Daily Respiratory Research Analysis
Analyzed 202 papers and selected 3 impactful papers.
Summary
Analyzed 202 papers and selected 3 impactful articles.
Selected Articles
1. Nirsevimab vs RSVpreF Vaccine for Respiratory Syncytial Virus-Related Hospitalization in Newborns.
In a national matched cohort of 42,560 infants, passive infant immunization with nirsevimab was associated with lower risks of RSV hospitalization (adjusted HR 0.74) and severe outcomes (PICU admission HR 0.58; ventilator support HR 0.57; oxygen therapy HR 0.56) compared with maternal RSVpreF vaccination. Findings were consistent across subgroups and sensitivity analyses.
Impact: This first-season, population-scale comparative effectiveness analysis directly informs choice of infant RSV prevention strategy and suggests greater protection with nirsevimab against severe outcomes.
Clinical Implications: Programs may prioritize nirsevimab for direct infant protection, especially in high-risk periods, while continuing to consider maternal vaccination where nirsevimab access is limited. Health systems should plan logistics for timely administration at birth discharge.
Key Findings
- Nirsevimab vs RSVpreF vaccine: lower risk of RSV hospitalization (adjusted HR 0.74; 95% CI 0.61–0.88).
- Severe outcomes reduced with nirsevimab: PICU admission HR 0.58; ventilator support HR 0.57; oxygen therapy HR 0.56.
- Median follow-up was 84 days; results consistent across subgroups and sensitivity analyses.
- Between-group difference in RSV hospitalizations: −11.8% (95% CI −18.1% to −5.5%).
Methodological Strengths
- Large, population-based matched cohort with inverse probability of treatment weighting.
- Robust outcome assessment across multiple severe endpoints and sensitivity analyses.
Limitations
- Observational design with potential residual confounding and confounding by indication.
- Single-season, early-implementation data from mainland France with limited follow-up.
Future Directions: Evaluate durability across multiple seasons, cost-effectiveness of program strategies, and combined or sequential use in different supply and epidemiologic contexts.
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 was 64% effective against RSV-associated ARI and 70% against hospitalization in infants <6 months, while nirsevimab was 81% effective against hospitalization and maintained 77% effectiveness at 130–210 days. Population-level RSV hospitalizations fell by 41–51% in infants <12 months (56–63% in 0–2 months).
Impact: First-season, multicenter US data quantify real-world effectiveness and durability, and demonstrate substantial population-level reductions in infant RSV hospitalizations.
Clinical Implications: Both strategies are effective; systems should ensure timely access to either approach. Where feasible, prioritizing nirsevimab for direct infant protection may maximize hospitalization prevention, while maintaining maternal vaccination coverage widens protection.
Key Findings
- Maternal RSV vaccination effectiveness: 64% (95% CI 37–79) against medically attended RSV-ARI and 70% (95% CI 37–86) against hospitalization in <6 months.
- Nirsevimab effectiveness: 81% (95% CI 71–87) against RSV hospitalization; durability 77% (95% CI 42–92) at 130–210 days.
- Population impact: RSV hospitalizations reduced by 41–51% in 0–11 months and 56–63% in 0–2 months age group.
Methodological Strengths
- Population-based, multicenter surveillance with systematic molecular testing and test-negative design.
- Assessed both product effectiveness and population-level impact using difference-in-differences.
Limitations
- Observational design; potential residual confounding and differential product uptake.
- Single-season analysis; effectiveness may vary with circulation patterns and coverage.
Future Directions: Assess combined program strategies, equity of access, and long-term safety and effectiveness across multiple seasons and geographies.
3. Accuracy of VIDAS® TB-IGRA in TB patients and individuals with different thresholds of exposure.
In a global, multicenter prospective accuracy study, the fully automated VIDAS TB-IGRA demonstrated markedly higher sensitivity than QFT-Plus in culture-confirmed TB while maintaining high specificity in low-prevalence blood donors. Agreement analyses and modeling showed better alignment with exposure gradients, supporting its value for tuberculosis infection diagnosis and screening.
Impact: This study provides robust, head-to-head evidence that an automated IGRA can improve TB infection detection without sacrificing specificity, with operational advantages for high-throughput laboratories.
Clinical Implications: VIDAS TB-IGRA could replace or complement QFT-Plus in diagnostic algorithms, particularly in contact investigations and pre-immunosuppression screening, enabling higher case detection with streamlined automated workflows.
Key Findings
- Sensitivity in culture-confirmed TB: 97.5% with VIDAS TB-IGRA vs 80.7% with QFT-Plus (p<0.0001).
- Specificity in low-prevalence blood donors remained high: 97.6% (VIDAS) vs 95.2% (QFT-Plus).
- Negative and positive percent agreement in the mixed-risk population were 90.1% and 92.1%, respectively, with VIDAS correlating better with exposure risk gradients.
Methodological Strengths
- Global, multicenter, prospective cross-sectional design with head-to-head comparator (QFT-Plus).
- Included both culture-confirmed TB cases and graded exposure-risk populations, plus low-prevalence specificity assessment.
Limitations
- Observational diagnostic accuracy design without randomized allocation.
- Latent TB lacks a definitive gold standard; potential spectrum effects across exposure categories.
Future Directions: Health-economic evaluations and implementation studies in high-burden settings should assess cost-effectiveness, throughput, and impact on cascade of care; head-to-head evaluations in special populations (e.g., HIV, children) are warranted.