P3.J197: Reducing Respiratory syncytial virus-associated hospitalizations among infants admitted to a regional hospital

Purpose/Objectives:

Background: Respiratory syncytial virus (RSV) accounts for up to 80,000 pediatric hospitalizations and 300 pediatric deaths per year in the US. Infants, particularly those < 6months of age are at greatest risk for severe illness. Maternal vaccination during pregnancy and infant immunization with nirsevimab have been shown in clinical trials to reduce risk of severe RSV and hospitalization. At baseline (2018-2023) 10.7% of all infants admitted to our hospital were due to RSV.

Objective: SMART aim is to reduce the proportion of infant hospitalizations due to RSV from 10.7% to < 5% by March 2025

Design/Methods: This quality improvement project was initiated in January 2024 in the Mother-Baby Unit using the Plan-Do- Study-Act (PDSA) model. Key drivers include increasing maternal vaccination and newborn immunization (Figure 1). Electronic charts of all infants < 1 year old admitted from January 2018 to March 2024 were reviewed. PDSA 1 (January to March 2024), began with nirsevimab administration initially per parental request in January 2024 due to supply shortages. Full-scale rollout began in February 2024, as supply chain challenges were overcome. The outcome measure is the proportion of total infant admissions due to RSV. The process measure is the rate of RSV immunization of eligible newborns. Hepatitis B was previously the only vaccine administered to newborns in the Mother-Baby unit. Routinely obtaining consent for an additional infant immunization (nirsevimab) could potentially increase overall vaccine hesitancy. Our balancing measure therefore is the rate of refusal of hepatitis B vaccination.

Results: A total of 6365 infants were included in this study. During the baseline period (2018 – 2023), the yearly rates of RSV admissions fluctuated widely before and after the year 2020 (during the COVID-19 pandemic), ranging from 3.5% to 14.7%, with an average of 10.7%. During the early stages of this initiative (PDSA 1), RSV admission rates decreased to 3.4% among all hospital admissions of infants < 1 year of age. None of the infants admitted for RSV during the intervention phase were immunized. When comparing the first quarter of 2024 (January to March) to that of previous years, there was a reduction in RSV-associated infant admissions from 6.4% at baseline to 3.4%. In PDSA 1, nirsevimab was administered to 67.5% of the inborn infant population with parental consent. The balancing measure of hepatitis B vaccination refusal rates was unchanged with an average refusal rate of 13%.

Conclusion/Discussion: Increasing newborn immunization coverage could lead to a reduction in RSV hospitalizations. Ongoing efforts will focus on optimizing rates of newborn RSV prophylaxis.