Objective:

To compare the risk of hospitalization for respiratory syncytial virus (RSV) in infants receiving nirsevimab versus those whose mothers were vaccinated during pregnancy.

Approach:

Key Findings:

• 44% of hospitalizations occurred in the nirsevimab group compared to 56% in the maternal vaccination group.
• Nirsevimab was associated with a 26% lower likelihood of RSV-associated lower respiratory tract infection.
• Severe outcomes were less prevalent in the nirsevimab group, including lower rates of PICU admission and need for ventilatory support.
• The relative benefit of nirsevimab increased over time, with lower hospitalization risk observed after 30 days.

Interpretation:

Nirsevimab may provide better protection against RSV-related hospitalization and severe outcomes in infants compared to maternal vaccination, particularly beyond the first week after discharge.

Limitations:

• Observational study design may include residual confounding despite matching.
• Analysis reflects a single RSV season with limited follow-up.
• Maternal vaccination was restricted to a specific gestational window, limiting generalizability.

Conclusion:

Both nirsevimab and maternal vaccination are effective in reducing RSV-related adverse outcomes, but nirsevimab shows lower hospitalization rates and severe outcomes in early infancy. Further studies are needed to evaluate their use.

Sources:

• JAMA
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