Nationwide survey of severe respiratory syncytial virus infection in children who do not meet indications for palivizumab in Japan

Mori, Masaaki; Kawashima, Hisashi; Nakamura, Hidefumi; Nakagawa, Masao; Kusuda, Satoshi; Saji, Tsutomu; Tsutsumi, Hiroyuki; Yokota, Shumpei; Itoh, Shinji

doi:10.1007/s10156-010-0121-1

Cited by 32 publications

(33 citation statements)

References 15 publications

(15 reference statements)

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“…Similarly, in a nationwide Japanese survey conducted from 2006 to 2008, 1,115 children aged <4 years who were hospitalized with RSV did not meet current criteria for prophylaxis. Among 756 infants with underlying disorders, 54.8% had respiratory conditions, 16.5% had neuromuscular impairments, 3.6% had CHD, 1.6% were immunocompromised, 1.1% had metabolic disorders, and 5.3% were documented with other illnesses [34]. Immunocompromised patients had a significantly worse outcome ( p < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have found that infants with medical conditions, such as neuromuscular impairment [47], Down syndrome [6], cystic fibrosis [1, 23], and immune dysfunction [22, 29] are at higher risk of hospitalizations due to RSV infection. Preexisting disease has also been previously shown to be associated with higher morbidities and mortality rates due to RSV infection [3, 34, 44, 46]. …”

Section: Discussionmentioning

confidence: 99%

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Respiratory hospitalizations and respiratory syncytial virus prophylaxis in special populations

Paes

Mitchell

et al. 2011

Eur J Pediatr

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Palivizumab utilization, compliance, and outcomes were examined in infants with preexisting medical diseases within the Canadian Registry Database (CARESS) to aid in developing guidelines for potential “at-risk” infants in the future. Infants who received ≥1 dose of palivizumab during the 2006–2010 respiratory syncytial virus (RSV) seasons at 29 sites were recruited and utilization, compliance, and outcomes related to respiratory infection/illness (RI) events were collected monthly. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for premature infants ≤35 completed weeks gestational age (GA) who met standard approval criteria (group 1) compared to those with medical disorders (group 2) using Cox proportional hazards regression models with adjustment for potential confounding factors. Of 7,339 registry infants, 4,880 were in group 1 and 952 in group 2, which included those with Down syndrome (20.3%), upper airway anomalies (18.7%), pulmonary diseases (13.3%), and cystic fibrosis (12.3%). Group 2 were older at enrolment (10.2 ± 9.2 vs. 3.5 ± 3.1 months, p < 0.0005), had higher GA (35.9 ± 6.0 vs. 31.0 ± 5.4 weeks, p < 0.0005), and were less compliant with treatment intervals (69.4% vs. 72.6%, p = 0.048). A greater proportion of group 2 infants were hospitalized for RI (9.0% vs. 4.2%, p < 0.0005) and RSV (2.4% vs. 1.3%, p = 0.003) (unadjusted). Being in group 2 was associated with an increased risk of RI (HR = 2.0, 95%CI 1.5–2.5, p < 0.0005), but not RSV hospitalization (HR = 1.6, 95%CI 0.9–2.8, p = 0.106). In infants receiving palivizumab, those with underlying medical disorders, though not currently approved for prophylaxis, are at higher risk for RI events compared with preterm infants. However, risk of RSV hospitalizations is similar.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Respiratory hospitalizations and respiratory syncytial virus prophylaxis in special populations

Paes

Mitchell

et al. 2011

Eur J Pediatr

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“…Until recently, the British Columbia Guidelines [65] has stated that infants eligible for palivizumab administration include infants with severe immunodeficiency. A recent Japanese study [67] reported that 1,115 infants younger than 4 years were hospitalized for RSV infections in a 2-year consecutive seasons: 756 of them had underlying disorders that were not included in the criteria for palivizumab prophylaxis in Japan. These disorders included severe immunodeficiency and Down syndrome.…”

Section: Rsv Prophylaxis In Immunocompromised Infantsmentioning

confidence: 99%

Respiratory Syncytial Virus Infections in Infants Affected by Primary Immunodeficiency

Lanari¹,

Vandini

Capretti

et al. 2014

Journal of Immunology Research

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Primary immunodeficiencies are rare inherited disorders that may lead to frequent and often severe acute respiratory infections. Respiratory syncytial virus (RSV) is one of the most frequent pathogens during early infancy and the infection is more severe in immunocompromised infants than in healthy infants, as a result of impaired T- and B-cell immune response unable to efficaciously neutralize viral replication, with subsequent increased viral shedding and potentially lethal lower respiratory tract infection. Several authors have reported a severe clinical course after RSV infections in infants and children with primary and acquired immunodeficiencies. Environmental prophylaxis is essential in order to reduce the infection during the epidemic season in hospitalized immunocompromised infants. Prophylaxis with palivizumab, a humanized monoclonal antibody against the RSV F protein, is currently recommended in high-risk infants born prematurely, with chronic lung disease or congenital heart disease. Currently however the prophylaxis is not routinely recommended in infants with primary immunodeficiency, although some authors propose the extension of prophylaxis to this high risk population.

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“…Premature infants with or without chronic lung disease and infants with hemodynamically significant congenital heart disease comprise these high-risk groups [52]. Other special populations that have been found to be at an increased risk of significant RSV-associated LRTI are patients with neuromuscular disease, Down syndrome, immunodeficiency and cystic fibrosis [1,7,17,25,39,53].…”

Section: Introductionmentioning

confidence: 98%

The impact of prophylaxis on paediatric intensive care unit admissions for RSV infection: a retrospective, single-centre study

et al. 2010

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Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections and hospitalizations in children aged < 2 years. The aim of this retrospective, single-centre study was to examine the characteristics of patients admitted to a paediatric intensive care unit (PICU) with RSV infection following the implementation of a RSV prophylaxis programme. Electronic hospital medical records of all PICU admissions for RSV infection were searched from 2003 to 2009. Data on baseline demographics, underlying disease, criteria for hospitalization, respiratory diagnosis and management, complications and palivizumab prophylaxis were collected. A total of 181 patients were admitted with RSV infection, accounting for 5.7% of all admissions. Eighty-four percent were ≤ 2 years of age. Majority (70.2%) had no underlying medical illness, and 79.6% received antibiotics as part of their medical treatment. Comparison of children aged ≤ 2 years and those >2 years revealed that fewer of the younger cohort (20.4% versus 79.3%; p < 0.001) had an underlying medical condition. RSV infection occurred in 3.3% (n = 6) children who had received palivizumab prophylaxis, and there were two deaths. The results indicate that > 88% of all PICU admissions would not qualify for RSV prophylaxis under our established guidelines and 66% of the children aged ≤ 2 years were > 36 weeks gestation and are not currently targeted for prophylaxis. The number of high-risk infants admitted to PICU with RSV infection has likely plateaued, and further reductions in admission rates may only be realised with the use of universal, vaccine immunization programmes.

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Nationwide survey of severe respiratory syncytial virus infection in children who do not meet indications for palivizumab in Japan

Cited by 32 publications

References 15 publications

Respiratory hospitalizations and respiratory syncytial virus prophylaxis in special populations

Respiratory hospitalizations and respiratory syncytial virus prophylaxis in special populations

Respiratory Syncytial Virus Infections in Infants Affected by Primary Immunodeficiency

The impact of prophylaxis on paediatric intensive care unit admissions for RSV infection: a retrospective, single-centre study

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