The American Academy of Pediatrics (AAP) released a new policy statement Monday concerning RSV infections and the use of the medication Palivizumab (Synagis), which is a monoclonal antibody.
Synagis has been used since 1998 in preterm infants as prophylaxis against serious RSV (respiratory syncytial virus) infections. RSV is one of the most prevalent respiratory infections during the winter months and causes the infection known as bronchiolitis. Bronchiolitis causes cold like symptoms in all ages but has been associated with wheezing and at times respiratory distress requiring hospitalization and supplemental oxygen in infants. The majority of children will have had RSV by the time they are 2 years of age.
For years it has been the standard of care to give preterm infants born at less than 32 weeks gestation (or 35 weeks with certain risk factors) a shot of Palivizumab every month during RSV season in hopes of preventing serious RSV infections and subsequent hospitalizations. Palivizumab is also not an inexpensive medication and dosing is based upon a child’s weight so cost went up as the babies weighed more each month.
But multiple studies are now showing that palivizumab prophylaxis really provided limited benefits in terms of total RSV hospitalizations, effect on wheezing and no measurable effect on mortality. Overall, about 2-3% of infants in the first 12 months of life are hospitalized with RSV infection each year. More than 80% of RSV hospitalizations in the U.S. occur among full-term previously healthy infants in their first 3 months of life. These healthy children were never recommended to receive the prophylactic medication.
So, based on newer data the recommendations will change and palivizumab prophylaxis will now be recommended for infants born before 29 weeks of gestation during their first year of life.( as well as for certain other groups at high risk).
The good news is that the care of premature infants has improved dramatically which has helped to prevent chronic lung disease. There are now fewer than 100 deaths a year due to complications of RSV. With that being said, the best way to prevent RSV infections in all infants, especially those born at preterm is by promoting breast feeding, practicing good hand and cough hygiene, avoiding smoke exposure,immunizing household contacts with flu vaccine and limiting attendance in large group child care during the first winter season if at all possible.
With temperatures across the country now in the “sweltering” range it is hard to think about winter respiratory infections, but these changes are important for both the medical community and new parents as well.