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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
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Respiratory syncytial virus and recurrent wheeze in healthy preterm infants

Maarten O Blanken1, Maroeska M Rovers, Jorine M Molenaar

  • 1Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.

The New England Journal of Medicine
|May 10, 2013
PubMed

Insights

Palivizumab significantly reduced wheezing days in preterm infants, suggesting respiratory syncytial virus (RSV) causes recurrent wheeze. This RSV prevention offers a new therapeutic strategy for infants.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Neonatology

Background:

  • Respiratory syncytial virus (RSV) infection is linked to recurrent wheeze in infants.
  • Distinguishing RSV as a cause versus a marker of pulmonary vulnerability in preterm infants is challenging.
  • Palivizumab is a monoclonal antibody proven to prevent severe RSV in high-risk infants.

Purpose of the Study:

  • To evaluate the efficacy of palivizumab in preventing recurrent wheeze in otherwise healthy preterm infants.
  • To determine if RSV infection is a causal mechanism for recurrent wheeze in this population.

Main Methods:

  • A double-blind, placebo-controlled trial (MAKI) involving 429 preterm infants (33-35 weeks gestational age).
  • Infants received monthly palivizumab or placebo during the RSV season.
  • Primary outcome: total parent-reported wheezing days in the first year of life; viral analysis via nasopharyngeal swabs.

Main Results:

  • Palivizumab reduced total wheezing days by 61% (1.8% vs. 4.5%, P<0.001).
  • The proportion of infants with recurrent wheeze was 10 percentage points lower with palivizumab (11% vs. 21%, P=0.01).
  • Benefits persisted even after treatment cessation.

Conclusions:

  • Palivizumab treatment significantly decreased wheezing days in preterm infants, indicating RSV's role in recurrent wheeze.
  • These findings support RSV infection as a key mechanism driving recurrent wheeze in the first year of life for these infants.
  • Palivizumab offers a potential preventative strategy against RSV-associated wheezing.
Abstract

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