresponding to one hospitalisation averted for every 39 (26–54) doses administered. In sensitivity analyses, nirsevimab remained effective against RSV-associated hospitalisations for bronchiolitis after emergency department attendance.</p></div><div><h3>Interpretation</h3><p>Our findings show that nirsevimab administration campaigns could effectively reduce the RSV-related hospital burden of bronchiolitis in children younger than 24 months.</p></div><div><h3>Funding</h3><p>European Commission, Laboratoire d'Excellence Integrative Biology of Eme
{"title":"Effect of nirsevimab on hospitalisations for respiratory syncytial virus bronchiolitis in France, 2023–24: a modelling study","authors":"Antoine Brault PhD , Isabelle Pontais PhD , Vincent Enouf PhD , Christine Debeuret PharmD , Emma Bloch MSc , Juliette Paireau PhD , Prof Marie-Anne Rameix-Welti PhD , Michael White PhD , Gaëlle Baudemont MsC , Prof Bruno Lina PhD , Isabelle Parent du Châtelet MD , Jean-Sébastien Casalegno MD , Sophie Vaux PharmD , Prof Simon Cauchemez PhD","doi":"10.1016/S2352-4642(24)00143-3","DOIUrl":"10.1016/S2352-4642(24)00143-3","url":null,"abstract":"<div><h3>Background</h3><p>Respiratory syncytial virus (RSV) is a major cause of hospitalisations and deaths among infants worldwide. France was one of the first countries to implement a national programme (beginning on Sept 15, 2023) for administration of nirsevimab, a single-dose long-acting monoclonal antibody treatment, to infants born on or after Feb 6, 2023, to prevent lower respiratory tract infection caused by RSV. We aimed to estimate the effectiveness of nirsevimab and the number of hospitalisations averted in children younger than 24 months in real-world settings.</p></div><div><h3>Methods</h3><p>In this modelling study, we developed an age-structured deterministic model characterising RSV transmission as well as plausible scenarios for the administration of nirsevimab doses based on maternity ward and community pharmacy supply data. We retrospectively estimated nirsevimab effectiveness in infants younger than 24 months during the 2023–24 RSV season in France (excluding overseas territories) and the number of averted hospitalisations for RSV bronchiolitis occurring after emergency department visits, by calibrating the model to hospital and virological surveillance data from Aug 21, 2017, to Feb 4, 2024, alongside serological data from a previous cross-sectional study. To assess the robustness of our estimates, we conducted sensitivity analyses in which we modified our assumptions about the number of doses administered, the reconstruction of the number of RSV-associated hospitalisations for bronchiolitis, the duration of maternal and post-infection immunity to RSV, and the number of contacts in children aged 0–2 months.</p></div><div><h3>Findings</h3><p>We estimated that nirsevimab administration prevented 5800 (95% credible interval 3700–7800) RSV-associated hospitalisations for bronchiolitis after emergency department visits among children younger than 24 months, including 4200 (2900–5600) hospitalisations among those aged 0–2 months, between Sept 15, 2023 (the date nirsevimab was introduced), and Feb 4, 2024—a 23% (16–30) reduction in the total number of hospitalisations and a 35% (25–44) reduction in the 0–2 months age group, compared with the scenario without administration. In our baseline scenario, in which we estimated that 215 000 doses of nirsevimab were administered by Jan 31, 2024, the estimated effectiveness against RSV-associated hospitalisations for bronchiolitis was 73% (61–84), corresponding to one hospitalisation averted for every 39 (26–54) doses administered. In sensitivity analyses, nirsevimab remained effective against RSV-associated hospitalisations for bronchiolitis after emergency department attendance.</p></div><div><h3>Interpretation</h3><p>Our findings show that nirsevimab administration campaigns could effectively reduce the RSV-related hospital burden of bronchiolitis in children younger than 24 months.</p></div><div><h3>Funding</h3><p>European Commission, Laboratoire d'Excellence Integrative Biology of Eme","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 10","pages":"Pages 721-729"},"PeriodicalIF":19.9,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants. Nirsevimab, an RSV-neutralising monoclonal antibody, was approved for use in the EU in 2022, and a national immunisation campaign began in France in September, 2023. We aimed to assess the effectiveness of nirsevimab in reducing paediatric emergency department visits (and subsequent hospitalisations) for all-cause bronchiolitis and RSV-associated bronchiolitis.
Methods
In this case–control study in a paediatric emergency department in Paris, France, we included all infants aged 12 months or younger who attended the department between Oct 14, 2023, and Feb 29, 2024, and whose nirsevimab status was known. Infants were classed as cases if they had all-cause bronchiolitis; all other infants were classed as controls. The primary outcome was the effectiveness of nirsevimab against paediatric emergency department visits for all-cause bronchiolitis during the 2023–24 RSV season. Secondary outcomes were paediatric emergency department visits for RSV-associated bronchiolitis; hospitalisations for all-cause bronchiolitis, RSV-associated bronchiolitis, and severe RSV-associated bronchiolitis requiring supplemental oxygen or feeding by nasogastric tube; and severe RSV-associated bronchiolitis requiring admission to the paediatric intensive care unit. Effectiveness estimates were adjusted for age, week of paediatric emergency department visit, and sex.
