Respiratory syncytial virus (RSV) infection in children with neuromuscular diseases (NMD): a literature review & a survey of Palivizumab prophylaxis in the UK

Abstract

<b>Background:</b> Palivizumab prophylaxis is advised for infants at risk of severe RSV infection. The UK Palivizumab guidelines do not include children with NMD e.g. Spinal Muscular Atrophy (SMA). <b>Aims:</b> To review published evidence for risks of RSV and role of Palivizumab in infants with NMD To survey UK healthcare practitioners (HCPs) on Palivizumab use for infants with NMD, including SMA-1 <b>Methods:</b> PubMed was searched using the terms ‘respiratory syncytial virus’ AND ‘neuromuscular disease OR neuromuscular disorder OR neuromuscular disability OR muscular atrophy OR muscular dystrophy’. Results were filtered to ‘infant: birth-23 months’. A questionnaire was circulated to paediatric teams in the UK. HCPs were asked about Palivizumab use for children with SMA-1. <b>Results:</b> PubMed identified 34 publications for review. Three database studies suggest NMD is a risk factor for severe RSV infection; 2 studies identify NMD as a potential mortality risk factor. Median age at diagnosis was higher in the NMD group (14 vs 6 months). Ten studies including 3 registry studies and a systematic review recommend offering Palivizumab to infants with NMD. Survey completed by 17 HCPs from 15 UK centres; 53% had used Palivizumab for children with SMA-1, mainly as part of standard pathway or for clinically severe cases. Most (82%) agree “there needs to be more evidence” for Palivizumab use in children with NMD. <b>Conclusions:</b> Evidence shows risk of severe RSV infection in children with NMD, but there are no randomised controlled trials for role of Palivizumab. Many HCPs use Palivizumab for SMA-1; immunisation guidelines should consider this for a consistent approach.