Disparities in Nirsevimab Uptake Across a Pediatric Primary Care Network.

Abstract

Nirsevimab, a monoclonal antibody for respiratory syncytial virus (RSV) prophylaxis, debuted during the 2023-2024 RSV season. The objective of this study was to examine the distribution of nirsevimab to determine factors associated with nirsevimab receipt. Primary care attendee cohort of children younger than 8 months attending 1 of 32 pediatric primary care practices with almost universal nirsevimab availability. Eligible children had at least 1 primary care visit within 14 days of birth and at least 1 primary care visit after turning 8 months old or after the end of RSV season. Logistic regression was used to determine factors associated with nirsevimab receipt. A total of 2534 (35%) of 7208 eligible patients received nirsevimab, ranging from 20% to 65% across practices. Factors associated with lower rates of nirsevimab receipt included older age (odds ratio [OR], 0.60; CI, 0.58-0.62 for each additional month), Black race (OR, 0.53; CI, 0.43-0.65 compared with white infants), very low Child Opportunity Index (COI) (OR, 0.70; CI, 0.54-0.91 compared with very high COI), and public insurance (OR, 0.79; CI, 0.67-0.92 compared with private insurance). In a large, diverse pediatric primary care network, 35% of eligible children received RSV prophylaxis despite near universal availability. Practice site, age, race, COI, and insurance were associated with nirsevimab receipt. Future work should examine the drivers of these disparities to inform quality improvement work to protect all infants from RSV.