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Published on: July 27, 2021
Expert consensus on palivizumab use for respiratory syncytial virus in developed countries
Manuel Sánchez Luna1, Paolo Manzoni2, Bosco Paes3
1Complutense University, Research Institute University Hospital Gregorio Marañon. Neonatology Division, Avda. de Séneca 2, 28040 Madrid, Spain.
Insights
New guidelines recommend palivizumab for infants and children at high risk of respiratory syncytial virus (RSV) infection. This monoclonal antibody prophylaxis aims to reduce hospitalizations in vulnerable young populations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Respiratory syncytial virus (RSV) is a major cause of childhood hospitalization.
- Palivizumab is the sole licensed preventive intervention for RSV.
- Updated guidelines are crucial, considering recent evidence, cost-effectiveness, and healthcare budgets.
Framework:
- A systematic review of nearly 400 publications over five years informed the recommendations.
- RSV experts from Europe, Canada, and Israel collaborated on the evidence-based guidelines.
- Recommendations focus on prophylaxis in industrialized nations.
Implementation:
- Palivizumab is recommended for specific high-risk groups, including preterm infants (e.g., <29, ≤31 weeks gestational age) and those up to 24 months with chronic lung disease, congenital heart disease, Down syndrome, pulmonary/neuromuscular disorders, immunocompromise, or cystic fibrosis.
- Up to five monthly doses are advised during the RSV season.
- Guidelines target infants and children up to 24 months of age, with specific gestational age and age criteria for preterm infants.
Implications:
- Adoption of these guidelines is expected to decrease the burden of RSV hospitalizations in children.
- Optimized palivizumab prophylaxis can improve health outcomes for high-risk pediatric populations.
- Evidence-based recommendations support informed clinical decision-making for RSV prevention.
Abstract:
Respiratory syncytial virus (RSV) infection is a leading cause of hospitalisation in early childhood and palivizumab is the only licensed intervention for prevention. Palivizumab guidelines should reflect the latest evidence, in addition to cost-effectiveness and healthcare budgetary considerations. RSV experts from Europe, Canada and Israel undertook a systematic review of the evidence over the last 5 years and developed recommendations regarding prophylaxis in industrialised countries. Almost 400 publications were reviewed. This group recommended palivizumab for: preterm infants (<29 and ≤31 weeks gestational age [wGA] and ≤9 and ≤6 months of age, respectively; high-risk 32-35wGA), former preterm children ≤24 months with chronic lung disease/bronchopulmonary dysplasia, children ≤24 months with significant congenital heart disease; and other high-risk populations, such as children ≤24 months with Down syndrome, pulmonary/neuromuscular disorders, immunocompromised, and cystic fibrosis. Up to 5 monthly doses should be administered over the RSV season. It is our impression that the adoption of these guidelines would help reduce the burden of RSV.
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