RSV Flashcards
What disease is caused by respiratory syncytial virus (RSV)?
Bronchiolitis
What drugs are used in the management and/or prevention of bronchiolitis? (2)
- Ribavirin
2. Palivizumab
When is ribavirin indicated in the treatment of RSV?
Ribavirin is licensed for administration by inhalation for the treatment of severe bronchiolitis caused by the respiratory syncytial virus (RSV) in infants, especially when they have other serious diseases. However, there is no evidence that ribavirin produces clinically relevant benefit in RSV bronchiolitis.
What is Palivizumab?
A monoclonal antibody
How is palivizumab used in management of bronchiolitis?
Used for prevention in children at high risk of disease; should be prescribed under specialist supervision and on the basis of the likelihood of hospitalization
For which subsets of children is palivizumab recommended? (5)
Recommended:
- Preterm babies under 9 months of age with chronic lung disease (defined as requiring oxygen for at least 28 days from birth)
- Preterm babies under 6 months of age with haemodynamically significant, acyanotic congenital heart disease
Considered:
- children under 2 years of age with severe combined immunodeficiency syndrome (SCID)
- children under 1 year of age who require long-term ventilation
- children 1–2 years of age who require long-term ventilation and have an additional co-morbidity (including cardiac disease or pulmonary hypertension)
What type of virus is RSV?
A paramyxovirus
What are the clinical features of bronchiolitis?
- rasping and persistent dry cough
- wheezing
- apnea
- feeding less and having fewer wet nappies
- vomiting after feeding
- being irritable
Symptoms are usually at their worst between day 3 and day 5. The cough usually gets better within 3 weeks.
When should parents of children with RSV be advised to call 999?
If the child is:
- using accessory muscles of breathing
- tachypneic
- un-arousable or unable to stay awake
- having extended periods of apnea
- cyanotic
How is ribavirin administered in treatment of bronchiolitis?
By inhalation of aerosol or nebulised solution: 20 mg/mL for 12-18 hours for 3-7 days
OR in cases of life-threatening RSV
By IV infusion
How is palivizumab administered?
By IM injection: 15 mg/kg once a month, preferably injected in the anterolateral thigh during season of RSV risk (under expert supervision)
*injection volume over 1 mL should be divided and administered at 2 or more sites
What months are considered highest risk for RSV infection?
November through April with peaks in January and February
How are most cases of bronchiolitis managed?
At home with supportive care only eg adequate hydration, regularly supervision throughout the night, upright positioning, smoke avoidance, fever relief with paracetamol, saline nasal drops to relieve blockage to help during feeding
What drugs are available to kill RSV?
None, symptomatic relief and prevention only
If admitted to hospital, what additional care is offered to children with bronchiolitis?
Oxygen, nasogastric feeding if trouble feeding due to URT blockage, nasal suction
