PREVENTION OF SEVERE RESPIRATORY SYNCYTIAL VIRUS INFECTIONS IN INFANTS IN PERU: RECOMMENDATIONS BASED ON THE GRADE METHODOLOGY

Abstract

Introduction: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and represents a major burden of morbidity, hospitalization, and mortality, particularly in the first months of life in low- and middle-income countries such as Peru. Objective: To develop evidence-based recommendations for the prevention of severe RSV infection in infants in Peru. Methods: A clinical practice guideline was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Five PICO questions were formulated, and a systematic review of the evidence was conducted using biomedical databases. Certainty of evidence was assessed considering risk of bias, consistency, precision, and applicability. An evidence-to-decision framework was used to formulate recommendations. Results: Maternal vaccination between 32 and 36 weeks of gestation is recommended to reduce severe RSV disease and hospitalizations in infants (strong recommendation, high-certainty evidence). In infants not protected by maternal vaccination, the administration of nirsevimab is recommended (strong recommendation, high-certainty evidence). In preterm infants and high-risk populations, nirsevimab is the preferred strategy, with strong or conditional recommendations depending on the subgroup and availability of direct evidence. Conclusion: RSV immunoprophylactic strategies have the potential to significantly reduce the disease burden in infants in Peru. Their implementation should be considered a public health priority.