Association between nirsevimab coverage and pediatric emergency department visits for bronchiolitis in 12 European countries: An interrupted time-series analysis.
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Lenglart Léa, Titomanlio Luigi, Alberti Ilaria, Almeida Laura, Aupiais Camille, Akyüz Özkan Esra, Barrett Michael, Basmaci Romain, Birbilen Ahmet, Borensztajn Dorine, Schönenberger Catarina Braz, Bressan Silvia, Buonsenso Danilo, Campos Teresa, Castanhinha Susana, Chiaretti Antonio, Claret Gemma, De Zan Francesca, Durnin Sheena, Fodor Laszlo, Gomez Borja, Greber-Platzer Susanne, Guedj Romain, Huege Alexander, Leonard Fiona, Maconochie Ian K, Marlow Robin, Milani Gregorio, Molina Gutierrez Miguel Angel, Musolino Anna Maria, Oostenbrink Rianne, Pucuka Zanda, Rivière Simon, Roland Damian, Rinder Malin Ryd, Supino Maria Chiara, Teksam Ozlem, Trenchs Victoria, Valtuille Zaba, Vanda Bento, Vrijlandt Sanne, Ouldali Naim, Nijman Ruud G, EPISODES Study Group
Аннотация
METHODS AND FINDINGS: We used routinely collected data from 27 pediatric emergency departments across 12 European countries (01/2018-03/2024). All bronchiolitis cases aged <12 months were included. Regions were classified as intervention or control based on nirsevimab implementation. Coverage was obtained from official regional reports. We estimated changes in monthly case using controlled interrupted time-series models accounting for seasonality and temporal trends, by age-groups (0-3 and 3-12 months) and regions during the intervention period (10/2023-03/2024) and examined their correlation to coverage using Pearson's test. Urinary tract infections served as a control outcome. We included 107,088 bronchiolitis cases. Reductions varied widely across regions and age-groups, from +0.6% (95% CI [-9.4, +20.5]) to -61.0% (95% CI [-67.8, -35.2]). Coverage strongly correlated with bronchiolitis reduction across age-groups and regions (ρ = -0.86, p = 0.001). Bronchiolitis trends in control countries remained stable, as did urinary tract infections. As an ecological study, causality cannot be inferred and unmeasured regional differences may have contributed to the variability.
CONCLUSIONS: This multinational interrupted time-series analysis identified coverage as a key factor associated to bronchiolitis reduction across age-groups and European regions. Implementation choices across Europe likely influenced coverage, highlighting that nirsevimab benefits depend not only on its intrinsic efficacy, but also on how effectively it is delivered.