Respiratory Syncytial Virus Disease: Immunoprophylaxis Policy Review and Public Health Concerns in Preterm and Young Infants

Abstract

Globally, respiratory syncytial virus (RSV) is a leading cause of hospitalization due to severe respiratory infections in infants of all gestational ages and children aged 5 years and younger, and it is associated with a substantial health care burden. Approximately, 1% to 3% of infants younger than 1 year are hospitalized with severe RSV disease in the United States. With no specific treatment or vaccine, palivizumab is the only licensed immunoprophylaxis for the prevention of severe RSV disease in high-risk pediatric populations, including infants born at or before 35 weeks’ gestational age (wGA). In the United States, the American Academy of Pediatrics (AAP) periodically publishes its recommendation for the use of RSV immunoprophylaxis, which is largely followed by health care professionals and payers. In 2014, the AAP Committee on Infectious Diseases stopped recommending RSV immunoprophylaxis for otherwise healthy infants born at or after 29 wGA and stated that the RSV hospitalization rates in infants 29 to 34 wGA and full-term infants were similar. Several studies have demonstrated that a significant decline in palivizumab use following the AAP 2014 recommendations was accompanied by increases in rates of RSV hospitalization and disease severity and hospital costs in infants 29 to 34 wGA versus full-term infants. Despite the growing evidence demonstrating high RSV morbidity in infants 29 to 34 wGA, the AAP reaffirmed its 2014 policy in 2019. This article will discuss the critical roles and strategies of advocacy groups and nurses in providing the maximum protection with RSV immunoprophylaxis to all high-risk and label-eligible preterm infants.

Preventing Respiratory Syncytial Virus in Children in France: A Narrative Review of the Importance of a Reinforced Partnership Between Parents, Healthcare Professionals, and Public Health Authorities

“…In one study, off-label use of palivizumab was observed in relatively high proportions of the overall (term + preterm) infant population (40% of infants aged less than 6 months and 59% of infants aged less than 24 months) [ 58 ]. However, widespread use of palivizumab is restricted by its high acquisition cost, its short half-life (requiring up to five monthly intramuscular injections during the RSV season [ 20 , 60 ]), and poor compliance (which often leads to incomplete prophylaxis) [ 53 ]. There is a clear need for a long-acting, cost-effective alternative to palivizumab to protect all infants, regardless of gestational age at birth or comorbidities, throughout their first RSV season [ 20 , 21 , 61 ].…”

Nasal-spraying Bacillus spores as an effective symptomatic treatment for children with acute respiratory syncytial virus infection

“…RSV is very contagious due to its multiple routes of infection from person-to-person by getting into the eyes, nose, or mouth while easily spreading through the air via viral droplets 12 . Prevention of RSV infection is important, as repeated infections may occur throughout one’s lifetime 13 , 14 . Up to now, there is no available vaccine and specific treatment for RSV-infected children.…”

Efficacy and safety of respiratory syncytial virus vaccination during pregnancy to prevent lower respiratory tract illness in newborns and infants: a systematic review and meta-analysis of randomized controlled trials

“…Respiratory syncytial virus (RSV) is a leading cause of hospitalization for lower respiratory tract diseases in infants worldwide. RSV is accountable for approximately 102,000 deaths annually from RSV infection worldwide, making it a prominent cause of death in infants under 6 months of age, particularly in low- and middle-income countries ( 1 , 2 ). Severe lower respiratory tract illness associated with RSV is most prevalent between the months of March and June following birth.…”