Increased Risk of RSV Infection in Children with Down's Syndrome: Clinical Implementation of Prophylaxis in the European Union

Dianne Van Beek,Louis Bont,Bosco Paes

doi:10.1155/2013/801581

Dianne Van Beek, Louis Bont + Show 1 more

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https://doi.org/10.1155/2013/801581

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Abstract

Prospective cohort studies show that Down's syndrome (DS) is an independent risk factor for hospitalization for RSV bronchiolitis. It is unknown whether this observation has been translated into specific management for DS children. The primary goal was to assess the knowledge of healthcare providers in the European Union about RSV infection in DS children and to determine whether it influenced the implementation of prophylaxis. DS caregivers were surveyed using a standardized questionnaire, and country-specific guidelines were obtained. Fifty-three caregivers participated. Thirty-nine (86.7%) had knowledge of the increased risk of severe RSV infection in DS children, and 30 (71.4%) graded that it was important to have a statement on the use of RSV prophylaxis in existing guidelines. Twenty-eight participants had a local DS guideline; hard copies of twelve unique guidelines were obtained. Only one (8.3%) contained a statement on RSV prophylaxis for DS, and five considered such a statement for the next version. Conclusion. Most pediatricians had knowledge that DS children have an increased risk of severe RSV infection. Despite the lack of a specific RSV prophylaxis trial in DS, they felt that a statement on RSV prophylaxis in DS guidelines was important, but this was rarely present in current guidelines.

Highlights

Children with Down’s syndrome (DS) suffer more often and more severely from respiratory tract infections
We found a statement on the use of Respiratory syncytial virus (RSV) prophylaxis in only one (8.3%) of the twelve guidelines
According to five DS caregivers who participated in the questionnaire, such a statement on the use of RSV prophylaxis is being considered for the version of the local guideline

Summary

Introduction

Children with Down’s syndrome (DS) suffer more often and more severely from respiratory tract infections. RSV management includes education of parents on how to prevent infection, the implementation of good hand hygiene, and/or the monthly administration of palivizumab (a monoclonal antibody against the RSV-F protein) during the RSV season [6] This humanized monoclonal antibody neutralizes the virus as it binds to the antigenic site of the F-fusion protein of RSV. Palivizumab has become the mainstay for infants with other risk factors for severe RSV bronchiolitis, such as congenital heart disease, chronic lung disease, and prematurity. In those infants, palivizumab has proven to reduce hospitalization rates by 39%–78% [7]. The adoption of RSV prophylaxis varies from 25%–100% [8]

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