Daily Respiratory Research Analysis
Analyzed 202 papers and selected 3 impactful papers.
Summary
Three high-impact studies reshape pediatric respiratory infection prevention and TB diagnostics. Two national-scale analyses show strong real-world effectiveness of infant RSV protection strategies—nirsevimab outperforming maternal RSVpreF for preventing hospitalization—while a US multi-center surveillance study confirms both maternal vaccination and nirsevimab substantially reduce RSV hospitalizations. Separately, a global diagnostic accuracy study finds the fully automated VIDAS TB-IGRA more sensitive than QFT-Plus without loss of specificity, aligning better with exposure gradients.
Research Themes
- Comparative effectiveness of RSV immunization strategies in infancy
- Population-level impact of maternal RSV vaccination and nirsevimab
- Automated interferon-gamma release assay improving TB infection diagnosis
Selected Articles
1. Nirsevimab vs RSVpreF Vaccine for Respiratory Syncytial Virus-Related Hospitalization in Newborns.
In a matched nationwide cohort of 42,560 infants during the first season of implementation, passive infant immunization with nirsevimab was associated with lower RSV-related hospitalization risk than maternal RSVpreF vaccination, and it reduced multiple severe outcomes (PICU, ventilation, oxygen therapy). Benefits were consistent across subgroups and sensitivity analyses.
Impact: This head-to-head, population-scale comparison provides actionable evidence to prioritize nirsevimab for infant RSV prevention programs where both options exist. It directly informs immunization policy and resource allocation.
Clinical Implications: Health systems can expect greater reduction in infant RSV hospitalizations by prioritizing nirsevimab administration prior to discharge, particularly during peak season, while continuing maternal vaccination where operationally advantageous or when infant dosing is not feasible.
Key Findings
- Nirsevimab reduced RSV hospitalization versus maternal RSVpreF vaccination (adjusted HR 0.74; 95% CI, 0.61–0.88).
- Severe outcomes were lower with nirsevimab: PICU admission (aHR 0.58), ventilator support (aHR 0.57), and oxygen therapy (aHR 0.56).
- Findings were robust across subgroups and sensitivity analyses over a median follow-up of 84 days.
Methodological Strengths
- Large national cohort with 1:1 matching and IPTW adjusted Cox models
- Hard clinical endpoints (hospitalization, PICU, ventilation, oxygen) with consistent sensitivity analyses
Limitations
- Observational design with potential residual confounding
- First-season implementation may reflect supply/logistical factors not generalizable to subsequent seasons
Future Directions: Evaluate cost-effectiveness, optimal integration with maternal vaccination, and long-term safety/effectiveness across multiple seasons and diverse settings.
IMPORTANCE: Respiratory syncytial virus (RSV) is a leading cause of hospitalization in infants. The comparative effectiveness of 2 recently introduced preventive strategies (infant immunization through placental antibody transfer after maternal vaccination with the RSV prefusion F protein [RSVpreF] vaccine and passive infant immunization with nirsevimab) remains unknown. OBJECTIVE: To compare the associations of maternal vaccination with the RSVpreF vaccine vs passive infant immunization with nirsevimab for the prevention of RSV-related hospitalization. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the French National Health Data System. Maternal vaccination with the RSVpreF vaccine occurred during 32 to 36 weeks' gestation among infants born in mainland France between September 1 and December 31, 2024. Passive infant immunization with nirsevimab occurred prior to hospital discharge. Infants were matched 1:1 by maternity ward discharge date, sex, gestational age, and region. Follow-up ended at the time of RSV hospitalization or death or on February 28, 2025. EXPOSURES: Maternal immunization with the RSVpreF vaccine and passive infant immunization with nirsevimab. MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalization for RSV-associated lower respiratory tract infection. The secondary outcomes included admission to the pediatric intensive care unit (PICU), admission to high-dependency unit, ventilator support, and oxygen therapy. The hazard ratios (HRs) were estimated using conditional Cox proportional hazards models with inverse probability of treatment weighting. RESULTS: A total of 42 560 infants (mean age, 3.7 [SD, 1.4] days; 51.7% male) were included in the study (21 280 per group) with a median follow-up of 84 days (IQR, 70-99 days). Of the 481 hospitalizations for RSV-associated lower respiratory tract infection, 212 (44.1%) occurred in the nirsevimab group vs 269 (55.9%) in the RSVpreF vaccine group (between-group difference, -11.8% [95% CI, -18.1% to -5.5%]). Compared with the RSVpreF vaccine, passive infant immunization with nirsevimab was associated with a lower risk of hospitalization for RSV-associated lower respiratory tract infection (adjusted HR, 0.74 [95% CI, 0.61 to 0.88]). Compared with the RSVpreF vaccine, passive infant immunization with nirsevimab was associated with a lower risk of severe outcomes, including PICU admission (adjusted HR, 0.58 [95% CI, 0.42 to 0.80]), requiring ventilator support (adjusted HR, 0.57 [95% CI, 0.40 to 0.81]), or requiring oxygen therapy (adjusted HR, 0.56 [95% CI, 0.38 to 0.81]). The results were consistent across subgroups and in the sensitivity analyses. CONCLUSIONS AND RELEVANCE: Compared with maternal vaccination with the RSVpreF vaccine, passive infant immunization with nirsevimab was associated with lower risks of RSV-related hospitalization and severe outcomes. These findings reflect the first RSV season with use of these immunization strategies in mainland France; their use should be reevaluated in future studies.
