Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Peter Krause

Abstract

We conducted a retrospective case-control study of children attending the Yale-New Haven Hospital Premature Infant Primary Care Clinic (YNHH-PIPCC). Subjects were prematurely born children under 24 months of age cared for at the YNHH-PIPCC between October 2000 and March 2011. They are eligible to receive monthly passive respiratory syncytial virus (RSV) immunization with palivizumab during the RSV season. All cases had laboratory-documented severe RSV disease necessitating hospital admission or outpatient visit. Controls did not have severe RSV disease during the same season as their matched case. Controls were matched to the cases by gestational age and month of birth. Risk of severe RSV disease was estimated using matched ORs and adjusted for potential confounders with the use of conditional logistic regression. The hypothesis of this study is that receiving less than all expected doses of palivizumab reduces the effectiveness of palivizumab in preventing severe RSV disease. Of 299 eligible subjects identified during the study's 11 RSV seasons (October 2000 through March 2011), 28 (9%) experienced RSV infections. Of the 28 subjects with RSV infection, 24 (85.7%) subjects were adherent to the dosing protocol. Severe RSV disease requiring hospital admission was noted in 15 of 217 (7%) of adherent subjects compared with 3 of 72 (4%) of non-adherent subjects. Cases of severe RSV disease were more likely to be Hispanic (61% vs. 39%; p-value: 0.05) than matched controls. There was no association between adherence to the dosing protocol and hospital admission due to severe RSV disease. These findings suggest the need for further study of palivizumab dosing recommendations and factors that may be influencing adverse health events in premature Hispanic children receiving health care at the YNHH-PIPCC.

Comments

This is an Open Access Thesis.

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