684 - Factors Associated with Nirsevimab Receipt for Respiratory Syncytial Virus Prophylaxis Among Asian and Pacific Islander Infants in Hawaii

Publication Number: 684.4841

Alex Ueoka, Columbia University, Honolulu, HI, United States; Chieko Kimata, Hawaii Pacific Health, Honolulu, HI, United States; Andrea Siu, Hawaii Pacific Health, Honolulu, HI, United States; Kara Wong Ramsey, Kapi'olani Medical Center for Women and Children, honolulu, HI, United States

Background: Nirsevimab is a monoclonal antibody that protects against Respiratory Syncytial Virus (RSV), a leading cause of infant hospitalization. There is limited data about disparities in Nirsevimab receipt, particularly in Native Hawaiian and Pacific Islander (NHPI) populations who previously had lower COVID-19 vaccination uptake.

Objective: The study objective was to identify factors associated with Nirsevimab receipt before hospital discharge for newborns in Hawaii.

Design/Methods: We performed a retrospective chart review of newborns at a hospital in Honolulu, Hawaii discharged between December 2023 and May 2024 who qualified for Nirsevimab by hospital policy: infants with Medicaid insurance, whose mothers did not receive RSV prophylaxis within 2 weeks before delivery, and who did not qualify for Palivizumab per AAP guidelines. A multivariable logistic regression model was used to examine associations between Nirsevimab administration and gestational age, length of stay, race, sex, primary language, residential district (based on home zip code), NICU admission, Hepatitis B immunization administration, and Vitamin K prophylaxis. The model was adjusted for gestational age, length of stay, race, sex, primary language, district, NICU admission, Hepatitis B immunization administration, and Vitamin K prophylaxis, and incorporated interaction variables for race, primary language, and district to obtain adjusted odds ratio (aOR) values.

Results: Of 1,011 eligible newborns, only 52.9% received Nirsevimab. Native Hawaiian (aOR 4.30, 95% CI [1.56, 11.89]) and Other Pacific Islander (aOR 4.81, 95% CI [2.14, 10.81]) newborns were more likely to receive Nirsevimab than Caucasians. Newborns residing in the Windward district of Oahu island were less likely (aOR 0.25, 95% CI [0.10, 0.63]) to receive Nirsevimab than newborns residing in Honolulu. Newborns who had non-English primary language mothers (aOR 2.29, 95% CI [1.22, 4.29]), were admitted to the NICU (aOR 2.34, 95% CI [1.34, 4.08]), or who received the Hepatitis B immunization (aOR 12.93, 95% CI [4.99, 33.54]) were more likely to receive Nirsevimab.

Conclusion(s): Race, language, and geographic residence disparities in Nirsevimab receipt highlight potential cultural differences in approaching healthcare. Higher Nirsevimab uptake among NHPI patients opposes COVID-19 vaccination trends, which may reflect less misinformation about Nirsevimab. The generalizability of our findings may be limited by its focus on Medicaid newborns. Further analysis of non-Medicaid infants is underway. Future research should investigate Nirsevimab refusal to inform targeted community education.

Table 1. Study population demographics


Table 2. Demographic variables by Nirsevimab not administered vs. Nirsevimab administered pre-discharge


Table 3. Likelihood of Nirsevimab administration by demographic variables