Daily Respiratory Research Analysis

BACKGROUND: Although both maternal respiratory syncytial virus (RSV) prefusion F vaccination (RSVpreF) and infant nirsevimab immunization have been approved for the prevention of RSV lower respiratory tract infections, the 2 have not been evaluated in a single study, and their sequential administration has not been studied systematically. METHODS: We performed a prospective, randomized, open-label, phase 4 study at 8 US sites of mother-infant pairs randomized 1:1:1:1 during pregnancy: maternal RSVpreF vaccine alone, maternal RSVpreF vaccine/infant nirsevimab at birth, maternal RSVpreF vaccine/infant nirsevimab at 3 months, or infant nirsevimab alone at birth. We are following the mother-infant pairs for 12 months to ascertain safety, infant tolerability, and the magnitude and durability of RSV-A and -B neutralizing antibodies (nAbs). We report interim data from September 19, 2024, to May 15, 2025, including 4-month infant follow-up. RESULTS: In total, 181 mothers were enrolled. Both products alone and in combination were safe. No related serious adverse events were observed in mothers or infants. Nirsevimab was well tolerated, and all local and systemic reactogenicity was mild to moderate in severity. RSVpreF vaccination boosted maternal RSV-A nAb titers 17.35-fold at the time of delivery, and titers were durable through 3 months postdelivery. The geometric mean transfer ratio of RSV-A nAbs was higher than 1.3 and similar across groups. RSV nAbs were highly elevated in infants at 6 weeks and 3 months, irrespective of group, with modest differences in waning. CONCLUSIONS: Maternal RSVpreF vaccine and infant nirsevimab administration, either alone or in combination, were safe and provided high RSV nAb titers in infants through interim follow-up.

BACKGROUND: Long COVID has emerged as a global health challenge, with increasing evidence of cardiovascular sequelae. Most previous studies have focused on hospitalised cohorts, whereas cardiovascular risk in community-managed long COVID cases remains less explored. We aimed to investigate the incidence of major cardiovascular events in individuals with long COVID compared to those without long COVID in a large population-based setting. METHODS: Multimorbidity Integrated Registry Across Care Levels in Stockholm (MIRACLE-S) is a population-based cohort that covers all providers of healthcare for around 2.5 million residents in Stockholm County. Individuals aged 18-65 years with a physician-assigned long COVID diagnosis (ICD-10: U09.9) between October 2020 and January 2025 were identified. Exclusion criteria were hospitalisation for acute COVID-19 or pre-existing cardiovascular disease. Cox proportional hazards models estimated the effect of long COVID on a composite cardiovascular outcome (myocardial infarction, heart failure, cardiac arrhythmias, stroke, peripheral arterial disease), adjusting for demographic, lifestyle, and mental health factors. FINDINGS: Among 1,217,693 individuals, 8999 (0.7%) had long COVID diagnosis (66% women). Cumulative incidence of any cardiovascular event was higher in long COVID group (women 18.2%, men 20.6%) compared with control group (women 8.4%, men 11.1%). In a fully adjusted model, long COVID was associated with the composite cardiovascular outcome (women HR 2.06, 95% CI 1.92-2.22; men HR 1.33, 1.20-1.48), cardiac arrhythmia (women HR 3.11, 2.85-3.39; men HR 1.61, 1.41-1.85), and coronary artery disease (women HR 1.25, 1.04-1.52; men HR 1.26, 1.05-1.51). Heart failure incidence was elevated in women only (HR 1.25, 1.00-1.55), as also was peripheral artery disease (HR 1.25, 1.05-1.50). Long COVID was not associated with stroke in either sex. INTERPRETATION: Long COVID is associated with increased risk of incident cardiovascular disease, particularly cardiac arrhythmias, heart failure, and coronary artery disease. These findings underscore the need for systematic follow-up and integration of long COVID into cardiovascular risk assessment. FUNDING: Region Stockholm and Heart Lung Foundation.

INTRODUCTION: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract disease in individuals aged ≥75 years. Differences in disease burden and vaccine uptake by socio-economic status (SES) are important considerations but are not usually incorporated into traditional cost-effectiveness analyses. We conducted a distributional cost-effectiveness analysis (DCEA) to evaluate RSV vaccination programs for older Australians. METHODS: We utilised a static multi-cohort Markov model to simulate age- and SES-specific RSV disease progression in adults aged ≥75 years, comparing no vaccination with the two currently approved RSV vaccines in Australia (Arexvy and Abrysvo). Where available, we used age and SES stratified healthcare utilisation data for RSV as input in the model, with SES represented by the Index of Relative Socio-economic Disadvantage (IRSD). Net health benefits were calculated considering the opportunity costs associated with the vaccination program. We transformed the health distribution from no vaccination and vaccination scenarios and then compared these using a social welfare function. RESULTS: We found that all IRSD subgroups benefited from vaccination. Disadvantaged subgroups received larger health benefits, despite relatively lower vaccination uptake, due to higher baseline probability of RSV-related hospitalisation and death. Under the base-case assumptions, including an assumed negotiated price of A$150 per vaccine dose and an opportunity cost threshold of A$50,000 per quality-adjusted life year for all IRSD subgroups, we found an increase in equity and an overall increase in net health benefit. The impact of vaccination on net health and on equity was sensitive to annual RSV incidence, probability of symptomatic RSV episode, vaccine efficacies against RSV hospitalisation, and vaccine price. CONCLUSION: RSV vaccination for Australians aged ≥75 years could improve overall population health and reduce existing health inequalities. However, the net health benefits were sensitive to the potential vaccine price to be negotiated by the government in Australia for older adults.