title: Respiratory syncytial virus prophylaxis in Down syndrome: a prospective cohort study.
abstract: OBJECTIVE
  Children with Down syndrome (DS) are at significant risk for respiratory syncytial virus (RSV) infection and related hospitalization. We compared hospitalization rates due to respiratory tract infection in children with DS aged <2 years who prospectively received palivizumab during the RSV season with a previously published, similar untreated DS birth cohort.
  
  
  METHODS
  A total of 532 children with DS who prospectively received palivizumab were assembled from the prospective Canadian RSV Evaluation Study of Palivizumab registry between 2005 and 2012. The untreated group included 233 children with DS derived from a nationwide Dutch birth cohort from 2003 to 2005. Events during the RSV seasons were counted. Poisson regression analysis was performed to compare incidence rate ratios (95% confidence intervals [CIs]) between groups while controlling for observation length and known risk factors for severe RSV infection.
  
  
  RESULTS
  In total, 31 (23 untreated, 8 treated) RSV-related hospitalizations were documented. The adjusted risk of RSV-related hospitalizations was higher in untreated subjects than in palivizumab recipients (incidence rate ratio 3.63; 95% CI, 1.52-8.67). The adjusted risk of hospitalization for all respiratory tract infection (147 events; 73 untreated, 74 treated) was similar (incidence rate ratio untreated versus palivizumab 1.11; 95% CI, 0.80-1.55).
  
  
  CONCLUSIONS
  These results suggest that palivizumab is associated with a 3.6-fold reduction in the incidence rate ratio for RSV-related hospitalization in children with DS during the first 2 years of life. A randomized trial is needed to determine the efficacy of RSV immunoprophylaxis in this specific high-risk patient population.
authors.affiliation: Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Hao
authors.initials: H
authors.lastname: Yi
authors.affiliation: Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, Netherlands;
authors.forename: Louis
authors.initials: L
authors.lastname: Bont
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, Netherlands;
authors.forename: Beatrijs L P
authors.initials: BL
authors.lastname: Bloemers
authors.affiliation: Department of Pediatrics, VU University Medical Center, Amsterdam, Netherlands;
authors.forename: Michel
authors.initials: M
authors.lastname: Weijerman
authors.affiliation: Department of Pediatrics, VU University Medical Center, Amsterdam, Netherlands;
authors.forename: Chantal
authors.initials: C
authors.lastname: Broers
authors.affiliation: Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Abby
authors.initials: A
authors.lastname: Li
authors.affiliation: Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Alexander
authors.initials: A
authors.lastname: Kiss
authors.affiliation: Division of Respirology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; and.
authors.forename: Ian
authors.initials: I
authors.lastname: Mitchell
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada paes@mcmaster.ca.
authors.forename: Bosco
authors.initials: B
authors.lastname: Paes
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D001724:Birth Weight; D002170:Canada; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D009426:Netherlands; D000069455:Palivizumab; D011446:Prospective Studies; D012042:Registries; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069455:Palivizumab
keywords: Down syndrome; outcomes; palivizumab; respiratory syncytial virus