Preventive Measures and Treatment Options for Respiratory Syncytial Virus (RSV) Disease
The most effective preventive measures for RSV include palivizumab immunoprophylaxis for high-risk infants, strict infection control practices, and supportive care as the primary treatment approach since there are no specific curative treatments available for established RSV disease. 1
Preventive Measures
Immunoprophylaxis with Palivizumab
Palivizumab (Synagis) is recommended for specific high-risk populations:
- Infants born before 29 weeks, 0 days' gestation who are 6 months of age or younger at the beginning of RSV season 1, 2
- Infants with chronic lung disease/bronchopulmonary dysplasia who required medical treatment within the previous 6 months and are 24 months of age or younger 2, 3
- Infants with hemodynamically significant congenital heart disease who are 24 months of age or younger 1, 3
- Infants with congenital abnormalities of the airway or neuromuscular disease that compromises handling of respiratory secretions 1, 2
Administration Guidelines:
- Recommended dose: 15 mg/kg body weight by intramuscular injection monthly 3
- Maximum of 5 doses during RSV season 2, 3
- For infants undergoing cardiac bypass surgery, an additional dose should be administered post-procedure due to a 58% decrease in palivizumab serum concentration 1, 2
Important Limitations:
- Palivizumab is not effective for treatment of established RSV disease 3
- Not recommended for primary asthma prevention or to reduce subsequent wheezing episodes 1, 2
Infection Control Measures
For High-Risk Infants:
- Keep high-risk infants away from crowds and situations where exposure to infected people cannot be controlled 1
- Restrict participation in group child care during RSV season when feasible 1
- Practice careful hand hygiene in all settings 1
- Ensure all infants (beginning at 6 months of age) and their contacts receive influenza vaccine and other age-appropriate immunizations 1
- Eliminate exposure to tobacco smoke 1
- Encourage breastfeeding for all infants 1, 2
In Healthcare Settings:
- Implement contact isolation precautions for confirmed or suspected RSV cases 1
- Wear gloves when handling patients with confirmed/suspected RSV or their respiratory secretions 1
- Wear gowns if clothing could be soiled by respiratory secretions 1
- Change gloves and wash hands between patients 1
- Restrict healthcare workers with acute respiratory illness from caring for high-risk patients 1
- During outbreaks, consider cohorting patients and staff 1
- Use rapid diagnostic techniques during RSV season to promptly identify cases 1
Treatment Options
Since there are no specific curative treatments for RSV disease, management is primarily supportive 4, 5:
- Maintain adequate hydration 4, 5
- Provide supplemental oxygen for hypoxemia 5
- High-flow nasal cannula may be beneficial in severe cases 5
- Mechanical ventilation may be necessary in severe cases 5
Special Populations:
- Immunocompromised patients may be considered for ribavirin treatment in addition to standard supportive care 4
- For children who develop breakthrough RSV infection while receiving palivizumab, monthly prophylaxis should continue as scheduled 1
Future Developments
- Several RSV vaccines are in development 6, 5
- The FDA has approved two RSV vaccines for older adults (not yet for children) 5
- Continued research on subunit vaccines targeting the F protein is ongoing 1
Common Pitfalls to Avoid
- Failing to administer an additional dose of palivizumab after cardiac bypass surgery 1, 2
- Using palivizumab for treatment of established RSV disease (not effective) 3
- Neglecting infection control measures, especially hand hygiene 1
- Overlooking the importance of environmental factors (crowding, daycare attendance, smoke exposure) in increasing RSV risk 7
- Administering palivizumab to patients who don't meet eligibility criteria, such as those with hemodynamically insignificant heart disease 1