CLINICAL QUESTION

Is universal prophylaxis for respiratory syncytial virus (RSV) effective for decreasing the need for medical care in infants?

BOTTOM LINE

RSV prophylaxis with the monoclonal antibody nirsevimab (Beyfortus) was effective in decreasing emergency visits and hospitalizations in infants with bronchiolitis when administered to the whole population. (Level of Evidence = 2b)

SYNOPSIS

Spain introduced universal prophylaxis for RSV in all infants before the 2023–2024 season and allowed catch-up dosing for infants younger than 6 months. To assess the effectiveness of this initiative, the authors compared episodes of respiratory illness in 15 Spanish pediatric emergency departments throughout the country during the November to January 2023–2024 season with the same time span in previous years, excluding the years 2020–2022 because of alterations in RSV circulation during the COVID-19 pandemic. In 2023–2024, there was a 57.5% decrease in episodes of lower respiratory tract infections in these emergency departments, a 59.2% decrease in acute bronchiolitis, a 63.1% decrease in related hospital admissions, and a 63.1% reduction in pediatric intensive care admissions. Results varied by region, in part because of the implementation of the catch-up process. This study uses a historical comparison, rather than a concurrent comparison group, and there may be other factors that explain the differences.