In a policy statement published in the August 2014 Pediatrics, "Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection," and an accompanying technical report, both published online July 28, the American Academy of Pediatrics (AAP) revises its recommendations for use of palivizumab for respiratory syncytial virus (RSV).
The updated recommendation targets the infants most likely to benefit from palivizumab prophylaxis based on a comprehensive review of the literature, which is included in the technical report.
RSV is a common infection in young children and usually causes mild upper respiratory tract illness, but it can cause more severe disease in premature infants and those with chronic illnesses. Multiple studies show that the overall rate of RSV hospitalization does not differ between African-American and white children younger than 24 months of age. Palivizumab, a monoclonal antibody given in a series of doses during the RSV season, has been shown to have a limited effect on reducing RSV hospitalizations. Studies show it does not reduce mortality from RSV or lower rates of subsequent wheezing or asthma. Overall advances in neonatal care since palivizumab was first licensed in 1998 mean preterm infants are generally healthier, and the rate of RSV hospitalizations has declined, regardless of whether or not infants receive palivizumab prophylaxis.
Evidence of these falling rates of RSV hospitalizations, along with new data about which children are at highest risk of RSV hospitalization, guided the AAP recommendation that palivizumab prophylaxis be limited to infants born before 29 weeks gestation, and to infants with certain chronic illnesses like congenital heart disease or chronic lung disease.
For all infants, particularly those born at preterm, the AAP emphasizes that it's important to minimize the risk of infection with RSV and other viruses by:
- Offering breast milk
- Immunizing members of the household against influenza
- Practicing good hand and cough hygiene
- Avoiding smoke exposure
- Limiting attendance in large group child care during the first winter season whenever possible
- Avoiding contact with anyone who is ill