By: Mahdieh Danesh Yazdi, Associate Student Editor

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Many of us have prepared for influenza season by receiving the flu vaccine.  (If you have not, please speak to your doctor or pharmacist soon!  Remember: even if you do not need it for your protection, get it for your patients’ well-being).  However, for the youngest members of our population, there is also another threat this season: respiratory syncytial virus (RSV).  RSV is a single-stranded RNA virus that causes symptoms of the common cold such as fever, runny nose, coughing, and wheezing.¹  For older children and adults, it causes self-limiting sickness that resolves within a couple of weeks.¹  However, in younger children and infants, infection with this virus may cause a much more serious illness.  In fact, it is a major cause of pediatric pneumonia and bronchiolitis.¹  This is especially true in infants and young children who have comborbidities such as congenital heart disease or immunosuppression.¹  There is currently no treatment specifically indicated for use against RSV and therapy usually involves supportive care.¹

As with many other diseases of viral etiology, the best medical option is prevention.  Non-pharmacologic prevention methods include minimizing sharing personal items and utensils between children, frequent hand washing, and avoiding contact with those who are sick.  Currently, there is only one medication indicated for the prevention of RSV: palivizumab (Synagis^®), a monoclonal antibody that works by preventing viral membrane fusion and blocking its entry to host cells.²

The American Academy of Pediatrics (AAP) has published guidelines for palivizumab in RSV prevention.³  They recommend a 15 mg/kg once monthly intramuscular injection for³

 

• Infants < 24 months of age with chronic lung disease requiring therapy in the past six months
• Infants < 24 months of age with congenital heart disease +
  • Therapy OR
  • Moderate to severe pulmonary hypertension OR
  • Cyanotic heart disease
  • Infants < 12 months of age with airway abnormality or neuromuscular disease that would decrease one’s ability to manage airway secretions
  • Infants < 12 months of age who were born at a gestational age ≤ 28 weeks
  • Infants  < 6 months of age who were  born at a gestational age of 29 to 31 weeks and 6 days
  • Infants < 3 months of age who were born at a gestational age of 32 to 34 weeks and 6 days +
    • Attends daycare
    • Has one or more siblings < 5 years of age in the same household (excluding multiple birth babies)

The AAP recommends that infants receive these monthly injections during RSV season with a maximum of five injections.³  The exception is in the case of infants < 3 months of age who were born at a gestational age of 32 to 34 weeks (and 6 days) and either attend daycare or have one or more siblings who are < 5 years of age in the same household.³  These patients should receive a maximum of three injections.³

The common side effects of this drug include erythema and swelling at the injection site, fever, and rash.⁴  It is important to keep in mind that injections of this drug may cause anaphylactic reactions in those with hypersensitivity to palivizumab or any component of the drug.⁴

RSV season varies yearly and based on region, but usually begins around November and ends in March or April.⁵  Palivizumab is recommended to be given the month before or during RSV season; therefore, the first dose is usually provided between September and November.⁵

If you have a new baby in your household and he/she meets the criteria above, speak to the pediatrician about RSV prevention for the infant.  Since this virus is highly contagious and is of special concern in infants with other comorbidities, those working in a hospital setting must be wary of the threat RSV poses.  Of course, if you are on rotations (within a pediatric or neonatal unit), be sure to screen patients to determine their eligibility for palivizumab.

SOURCES:

1. Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D.  Rubin’s Pathology: Clinicopathologic Foundations of Medicine.  Fourth ed.  Philadelphia, PA: Lippincottt Williams & Wilkins;2005: 364.
2. Synagis [package insert].  Gaithersberg, MD: Medimmune, LLC; 2012.
3. American Academy of Pediatrics.  Respiratory Syncytial Virus.  In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds.  Red Book: 2009 Report of the Committee on Infectious Diseases.  28th ed.  Elk Grove Village, IL: American Academy of Pediatrics; 2009.
4. Synagis [package insert].  Gaithersberg, MD: Medimmune, LLC; 2012.
5. CDC features page.  Centers for Disease Control and Prevention Web site.  http://www.cdc.gov/Features/dsRSV/.  Accessed Oct 30, 2012.

Published by Rho Chi Post