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Respiratory Syncytial Virus Infection in High-risk Infants - an Update on Palivizumab Prophylaxis
1Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Austria.
Insights
Respiratory syncytial virus (RSV) causes significant illness in young children. Palivizumab prophylaxis is recommended for high-risk infants, with ongoing discussion to extend its use to children with rare diseases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Respiratory syncytial virus (RSV) remains a major cause of morbidity and mortality in infants and young children globally.
- High-risk infant populations susceptible to severe RSV disease have been identified for prophylaxis.
Purpose of the Study:
- To review current guidelines for palivizumab prophylaxis in infants and children.
- To discuss the potential expansion of palivizumab prophylaxis to children with specific rare diseases associated with high RSV morbidity.
Main Methods:
- Review of existing national recommendations for palivizumab prophylaxis.
- Analysis of literature and meta-analyses on palivizumab efficacy.
- Consideration of economic analyses regarding cost-effectiveness.
Main Results:
- Palivizumab is recommended for preterm infants (≤32 weeks GA), late preterm infants (33-35 weeks GA) with risk factors, and those with hemodynamically significant congenital heart disease.
- Increasing discussion surrounds extending prophylaxis to infants and children with rare conditions like malignancy, immune deficiencies, Down syndrome, and cystic fibrosis due to high RSV-associated morbidity.
Conclusions:
- Palivizumab prophylaxis is effective and cost-effective for established indications.
- Evidence supports the expansion of palivizumab prophylaxis to broader pediatric populations with rare diseases and high RSV risk.
Abstract:
Morbidity due to respiratory syncytial virus (RSV) disease is still high in infants and children worldwide during the first two to five years of life. Certain categories of high-risk infants with increased morbidity and mortality attributed to RSV disease have been identified and are included in national recommendations for prophylaxis with the monoclonal RSV antibody palivizumab. Most guidelines recommend palivizumab for preterm infants born less than or equal to 32 weeks gestational age with or without bronchopulmonary dysplasia, those born between 33 and 35 weeks gestational age with additional risk factors, and infants and children with hemodynamically significant congenital heart disease. Over the last years several rare diseases have been identified demonstrating high morbidity associated with RSV disease, thus, extension of guidelines for the prophylaxis with palivizumab for these patients with rare diseases including children with malignancy, congenital and acquired immune deficiency, Down syndrome, neuromuscular impairment, cystic fibrosis, congenital diaphragmatic hernia and other severe respiratory disease is increasingly discussed. Efficacy of palivizumab prophylaxis is documented by meta-analysis, and different economic analyses demonstrate cost-effectiveness of palivizumab for the most common indications during the first RSV season.
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