Journal of Allergy and Clinical Immunology: Global (May 2023)

Model-estimated impacts of pediatric respiratory syncytial virus prevention programs in Mali on asthma prevalence

  • Justin R. Ortiz, MD,
  • Rachel S. Laufer, MPH,
  • Steven M. Brunwasser, PhD,
  • Flanon Coulibaly, MD,
  • Fatoumata Diallo, MD,
  • Moussa Doumbia, MD,
  • Amanda J. Driscoll, PhD,
  • Deshayne B. Fell, PhD,
  • Fadima C. Haidara, MD,
  • Tina V. Hartert, MD,
  • Adama M. Keita, MD,
  • Kathleen M. Neuzil, MD,
  • Brittney M. Snyder, PhD,
  • Samba Sow, MD,
  • Meagan C. Fitzpatrick, PhD

Journal volume & issue
Vol. 2, no. 2
p. 100092

Abstract

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Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in young children and is associated with subsequent recurrent wheezing illness and asthma (wheeze/asthma). RSV prevention may therefore reduce wheeze/asthma prevalence. Objectives: We estimated the contribution of RSV LRTI and the impact of RSV prevention on recurrent wheeze/asthma in Mali. Methods: We simulated 12 consecutive monthly birth cohorts in Mali and estimated RSV LRTI cases through 2 years and recurrent wheeze/asthma prevalence at 6 years under different RSV prevention scenarios: status quo, seasonal birth-dose extended half-life mAb, and seasonal birth-dose extended half-life mAb followed by 2 doses of pediatric vaccine (mAb + vaccine). We used World Health Organization (WHO) Preferred Product Characteristics for RSV prevention, demographic and RSV epidemiologic data from Mali, regional recurrent wheeze/asthma prevalence, and relative risk of recurrent wheeze/asthma given early childhood RSV LRTI. Results: Among the simulated cohort of 778,680 live births, 10.0% had RSV LRTI by 2 years and 89.6% survived to 6 years. We estimated that 13.4% of all recurrent wheeze/asthma at 6 years was attributable to RSV LRTI. Recurrent wheeze/asthma prevalence at 6 years was 145.0 per 10,000 persons (RSV LRTI attributable) and 1084.2 per 10,000 persons (total). In mAb and mAb + vaccine scenarios, RSV LRTI cases decreased by 11.8% and 44.4%, respectively, and recurrent wheeze/asthma prevalence decreased by 11.8% and 44.4% (RSV LRTI attributable) and 1.6% and 5.9% (total). Conclusion: In Mali, RSV prevention programs may have a meaningful impact on chronic respiratory disease, strengthening the case for investment in RSV prevention.

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