The 2009 COID Recommendations for RSV Prophylaxis: Issues of Efficacy, Cost, and Evidence-Based Medicine

Abstract

The American Academy of Pediatrics (AAP) Committee on Infectious Disease (COID) recently published its updated recommendations for palivizumab prophylaxis for infants at high risk for severe respiratory syncytial virus (RSV) infection.1 Comparison of these guidelines with those published in 20062 reveals changes that would significantly decrease the number of premature infants who would be considered for palivizumab prophylaxis. The most notable changes in the 2009 guidelines are the indications for prophylaxis in premature infants 32 to 35 weeks' gestational age (GA). These changes included: 1. decreasing the chronological age (CA) for infants 32 to 35 weeks' GA for whom palivizumab would be considered from 6 months to 90 days of age at the start of RSV season (in addition, these infants should have at least 1 more risk factor [ie, day care attendance and/or have sibling(s) <5 years of age]); and 2. continuing palivizumab in these infants only until they reach a CA of ≥90 days (ie, a total of 1–3 doses based on date of birth). We believe that some aspects of the new guidelines extend beyond the available evidence-based data and merit discussion. ![Graphic][1] For further study of the AAP's policy on RSV treatments, download “RSV: Prevention of Disease”. This complementary issue of PREP® Audio is being offered exclusively to Pediatrics subscribers and AAP members. This is a must hear for all pediatricians! Current evidence indicates that young CA (infants born within 3 months before or during the RSV season) is an independent risk factor for RSV hospitalization during that RSV season.3 Law et al4 also documented that infants 33 to 35 weeks' GA born between November and January were at increased risk for RSV hospitalization throughout that season. Although they noted higher RSV-related hospitalization rates in 33- to 36-week-GA infants at a CA of … Address correspondence to Leonard R. Krilov, MD, Winthrop University Hospital, 120 Mineola Blvd, Suite 210, Mineola, NY 11501. E-mail: lkrilov{at}winthrop.org [1]: /embed/inline-graphic-1.gif