New Study Identifies High-Risk Pediatric Groups for RSV Prophylaxis

A recent study published in the Journal of the American Medical Association Network Open (JAMA Netw Open) has highlighted specific groups of children with chronic medical conditions (CMCs) who are at heightened risk for respiratory syncytial virus (RSV) hospitalization. Conducted in British Columbia, Canada, the retrospective cohort study analyzed data from 431,937 children born between April 1, 2013, and March 31, 2023, and found that those with CMCs are significantly more vulnerable to RSV-related complications during their first two RSV seasons.

The study, which followed participants until their third RSV season or until April 1, 2024, revealed that approximately 5.9% of the cohort had at least one chronic medical condition diagnosed within their first two years of life. Among these children, the hospitalization rate for RSV during their first season was 15.9 per 1,000 person-years, compared to 8.0 per 1,000 person-years for those without CMCs. The disparity continued into the second RSV season, where hospitalization rates for children with CMCs decreased to 7.8 per 1,000 person-years, yet remained substantially higher than the 2.2 per 1,000 person-years hospitalization rate for children without CMCs.

Notably, children with respiratory or cardiovascular conditions, as well as those with genetic disorders such as Down syndrome, exhibited hospitalization rates that were markedly greater than their peers. The findings underscore the need for updated recommendations regarding RSV prophylaxis, as current guidelines primarily focus on high-risk infants.

According to Dr. Viñeta Paramo, a lead researcher in the study and a pediatrician at the University of British Columbia, “This population-based retrospective cohort study identified specific groups of higher-risk children with chronic medical conditions who could most benefit from prophylaxis with long-acting monoclonal antibodies in their first and second RSV seasons.”

The study's implications are significant, particularly as National Immunization Technical Advisory Groups (NITAGs) in North America and Europe have begun to recommend broader immunization strategies against RSV. Previously, prophylaxis with palivizumab was limited to select high-risk groups; however, the emerging data supports a shift towards universal immunization for infants entering their first RSV season.

Furthermore, the study indicates that children born prematurely or those with conditions requiring specialized medical intervention, such as gastrostomy or assisted ventilation, demonstrate an increased susceptibility to severe RSV outcomes. This has prompted some NITAGs to advocate for expanded eligibility criteria for nirsevimab, a long-acting monoclonal antibody designed to provide protection against RSV in infants.

This shift toward more inclusive RSV prophylaxis is not only crucial for the health of vulnerable pediatric populations but also for public health overall, given the substantial economic burden associated with RSV hospitalizations. According to the Centers for Disease Control and Prevention (CDC), RSV leads to approximately 57,000 hospitalizations annually among children under five in the United States alone.

In conclusion, as research continues to illuminate the risks faced by children with chronic medical conditions, there is a pressing need for healthcare policymakers to reconsider existing guidelines. The findings from this study advocate for a more proactive stance in protecting high-risk pediatric populations, ensuring that the most vulnerable children receive the preventive care necessary to reduce hospitalization rates and improve health outcomes during RSV seasons.

Reference: Viñeta Paramo M, Watts AW, Bone JN, et al. RSV Hospital Admissions During the First 2 Seasons Among Children With Chronic Medical Conditions. JAMA Netw Open. 2025;8(7):e2519410. doi:10.1001/jamanetworkopen.2025.19410.