What are the recommendations for preventing and treating Respiratory Syncytial Virus (RSV) infection?

Recommendations for Preventing and Treating Respiratory Syncytial Virus (RSV) Infection

Palivizumab prophylaxis is recommended for high-risk infants and children to prevent serious RSV disease, while general preventive measures are recommended for all individuals. 1, 2

Prevention Strategies for High-Risk Infants

Palivizumab Prophylaxis Eligibility

• Palivizumab (Synagis) is indicated for prevention of serious lower respiratory tract disease caused by RSV in specific high-risk pediatric populations 3:
  • Infants born before 29 weeks, 0 days' gestation who are younger than 12 months at the start of RSV season 1, 2
  • Infants with chronic lung disease (CLD) who received medical therapy within 6 months before the start of the RSV season and are younger than 24 months 4, 2
  • Infants with hemodynamically significant congenital heart disease (CHD) who are younger than 24 months 4
  • Children with pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the upper airways 2

Palivizumab Administration

• The recommended dose is 15 mg/kg body weight given monthly by intramuscular injection 3
• Maximum of 5 doses for most eligible infants during the RSV season 4, 1
• Maximum of 3 doses for infants born at 32-34 weeks' gestation with qualifying risk factors 4
• First dose should be administered prior to commencement of the RSV season 3
• For hospitalized infants who qualify for prophylaxis, administer the first dose 48-72 hours before discharge or promptly after discharge 4, 2
• Children who undergo cardiac bypass should receive an additional dose after the procedure due to a 58% decrease in palivizumab serum concentration 4, 2

Special Considerations for Palivizumab

• Not effective for treatment of established RSV disease 3
• Not recommended for primary asthma prevention or to reduce subsequent wheezing episodes 2
• Does not interfere with response to vaccines 4
• If a child receiving monthly prophylaxis experiences breakthrough RSV infection, monthly prophylaxis should continue according to the recommended schedule 4

Prevention Strategies for Adults

• RSV vaccination is recommended for all adults aged ≥60 years, regardless of previous infection history 5
• For adults aged 50-59 years, vaccination is recommended if they have risk factors such as chronic respiratory disease, chronic heart disease, chronic kidney disease, diabetes, immunocompromised status, obesity, neurological conditions, or residence in a nursing home 5
• A single intramuscular dose of RSV vaccine is recommended, preferably administered between September and November, before or early in the RSV season 5

General Preventive Measures for All Ages

• Keep high-risk infants away from crowds and situations where exposure to infected people cannot be controlled 4, 2
• Restrict participation in group child care during RSV season for high-risk infants when feasible 4, 2
• Practice careful hand hygiene 2
• Ensure all eligible infants and their contacts receive influenza vaccine and other age-appropriate immunizations 4, 2
• Eliminate exposure to tobacco smoke 4, 2
• Restrict healthcare personnel with upper respiratory tract infections from caring for high-risk patients 4
• Do not allow persons with symptoms of respiratory infection to visit pediatric, immunosuppressed, or cardiac patients 4

Treatment of RSV Infection

• Primarily supportive care, as no specific antiviral therapy has proven widely effective 6
• Palivizumab is not indicated for treatment of established RSV disease 3
• For hospitalized patients with confirmed RSV infection:
  • Cohort patients according to their specific infections 4
  • When possible, cohort healthcare personnel (restrict personnel who care for infected patients from caring for uninfected patients) 4

Efficacy of Prevention Strategies

• Palivizumab provides a 55% overall decrease in RSV-related hospitalization in premature infants and those with chronic lung disease 1, 3
• 45% decrease in RSV-related hospitalization in infants and children with hemodynamically significant congenital heart disease 1, 3
• Palivizumab has a well-established safety profile, with adverse events similar to placebo 1

Common Pitfalls to Avoid

• Failure to administer an additional dose of palivizumab after cardiac bypass surgery 4, 2
• Inappropriate use of palivizumab in infants with hemodynamically insignificant heart disease (e.g., secundum atrial septal defect, small ventricular septal defect) 4
• Using palivizumab for treatment rather than prevention of RSV infection 3
• Discontinuing prophylaxis prematurely before the end of RSV season 4, 2
• Neglecting general preventive measures while relying solely on pharmacological prophylaxis 4, 2