Preventing Hospitalizations for RSV Infection

Question 1

What is the most common cause of LRTIs in young children?

Answer 1

• RSV
• Almost all kids experience first infection by 2 yrs

Question 2

What is he incidence of hospitalization for RSV infection?

Answer 2

1-3% of infants hospitalized with RSV infection

Question 3

When does RSV season start in Canada and how long does it last?

Answer 3

• Starts in November-December
• Lasts 4-5 months

Question 4

How can parents decrease the risk of RSV?

Answer 4

• Young infants and siblings should avoid individuals sick with LRTI
• Hand hygiene
• Breastfeeding
• Avoiding cigarette smoke

Question 5

What is Palivizumab?

Answer 5

• HUmanized monoclonal murine IgG-1 directed against an F glycoprotein of RSV
• Produced by recombinant DNA technology

Question 6

What is the dose of Palivizumab?

Answer 6

• 15mg/kg IM Q30 days during RSV season
• Maximum 5 doses

Question 7

Is there any evidence showing increased rates of hospitalization for RSV between the first and second doses of Palivizumab?

Answer 7

• No!
• No evidence to show giving the second dose 20 days after the first dose is beneficial

Question 8

How much does Palivizumab cost?

Answer 8

• $5600 for 5 doses for a 5kg baby assuming no waste

Question 9

Are there any recognized serious adverse events associated with Palivizumab?

Answer 9

Rare cases of anaphylaxis reported

Question 10

What strategies are used to determine that start of prophylaxis?

Answer 10

• Different provincial/territorial programs govern individual programs
• Some programs have uniform start/stop dates
• Other programs rely on lab surveillance data to determine start dates
  
  • This is a more cost effective strategy
  • But more complicated to organize

Question 11

What is the efficacy of Palivizumab?

Answer 11

• 80% reduced RSV hospitalization for prem infants with no CLD
• 40% reduced RSV hospitalization for prem infants with CLD
• 45% reduced RSV hospitalization for babies with CHD
• Efficacy not demonstrated in CHD subgroup with cyanotic dz

Question 12

What confounding factors make Palivizumab seem more effective than it is?

Answer 12

False-negative results for RSV detection in the presence of Palivizumab have been reported

Question 13

What are the short-term benefits of Palivizumab?

Answer 13

• No evidence that Palivizumab prevents ICU admission of that the severity of breakthrough RSV is less severe