2. Effectiveness and Impact of Maternal RSV Immunization and Nirsevimab on Medically Attended RSV in US Children.
In US population-based surveillance using a test-negative design, maternal RSV vaccination and nirsevimab both significantly reduced RSV-associated hospitalizations in infants, with nirsevimab VE at 81% and sustained protection up to 210 days. Population-level RSV hospitalization rates fell by roughly half compared with pre-introduction seasons.
Impact: Provides real-world VE estimates for both maternal vaccination and nirsevimab and quantifies population-level impact in the first US season, directly guiding immunization strategy, supply planning, and parent counseling.
Clinical Implications: Health systems can leverage both strategies to reduce infant RSV hospitalizations, with nirsevimab offering high and durable protection; planning should target early life (0–2 months) for the largest absolute benefit.
Key Findings
- Maternal RSV vaccine VE: 64% against medically attended RSV-ARI and 70% against RSV hospitalization in <6-month-olds.
- Nirsevimab VE: 81% against RSV hospitalization with sustained 77% protection at 130–210 days.
- RSV hospitalizations reduced by 41–51% in infants 0–11 months compared with pre-introduction seasons; 56–63% reduction in 0–2 months.
Methodological Strengths
- Population-based, multi-center surveillance with systematic molecular testing
- Test-negative design limiting care-seeking bias; population impact assessed by two comparator frameworks
Limitations
- Potential residual confounding inherent to observational designs
- One-season data; effectiveness may vary by seasonality, viral dynamics, and uptake
Future Directions: Assess comparative programmatic effectiveness, equity of access, and long-term safety across multiple seasons; refine optimal timing for maternal vaccination and infant dosing.
IMPORTANCE: During the 2024-2025 respiratory syncytial virus (RSV) season in the US, nirsevimab and maternal RSV vaccination became widely available to prevent severe RSV disease in infants. Assessments of the real-world effectiveness and impact of both products are needed to inform RSV prevention policy. OBJECTIVES: To estimate nirsevimab and maternal RSV vaccine effectiveness against medically attended RSV-associated acute respiratory illness (ARI) and to estimate the impact of these products on RSV-associated hospitalizations during 2024-2025. DESIGN, SETTING, AND PARTICIPANTS: Population-based surveillance for medically attended ARI was conducted among children younger than 2 years with systematic molecular testing for RSV. Children were enrolled at 7 US pediatric medical centers from October 1, 2024, through April 30, 2025. A test-negative case-control design was used to estimate maternal RSV vaccine and nirsevimab effectiveness. EXPOSURES: To estimate maternal RSV vaccine effectiveness, the exposure was maternal RSV vaccination among newborns and infants younger than 6 months at medical encounters; to estimate nirsevimab effectiveness, the exposure was nirsevimab receipt among newborns and infants younger than 8 months as of October 1, 2024, or born after that date. MAIN OUTCOMES AND MEASURES: The primary outcome was medically attended RSV-associated ARI and RSV-associated hospitalization. Immunization effectiveness was calculated as (1 - adjusted odds ratio) × 100%. To estimate population-level impact of RSV prevention products, relative rate reductions were estimated by comparing observed RSV-associated hospitalization rates during 2024-2025 to (1) observed rates in 2017-2020 or (2) counterfactual 2024-2025 rates estimated by a difference-in-differences approach; estimates from both approaches are presented as ranges. RESULTS: Overall, 5029 children younger than 2 years with medically attended ARI were enrolled during October 2024 to April 2025. Median (IQR) age was 10 months (5-16 months), and 2176 children (43.3%) were female. Among newborns and infants younger than 6 months, maternal RSV vaccine effectiveness was 64% (95% CI, 37%-79%) against any medically attended RSV-associated ARI and 70% (95% CI, 37%-86%) against RSV-associated hospitalization. Nirsevimab effectiveness was 81% (95% CI, 71%-87%) against RSV-associated hospitalization, and nirsevimab remained 77% (95% CI, 42%-92%) effective against RSV-associated hospitalization at 130 to 210 days after receipt. RSV-associated hospitalizations were reduced by 41% to 51% among newborns and infants aged 0 to 11 months, with the highest reduction of 56% to 63% in those aged 0 to 2 months. CONCLUSIONS AND RELEVANCE: According to the results of this population-based surveillance study, during 2024-2025, both maternal RSV vaccine and nirsevimab were estimated to be effective at protecting infants from RSV-associated hospitalizations in their first RSV season, and RSV-associated hospitalization rates in newborns and infants aged 0 to 11 months were reduced by up to half compared to seasons before these products were introduced.
