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Respiratory syncytial virus prevention: past and present strategies
1Guy's, King's & St Thomas' School of Medicine, King's College Hospital, London SE5 9RS, UK. anne.greenough@kcl.ac.uk
Insights
Respiratory syncytial virus (RSV) immunoprophylaxis can reduce hospitalizations in high-risk infants. Palivizumab is a preferred monoclonal antibody for preventing severe RSV disease, offering a safer option than RSV immunoglobulin.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Respiratory syncytial virus (RSV) is a leading cause of respiratory illness in young children, with potential for long-term respiratory issues.
- Severe RSV disease disproportionately affects very young infants and those with underlying health conditions.
- Current RSV management is primarily supportive, highlighting the need for effective preventive strategies like immunoprophylaxis.
Purpose of the Study:
- To review the efficacy and safety of immunoprophylaxis for preventing severe respiratory syncytial virus (RSV) infections in high-risk infants.
- To compare the effectiveness of different immunoprophylactic agents, including RSV immunoglobulin and monoclonal antibodies.
- To inform recommendations for the use of immunoprophylaxis in pediatric populations at risk for RSV.
Main Methods:
- Review of randomized controlled trials and clinical studies evaluating RSV immunoprophylaxis.
- Analysis of data on hospitalization rates, adverse events, and cost-effectiveness.
- Examination of antibody titers and neutralizing capacities of different immunoglobulins and monoclonal antibodies.
Main Results:
- RSV immunoglobulin (RSV-IGIV) demonstrated reduced hospitalization in preterm infants but carried risks for those with cyanotic congenital heart disease.
- Palivizumab, a humanized monoclonal antibody, significantly reduced RSV-related hospitalizations in high-risk infants without serious adverse events.
- Patient selection is crucial for the cost-effective implementation of immunoprophylaxis.
Conclusions:
- Immunoprophylaxis is a viable strategy to mitigate the impact of severe RSV infections in vulnerable infants.
- Palivizumab is recommended by the American Academy of Pediatrics as the preferred agent for high-risk infants due to its safety and efficacy profile.
- Careful patient selection is essential for optimizing the benefits and cost-effectiveness of RSV immunoprophylaxis.
Abstract:
Respiratory syncytial virus (RSV) is a common cause of respiratory illness in young children, almost all will have been infected by the age of two years old. Very young infants, and those with underlying disease, are at risk of severe RSV disease, but even those who were previously healthy can suffer recurrent respiratory symptoms 9 to 10 years after their initial infection. The management of RSV infection is essentially supportive, thus prophylaxis offers the best hope of reducing the morbidity and mortality of RSV infection. There is no safe and effective RSV vaccine to use in those infants who are at highest risk from the infection. Immunoprophylaxis, however, has been shown to have benefits in randomised controlled trials. Standard immunoglobulin, however, is ineffective as its administration does not achieve an adequate titre of neutralising antibodies. RSV immunoglobulin (RSV-IGIV, RespiGam, Massachusetts Public Health Laboratories, Boston, MA), in contrast, contains high levels of RSV neutralising antibody and has been shown to significantly reduce hospitalisation in preterm infants with or without bronchopulmonary dysplasia (BPD). Its use is not recommended in infants with cyanotic congenital heart disease (CHD), as it was associated with an excess of adverse events. A humanised RSV monoclonal antibody (Palivizumab, MEDI-493, Synagis, MedImmune Inc, Gaithersburg, MD) also significantly reduces hospitalisation for RSV infection in high risk infants, but without serious side effects. The American Academy of Paediatrics has recommended that immunoprophylaxis should be considered for young children at high risk of severe RSV infection and that palivizumab is the preferred agent. Studies have suggested it is essential to carefully select patients for immunoprophylaxis, if its use is to be cost-effective.