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Respiratory syncytial virus infection: clinical features, management, and prophylaxis
1Department of Paediatrics, Guy's, King's & St Thomas' School of Medicine, King's College, London, UK. anne.greenough@kcl.ac.uk
Insights
Respiratory syncytial virus (RSV) causes widespread infant hospitalizations and reactive airway disease. While immunoprophylaxis with Palivizumab reduces admissions, its high cost may outweigh savings, especially for non-high-risk infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Respiratory syncytial virus (RSV) is a common childhood infection, affecting nearly all children by age two.
- RSV infection frequently leads to infant hospitalizations and can cause reactive airway disease, even in healthy children.
- Current management for acute RSV infection is primarily supportive.
Purpose of the Study:
- To review the management and prevention strategies for respiratory syncytial virus (RSV) in infants.
- To evaluate the efficacy and cost-effectiveness of different interventions for RSV infection and its sequelae.
Main Methods:
- Review of existing literature on RSV management and immunoprophylaxis.
- Analysis of the cost-effectiveness of Palivizumab compared to RSV immune globulin for prophylaxis.
- Assessment of controversial treatments like ribavirin and corticosteroids.
Main Results:
- Preliminary evidence suggests surfactant administration may benefit ventilated infants with RSV.
- Palivizumab offers a more cost-effective immunoprophylaxis option compared to RSV immune globulin.
- The cost of immunoprophylaxis often exceeds the savings from reduced hospital admissions, except for very high-risk infants.
Conclusions:
- RSV remains a significant cause of infant morbidity and hospitalization.
- Palivizumab is a viable immunoprophylaxis option, but cost-effectiveness is a major consideration.
- Further research is needed on treatments like ribavirin and corticosteroids for RSV-related respiratory morbidity.
Abstract:
Respiratory syncytial virus (RSV) infects almost all children by two years of age, resulting in a large number of hospital admissions in infants. Reactive airway disease is more common after RSV infection, even in previously healthy children. Management of the acute infection is supportive, but preliminary evidence suggests surfactant administration to ventilated infants may be of benefit. Whether ribavirin or corticosteroids reduce respiratory morbidity after RSV infection remains controversial. Immunoprophylaxis reduces RSV admissions, Palivizumab, a humanized monoclonal antibody, is a more cost-effective prophylaxis than RSV immune globulin. Nevertheless, the cost of prophylaxis, unless only given to very high-risk infants, exceeds savings made in reducing admissions.