Impact of Respiratory Syncytial Virus Immune Globulin in 1996-1997

Abstract

Background: Immune globulin containing high titers of neutralizing antibodies specific for respiratory syncytial virus (RSV) is clinically used to prevent hospitalizations for RSV-related respiratory infections among highrisk infants. However, recommendations regarding which patient populations should receive RSV immune globulin are inconsistent.Objective: To compare hospitalization rates for prematurely born infants with and without chronic lung disease who received RSV immune globulin with similar infants whose parents refused such treatment during the 1996-1997 winter season.Design: Inception cohort study.Participants: Infants born at less than 35 weeks' gestation and less than 6 months old without lung disease and children who had been born prematurely, had chronic respiratory disease, and were less than 2 years old at the onset of the RSV season.Main Outcome Measure: Hospitalization for an RSV-related respiratory illness.Results: Seventy-six infants (66 [87%] with chronic lung disease and 10 [13%] born prematurely without lung disease) received RSV immune globulin; 65 infants (18 [28%] with chronic lung disease and 47 [72%] born prematurely without lung disease) did not. Three (4%) of the treated group and 2 (3%) of the untreated group were hospitalized for RSV infections. Of those with chronic lung disease, 5% (3/66) of those treated with RSV immune globulin were hospitalized, compared with 11% (2/18) of those untreated. Of those born prematurely without lung disease, no infant in the treated (0/10) or untreated (0/47) group was hospitalized. Conclusions:The risk of hospitalization of infants born prematurely who are younger than 6 months without lung disease is low. Current recommendations for preventing RSV illness in this group by using RSV immune globulin may require inclusion of more specific clinical characteristics rather than gestational age alone.

Past, Present and Future Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children

“…RSV-IGIV prophylaxis was associated with a 41% reduction in RSVH and a 53% reduction in total days of hospitalization per 100 children versus placebo (Table 1 ) [ 53 ]. Another study demonstrated that RSV-IGIV is effective in preventing severe RSV disease in preterm infants, with similar results to the PREVENT trial [ 55 ]. In a long-term follow-up study of children with CLD/BPD who had received RSV-IGIV 7–10 years previously in the seminal NIAID trial [ 51 ], these children were shown to have better lung function ( P = 0.02) and less atopy (15 vs. 50%; P < 0.04) compared with matched children who had not received prophylaxis in that trial [ 26 ].…”

Palivizumab prophylaxis and hospitalization for respiratory syncytial virus disease in the Stockholm infant population, 1999 through 2002

“…In other studies it has been shown that hospitalization rates for RSV disease vary considerably, both between and within countries and over time. 11,12 In two recent Spanish studies, the hospitalization rates ranged from 2 to 33% between centers. 3 The difficulties in making comparisons and drawing conclusions from seemingly similar studies underscores the importance of developing local guidelines.…”

Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infections in Children With Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis

“…Fourteen studies reported the risk of RSV hospitalizations [6][7][8][9][10][11][12][13][14][15][16][17][18][19]: 16.8% in BPD and 9.1% in non-BPD (OR, 2.6; 95% CI, 1.7-4.2; P < .001) (Figure 1). Within the prematurity subgroup, BPD was 15.2% versus non-BPD at 9.2%: OR = 2.2 (95% CI, 1.2-4.1; P = .013) (in overall premature group), OR = 1.9 (95% CI, .9-4.0; P = .104) (≤35 weeks GA), and OR = 2.6 (95% CI, 1.0-7.2; P = .062) (≤33 weeks GA).…”

“…Weigl et al [22] reported a 17.8-fold increased risk of hospitalization for RSV in children less than 2 years old with BPD (95% CI, 1.7-188.0) compared with non-BPD (GA of <32 weeks for both groups). Lee et al [16] Homaira et al [12] Redding et al [18] PREVENT Study Group [11] Other possible co-morbidities not specified(a) Subtotal (I-squared = 97.9%, p = 0.000)…”