Findings
Our study included 2786 infants, 864 with all-cause bronchiolitis (cases) and 1922 without bronchiolitis (controls). 178 (21%) of the 864 cases had received nirsevimab, and 305 (35%) cases were hospitalised for all-cause bronchiolitis. 200 (72%) of the 277 cases tested for RSV were positive, of whom 22 (11%) had received nirsevimab. 701 (36%) of 1922 infants in the control group had received nirsevimab. The effectiveness of nirsevimab against paediatric emergency department visits for all-cause bronchiolitis was 47% (95% CI 33–58). Nirsevimab effectiveness was 83% (71–90) against paediatric emergency department visits for RSV-associated bronchiolitis, 59% (42–71) against hospitalisations for all-cause bronchiolitis, 83% (72–90) against hospitalisations for RSV-associated bronchiolitis (91% [78−96] against those necessitating supplement oxygen and 88% [74−95] against those necessitating feeding via a nasogastric tube). Nirsevimab did not significantly reduce admissions to the paediatric intensive care unit (67% [95% CI –100 to 95]).
Interpretation
During the first French national immunisation campaign, a single dose of nirsevimab effectively reduced paediatric emergency department visits (both all-cause visits and visits related to RSV-associated bronchiolitis) and subsequent hospitalisations.
{"title":"Real-world effectiveness of nirsevimab immunisation against bronchiolitis in infants: a case–control study in Paris, France","authors":"Prof Ricardo Carbajal PhD , Prof Pierre-Yves Boelle PhD , Aurélie Pham PhD , Yoann Chazette , Mathilde Schellenberger MD , Clara Weil , Anne-Sophie Colas MD , Thibault Lecarpentier MD , Aurélie Schnuriger PhD , Romain Guedj PhD , Prof Mathie Lorrot PhD , Prof Harriet Corvol PhD , Maxime Enault MD","doi":"10.1016/S2352-4642(24)00171-8","DOIUrl":"10.1016/S2352-4642(24)00171-8","url":null,"abstract":"<div><h3>Background</h3><p>Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants. Nirsevimab, an RSV-neutralising monoclonal antibody, was approved for use in the EU in 2022, and a national immunisation campaign began in France in September, 2023. We aimed to assess the effectiveness of nirsevimab in reducing paediatric emergency department visits (and subsequent hospitalisations) for all-cause bronchiolitis and RSV-associated bronchiolitis.</p></div><div><h3>Methods</h3><p>In this case–control study in a paediatric emergency department in Paris, France, we included all infants aged 12 months or younger who attended the department between Oct 14, 2023, and Feb 29, 2024, and whose nirsevimab status was known. Infants were classed as cases if they had all-cause bronchiolitis; all other infants were classed as controls. The primary outcome was the effectiveness of nirsevimab against paediatric emergency department visits for all-cause bronchiolitis during the 2023–24 RSV season. Secondary outcomes were paediatric emergency department visits for RSV-associated bronchiolitis; hospitalisations for all-cause bronchiolitis, RSV-associated bronchiolitis, and severe RSV-associated bronchiolitis requiring supplemental oxygen or feeding by nasogastric tube; and severe RSV-associated bronchiolitis requiring admission to the paediatric intensive care unit. Effectiveness estimates were adjusted for age, week of paediatric emergency department visit, and sex.</p></div><div><h3>Findings</h3><p>Our study included 2786 infants, 864 with all-cause bronchiolitis (cases) and 1922 without bronchiolitis (controls). 178 (21%) of the 864 cases had received nirsevimab, and 305 (35%) cases were hospitalised for all-cause bronchiolitis. 200 (72%) of the 277 cases tested for RSV were positive, of whom 22 (11%) had received nirsevimab. 701 (36%) of 1922 infants in the control group had received nirsevimab. The effectiveness of nirsevimab against paediatric emergency department visits for all-cause bronchiolitis was 47% (95% CI 33–58). Nirsevimab effectiveness was 83% (71–90) against paediatric emergency department visits for RSV-associated bronchiolitis, 59% (42–71) against hospitalisations for all-cause bronchiolitis, 83% (72–90) against hospitalisations for RSV-associated bronchiolitis (91% [78−96] against those necessitating supplement oxygen and 88% [74−95] against those necessitating feeding via a nasogastric tube). Nirsevimab did not significantly reduce admissions to the paediatric intensive care unit (67% [95% CI –100 to 95]).</p></div><div><h3>Interpretation</h3><p>During the first French national immunisation campaign, a single dose of nirsevimab effectively reduced paediatric emergency department visits (both all-cause visits and visits related to RSV-associated bronchiolitis) and subsequent hospitalisations.</p></div><div><h3>Funding</h3><p>None.</p></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"8 10","pages":"Pages 730-739"},"PeriodicalIF":19.9,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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