Guidelines for palivizumab prophylaxis in infants and young children at increased risk for respiratory syncytial virus infection in Saudi Arabia

Abstract

Respiratory syncytial virus (RSV) is a leading cause of serious seasonal lower respiratory tract infections (LRTI) in high-risk infants and children, with epidemics occurring annually in Saudi Arabia from October to March.Premature infants born at less than 29 weeks gestation with chronic lung disease or those with significant congenital heart disease who have RSV infection are more likely to be hospitalized and have increased morbidity and mortality. Palivizumab (Synagis®, Medimmune) is a humanized monoclonal antibody for the prevention of severe LRTI by RSV in high-risk children. The current use of Palivizumab in Saudi Arabia is not regulated and does not meet approved standards.This clinical practice policy statement was developed by the Ministry of Health and is supported by the National Immunization Technical Advisory Group (NITAG) in Saudi Arabia. It is based on available national and international data on the use of Palivizumab for the prevention of severe LRTI caused by RSV in high-risk pediatric patients. These guidelines were solicited and endorsed by two Saudi societies: The Neonatology and the Pediatric Infectious Diseases Societies.

Effectiveness of Palivizumab in High-risk Infants and Children

“…Pediatric societies in several other countries have similarly revised recommendations toward more restrictive use of palivizumab in preterm children. 28 – 30 In contrast, we found that palivizumab had a 58% (95% CI, 43.1%–69%) effectiveness in the prevention of RSV-related hospitalizations after adjusting PE for underlying differences that exist in those who receive palivizumab. Importantly, the point estimate of PE for those 29–35 wGA and ≤6 months of chronologic age without hsCHD or CLD was 74.1% (95% CI, 56.2%–84.7%).…”

Respiratory Syncytial Virus Immunoprophylaxis with Palivizumab: 12-Year Observational Study of Usage and Outcomes in Canada

“…These three groups feature in national RSV prophylaxis guidelines from pediatric societies, such as the United States, 31 Canada, 6 Italy, 32 , and Saudi Arabia. 33 These three high risk groups were also prominent in the reports from the United States, 34 Bosnia, and Herzegovina 15 and from Germany. 16 However, the report from Bosnia and Herzegovina differed from ours and the German report in that HSCHD (34.1%) was almost as common an indication as prematurity (49.2%).…”

The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience

“…Another potential explanation may be the change in prevention strategy, such as change in palivizumab policy for high-risk group prophylaxis against RSV. Nationally, the age of targeted candidate for palivizumab was extended from 29-weeks of gestation up to 32-weeks in the later guidelines [ 22 , 23 ]. Still, the implementation of this change occurred only at end of 2018, which is less likely to affect the prevalence in our cohort that ended in 2018.…”