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Practice recommendations for respiratory syncytial virus prophylaxis among children in Hong Kong
K L Hon1, E W Y Cheung2, A M Li3
1Department of Paediatrics, CUHK Medical Centre, The Chinese University of Hong Kong, Hong Kong SAR, China.
Insights
New Hong Kong guidelines recommend respiratory syncytial virus (RSV) prophylaxis based on gestational age, not season, for high-risk infants. This addresses the local burden of RSV hospitalizations in young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Hong Kong experiences a significant burden of respiratory syncytial virus (RSV) hospitalizations in young children.
- Existing international RSV prophylaxis guidelines may not be optimal for subtropical climates like Hong Kong due to differing epidemiology.
- There is a lack of clear seasonal patterns for RSV in Hong Kong, complicating traditional prophylaxis timing.
Purpose of the Study:
- To develop localized recommendations for respiratory syncytial virus (RSV) prophylaxis in Hong Kong.
- To adapt international guidelines to the specific epidemiological context of Hong Kong.
- To provide expert consensus on the optimal use of RSV prophylaxis for vulnerable infant populations.
Main Methods:
- A panel of nine Hong Kong-based experts in neonatology, pediatric intensive care, respiratory medicine, and cardiology convened.
- Recommendations were formulated based on a comprehensive literature review and in-depth expert discussions.
- Consensus was reached on 11 statements covering epidemiology, prophylaxis goals, outcomes, safety, and cost.
Main Results:
- The panel emphasized using gestational age, rather than seasonality, to guide RSV prophylaxis decisions in Hong Kong.
- Consensus was achieved on specific criteria for administering prophylaxis to preterm infants and those with congenital heart disease or bronchopulmonary dysplasia.
- Prophylaxis is recommended for 5-6 months post-discharge for preterm infants born at <29 weeks gestational age.
Conclusions:
- RSV prophylaxis recommendations in Hong Kong should prioritize gestational age due to the absence of distinct seasonality.
- Infants born at <29 weeks gestational age and those under 1 year with specific cardiac or pulmonary conditions are key targets for prophylaxis.
- These localized guidelines aim to optimize RSV prevention strategies for high-risk infants in Hong Kong.
Abstract:
Hong Kong has a high burden of hospitalisations associated with respiratory syncytial virus (RSV) infection in young children. Most international guidelines concerning RSV prophylaxis are based on studies conducted in temperate climates and may not fully apply to subtropical locations such as Hong Kong. In July 2022, a group of nine experts in neonatology, paediatric intensive care, paediatric respiratory medicine, and paediatric cardiology in Hong Kong convened to formulate recommendations for RSV prophylaxis. The recommendations were based on literature review and expert discussion. Each expert reviewed evidence specific to a particular area and formulated consensus statements. The expert panel reached a consensus on 11 statements, which addressed the epidemiology of RSV infection in Hong Kong, the goals and outcomes of RSV prophylaxis in preterm infants and infants with congenital heart disease or bronchopulmonary dysplasia, safety, and cost. Because there is no clear seasonality pattern for RSV infection in Hong Kong, panel members emphasised using gestational age, rather than season, to guide prophylaxis recommendations. The experts agreed that RSV prophylaxis should be considered for 5 to 6 months after hospital discharge among preterm infants born at <29 weeks gestational age; it should also be considered for children aged <1 year with haemodynamically significant congenital heart disease or bronchopulmonary dysplasia.
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