3. Accuracy of VIDAS® TB-IGRA in TB patients and individuals with different thresholds of exposure.
In a global prospective diagnostic accuracy study, the fully automated VIDAS TB-IGRA showed markedly higher sensitivity than QFT-Plus in culture-confirmed TB with similar high specificity and better alignment with exposure gradients. These results support VIDAS TB‑IGRA as an improved, scalable diagnostic for TB infection programs.
Impact: Improves TB infection detection accuracy while maintaining specificity and operational simplicity, enabling broader programmatic adoption and potentially better targeting of preventive therapy.
Clinical Implications: Adopting VIDAS TB‑IGRA could reduce false negatives in high-burden settings and streamline workflows through automation, aiding contact investigations and preventive therapy decisions.
Key Findings
- Sensitivity in culture-confirmed TB was higher with VIDAS TB-IGRA than QFT-Plus (97.5% vs 80.7%; p<0.0001).
- Specificity remained high and comparable in low-prevalence blood donors (97.6% vs 95.2%).
- VIDAS TB-IGRA correlated better with TB exposure risk gradients, suggesting improved clinical risk discrimination.
Methodological Strengths
- Global, multi-center, prospective cross-sectional diagnostic accuracy design
- Head-to-head comparison with established QFT-Plus across disease and exposure-risk cohorts
Limitations
- Cross-sectional design; lacks longitudinal conversion/reversion data
- Specificity assessed in low-prevalence donors may not reflect all settings
Future Directions: Head-to-head programmatic evaluations in high-burden settings, cost-effectiveness analyses, and longitudinal studies of IGRA dynamics under preventive therapy.
OBJECTIVES: To achieve global TB control, more sensitive and user-friendly diagnostic tools for tuberculosis infection (TBI) are necessary, as it is a potential transmission reservoir. VIDAS® TB-IGRA (bioMérieux) is a fully automated assay recently developed. We report here the results of a global, multi-center, cross-sectional, prospective study to evaluate the diagnostic accuracy of the assay. METHODS: Patients with TB disease (n=200) or participants at varying levels of TB exposure risk (n=1460; mixed TB-exposure risk population) were tested with both the VIDAS® TB-IGRA and the QuantiFERON®-TB Gold Plus (QFT®-Plus, QIAGEN). RESULTS: In culture-confirmed TB cases, VIDAS® TB-IGRA had a sensitivity significantly higher than QFT®-Plus (97.5% vs. 80.7%, p<0.0001). Specificity evaluated in blood donors from a low-prevalence country (n = 125) was high for both VIDAS® TB-IGRA and QFT®-Plus (97.6% [93.1-99.5] vs. 95.2% [89.8-98.2]; p=0.083), respectively. In the whole mixed TB-exposure risk population, negative (NPA) and positive percent agreement (PPA) were 90.1% (1097/1217) and 92.1% (223/242), respectively. However, regression analyses revealed that VIDAS® TB-IGRA correlated better with the TB-exposure risk gradient than QFT®‑Plus. CONCLUSIONS: Compared with QFT®-Plus, VIDAS® TB-IGRA was significantly more sensitive without a reduction in specificity, and it correlated better with an exposure gradient, suggesting that it is a valuable tool for TBI diagnosis.