O3310: Uptake of RSV Prevention for Neonates is >85% in a Military Treatment Facility, a Model of Universal Healthcare

Background: Though preterm infants have the highest risk for morbidity and mortality from respiratory syncytial virus (RSV)-associated lower respiratory tract illness (LRTIs), the majority of RSV hospitalizations are in healthy term infants. Two new methods of RSV prevention became available in 2023 to address efforts for RSV prevention amongst term and preterm infants: nirsevimab, a long-acting monoclonal antibody (mAb), and RSVPreF, a maternal vaccine that confers passive immunity to infants when administered to pregnant people between 32 and 36 weeks of pregnancy, and at least two weeks before delivery. Medically-pertinent services are issued at no cost to servicemembers and their dependents through the military health system in the United States (US). With this universal healthcare coverage, we strived to achieve a >80% rate of recommended prevention for RSV in eligible infants amongst our military families.

Methods: From October 16, 2023 to February 29, 2024, a computer-generated query was performed on the electronic medical record on a monthly basis to identify in-hospital born infants and mothers who were admitted to the mother-baby-unit (MBU). Demographics, RSVPreF administration, nirsevimab administration, or reason for declination were ascertained. Infants who had a brief course in the neonatal intensive care unit (NICU) and were transferred back to the MBU prior to discharge were included. Out-of-hospital-born infants and infants discharged from the NICU were excluded from data collection. Descriptive statistics were performed.

Results: Of 483 infants, 413 (85.5%) received adequate RSV prevention. Of the 413 infants, 204 (49.4%) received protection from nirsevimab while 209 (50.6%) received protection from passive immunity through maternal RSVPreF (Table 1). There were no reported adverse outcomes with nirsevimab administration from the point of administration to infant’s hospital discharge. RSV prevention measures shifted from primarily nirsevimab to a combination of nirsevimab and RSVPreF over the course of RSV season (Figure 1). Reasons for declination are found in Table 1. There was a steady decline in the number of parents who were refusing nirsevimab for their infants due to concerns of its newness as duration from the time of Food and Drug Administration (FDA) approval of the mAb lengthened (Table 1).

Conclusion: This is the first study to report the uptake of RSV prevention in newborns in the US. We were able to achieve >85% uptake of RSV prevention methods for newborns in a single-center military treatment facility. Overall, our results suggest that a majority of families accept intervention to prevent RSV disease in their infants when these interventions are easily available. Campaigns to improve education related to RSV, advocate for measures of RSV prevention, and proactively address a-priori doubts are paramount to maintaining or improving uptake. Our data may help health systems plan for future RSV seasons and tailor campaigns to improve RSV prevention.