Respiratory Syncytial Virus Prophylaxis

Abstract

After completing this article, readers should be able to: 1. Identify risk factors for severe respiratory syncytial virus (RSV) lower respiratory tract disease in children. 2. Identify strategies for prevention of severe RSV disease among high-risk infants and children. 3. Know the recommendations for prophylaxis of RSV disease with palivizumab. RSV is the leading viral pathogen responsible for bronchiolitis and pneumonia in infants and young children worldwide. Preterm infants and children who have bronchopulmonary dysplasia (BPD) (otherwise known as chronic lung disease of prematurity) or congenital heart disease are at increased risk for severe RSV disease that requires hospitalization (Table 1). | | Hospitalization | PICU Admission | Death | |:-----------:| --------------- | -------------- | ----- | | Prematurity | 8% | 3% | 1% | | BPD (CLD) | 13% | 36% | 5% | | CHD | 10% | 4% | 0.6% | * PICU=pediatric intensive care unit, BPD=bronchopulmonary dysplasia, CLD=chronic lung disease of prematurity, CHD=congenital heart disease. Table 1. Clinical Outcomes of Respiratory Syncytial Virus Infection Among Infants and Children Who Have High-risk Conditions Education of parents and other caregivers about methods to decrease the infant’s exposure to RSV and to factors that may contribute to the severity of the RSV infection must form the basis of any RSV prophylaxis program. Because RSV is transmitted by direct or close contact with contaminated secretions and the virus is known to persist for hours on environmental surfaces and for 30 minutes or longer on hands, emphasis on hand hygiene is crucial. High-risk infants and children should not be exposed to individuals who have respiratory infections, and if at all possible, they should not be in settings (eg, child care centers) where such exposures are likely. Exposure to tobacco smoke must be eliminated because it has been associated with more severe RSV disease. These measures have the added benefit of decreasing transmission of other respiratory pathogens. In addition, all high-risk children older than 6 months of age and their contacts must receive influenza vaccine. Passive immunoprophylaxis of high-risk children with RSV immune globulin intravenous (RSV-IGIV) and palivizumab has been …