Respiratory infections in children up to two years of age on prophylaxis with palivizumab

Abstract

OBJECTIVE:To identify the viruses involved in acute respiratory tract infections and to analyze the rates of hospitalization and death in children on palivizumab prophylaxis.METHODS:Prospective cohort of 198 infants up to one year old who were born before 29 weeks of gestational age and infants under two years old with hemodynamically unstable cardiopathy or chronic pulmonary disease who received prophylactic palivizumab against severe respiratory syncytial virus infections in 2008. During the study period, in each episode of acute respiratory tract infection, nasopharyngeal aspirate was collected to identify respiratory syncytial virus, adenovirus, parainfluenza 1, 2 and 3, influenza A and B by direct immunofluorescence, rhinovirus and metapneumovirus by polymerase chain reaction preceded by reverse transcription. Data regarding hospitalization and deaths were monitored.RESULTS:Among the 198 studied infants, 117 (59.1%) presented acute respiratory tract infections, with a total of 175 episodes. Of the 76 nasopharyngeal aspirates collected during respiratory tract infections, 37 were positive, as follow: rhinovirus (75.7%), respiratory syncytial virus (18.9%), parainfluenza (8.1%), adenovirus 2 (2.7%), metapneumovirus (2.7%) and three samples presented multiple agents. Of the 198 children, 48 (24.4%) were hospitalized: 30 (15.2%) for non-infectious etiology and 18 (9.1%) for respiratory causes. Among these 18 children, one case of respiratory syncytial virus was identified. Two deaths were reported, but respiratory syncytial virus was not identified.CONCLUSIONS:During the prophylaxis period, low frequency of respiratory syncytial virus infections and low rates of hospitalization were observed, suggesting the benefit of palivizumab prophylaxis.

Impact of the use of immunoglobulin palivizumab in the State of São Paulo: a cohort study

“…In Brazil, a prospective cohort study with 198 children verified that 48 (24.2%) were hospitalized, 30 (15.2%) due to non-respiratory causes and 18 (9.1%) due to respiratory causes. In only one case (0.5%) the RSV 12 was identified, a value lower than the one found in another study(1.5%) 13 .…”

Avaliação do programa de uso da imunoglobulina palivizumabe no Estado de São Paulo, Brasil

“…Nesse sentido, uma meta-análise realizada em 2009 apontou que a profilaxia resulta em redução de hospitalização em UTI em relação ao placebo (p = 0,0007; RR = 0,29; IC95%: 0,14-0,59) 23 . Outros estudos apontam vantagens do uso da palivizumabe entre crianças de risco, sendo a imunoglobulina considerada eficiente na profilaxia de hospitalização decorrente do VSR 23,24,25 . Outra forma de medir o impacto das falhas: verificou-se que deixar de receber o imunobiológico nos meses de março, abril e junho resultou em hospitalização nos meses subsequentes (abril, maio e julho, respectivamente).…”

“…Nesta pesquisa, o percentual de hospitalização em UTI relacionada à etiologia respiratória foi de 18,8%, tanto para crianças que receberam todas as doses quanto para aquelas que perderam uma dose da imunoglobulina -praticamente o dobro do valor encontrado na coorte brasileira de 198 crianças, na qual a taxa foi de 9,1% 25 . O estudo IMpact 11 , ensaio clínico que fundamentou a adoção da palivizumabe nos Estados Unidos, também encontrou taxa de hospitalização por VSR inferior a deste estudo: 10,6% no grupo sem profilaxia e de 4,8% no grupo que recebeu a imunoglobulina, o que correspondeu à redução de 55%.…”

Immunoprophylaxis against respiratory syncytial virus with palvizumab: what is new?

“…The current edition of the Journal includes an article by Monteiro et al ( 7 ) , which presents results of a study including a cohort of 198 infants who received palivizumab, according to the recommendations in the state of São Paulo, Southeast Brazil. Infants were followed prospectively during a year, to assess the impact of palivizumab on the viral etiology of acute infections in the respiratory tract and rates of hospitalization and death.…”

“…Nesta edição da Revista, Monteiro et al ( 7 ) apresentam os resultados de um estudo que incluiu uma coorte de 198 lactentes que receberam palivizumabe, segundo as recomendações vigentes no Estado de São Paulo. Os lactentes foram acompanhados prospectivamente, durante um ano, para avaliar o impacto do palivizumabe na etiologia viral das infecções agudas do trato respiratório e nas taxas de internação e óbito em crianças submetidas a essa imunoprofilaxia.…”