Expert consensus on the burden of respiratory syncytial virus disease and the utility of nirsevimab for disease prevention and protection of infants

Abstract

Background: Respiratory syncytial virus (RSV) is the most common cause of pediatric acute lower respiratory tract infection worldwide. In Singapore, RSV substantially contributes to the morbidity and mortality of children aged < 5 years, particularly during their first year of life, with hospitalization rates peaking during epidemic outbreaks. This expert consensus paper aims to provide an overview of the RSV disease burden, unmet needs, and the urgency for RSV prevention in all infants.

Data sources: A comprehensive literature review was conducted using Medline via PubMed, to identify relevant studies, including randomized controlled trials, observational studies, systematic reviews, and meta-analyses, related to RSV burden and prevention and nirsevimab. A multidisciplinary group of physicians with RSV expertise from leading institutions in Singapore reviewed the literature on RSV-related topics, convened to deliberate and formulate evidence-based recommendations, summarizing the overall disease burden, unmet needs, and the optimal implementation of an immunization strategy for all infant protection against RSV infections in Singapore. Premeeting and in-meeting surveys were conducted to guide the development of final consensus recommendations.

Results: Epidemiology and burden of RSV in Singapore, current protection against RSV infections in infants, implementations of nirsevimab, and optimization of nirsevimab implementation in Singapore were discussed in this study. Although RSV brings substantial burden with underestimated costs, palivizumab is the only approved product for RSV prevention in Singapore. Existing evidences reveal that nirsevimab has a good safety profile and is effective in preventing RSV lower respiratory tract infections. Seven statements were formulated on the epidemiology and burden of RSV in Singapore, with emphasis on its high incidence and associated healthcare cost, and the clinical efficacy and safety of nirsevimab as a basis of its implementation for all infant protection in Singapore.

Conclusions: The burden of RSV disease in young children is substantial, especially in those < 2 years old, accounting for up to 47% of bronchiolitis and pneumonia admissions in children < 6 months. The administration of a single dose of nirsevimab may be offered to infants at birth for the prevention of RSV in Singapore.

Keywords: Consensus; Infants; Monoclonal antibody; Nirsevimab; Respiratory syncytial virus.