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. 2023 Feb 20;15(1):154-174.
doi: 10.3390/pediatric15010013.

Respiratory Syncytial Virus Prevention through Monoclonal Antibodies: A Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Pediatricians

Affiliations

Respiratory Syncytial Virus Prevention through Monoclonal Antibodies: A Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Pediatricians

Matteo Riccò et al. Pediatr Rep. .

Abstract

Respiratory Syncytial Virus (RSV) is a leading cause of morbidity and hospitalization in all infants. Many RSV vaccines and monoclonal antibodies (mAb) are currently under development to protect all infants, but to date preventive options are available only for preterms. In this study, we assessed the knowledge, attitudes, and practices towards RSV and the preventive use of mAb in a sample of Italian Pediatricians. An internet survey was administered through an internet discussion group, with a response rate of 4.4% over the potential respondents (No. 389 out of 8842, mean age 40.1 ± 9.1 years). The association of individual factors, knowledge, and risk perception status with the attitude towards mAb was initially inquired by means of a chi squared test, and all variables associated with mAb with p < 0.05 were included in a multivariable model calculating correspondent adjusted Odds Ratio (aOR) with 95% confidence intervals (95%CI). Of the participants, 41.9% had managed RSV cases in the previous 5 years, 34.4% had diagnosed RSV cases, and 32.6% required a subsequent hospitalization. However, only 14.4% had previously required mAb as immunoprophylaxis for RSV. Knowledge status was substantially inappropriate (actual estimate 54.0% ± 14.2, potential range 0-100), while the majority of participants acknowledged RSV as a substantial health threat for all infants (84.8%). In multivariable analysis, all these factors were characterized as positive effectors for having prescribed mAb (aOR 6.560, 95%CI 2.904-14.822 for higher knowledge score; aOR 6.579, 95%CI 2.919-14.827 for having a hospital background, and a OR 13.440, 95%CI 3.989; 45.287 for living in Italian Major Islands). In other words, reporting less knowledge gaps, having worked in settings with a higher risk of interaction with more severe cases, and being from Italian Major Islands, were identified as positive effectors for a higher reliance on mAb. However, the significant extent of knowledge gaps highlights the importance of appropriate medical education on RSV, its potential health consequences, and the investigational preventive interventions.

Keywords: RSV; RSV all infants; RSV epidemiology; RSV pediatric burden; RSV prevention; RSV vaccines; monoclonal antibodies; respiratory syncytial virus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the selection of study participants.
Figure 2
Figure 2
Density plot for General Knowledge Score (GKS) in 389 Italian Pediatricians participating into the survey, broken down by having or not having cared for Respiratory Syncytial Virus (RSV) cases in the previous 5 years. Cumulative score was substantially skewed for GKS (D’Agostino–Pearson’s normality test: p = 0.084). GKS was substantially greater among participants that had previously cared for RSV cases (56.6% ± 15.5) than among those having not (50.4% ± 12.6, Mann–Whitney test p value < 0.001).
Figure 3
Figure 3
Violin plot with the comparisons of risk perception score (potential range: 0.0–100%) for Respiratory Syncytial Virus (RSV) infections in infants, adults, and elders. (a) All of the respondents’ (No. 389) RPS score for RSV infection in infants (78.3% ± 19.5, range 36.0% to 100%) were substantially higher than that for adults (35.5% ± 22.9, range 4.0% to 100; p < 0.001), and elders (56.1% ± 23.9, p < 0.001). (b) Only respondents having previously cared for RSV cases in previous 5 years (No. 163): RPS score for RSV infection in infants (78.3% ± 17.8, range 48.0% to 100%) was substantially higher than that for adults (32.7% ± 24.9, range 4.0% to 100; p < 0.001), and elders (53.6% ± 23.6, p < 0.001).
Figure 4
Figure 4
Ratings of the perceived importance of monoclonal antibodies in the management of respiratory tract infections by Respiratory Syncytial Virus (RSV) in terms of avoiding natural infections and its complications. Data are reported by including the sample as a whole (a), and only participants that had actually cared for RSV cases in the previous 5 years (b).
Figure 5
Figure 5
Density plot for Risk Perception Score (RPS) in infants (a), adults (b), and elderly (c) in 389 Italian Pediatricians participating into the survey. Cumulative scores were substantially skewed for infants (D’Agostino–Pearson’s normality test: p value 0.006) and adults (p < 0.001), but not for elderly (p = 0.594). When samples were broken down by having or not having previously cared for respiratory syncytial virus cases, no substantial differences in RPS were reported for infants (78.4% ± 17.8 vs. 78.3% ± 20.8; Mann–Whitney test p value 0.432), and elderly (53.6% ± 23.6 vs. 57.9% ± 23.9; p = 0.187). On the contrary, RPS for adults was substantially lower among participants having cared for RSV cases (32.7% ± 24.9) than among those having not (37.4% ± 21.3, p = 0.004).

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