Severe Respiratory Syncytial Virus Infection in Older Children

Groothuis, Jessie R.; Salbenblatt, Carol K.; Lauer, Brian A.

doi:10.1001/archpedi.1990.02150270096033

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…No evidence of enhanced pulmonary disease, such as that described 20 years ago following immunization with formalin-inactivated vaccine (6), was seen in 12 documented episodes of RSV infection over a 2-year follow-up period. One would not expect to see this with a preparation of natural antibody.…”

Section: Discussionmentioning

confidence: 97%

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Groothuis

Levin

Rodríguez

et al. 1991

Antimicrob Agents Chemother

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Infants with cardiopulmonary disease develop severe illness from respiratory syncytial virus (RSV) infection. Safety, feasibility, and pharmacokinetics of intravenous gamma globulin (IVIG) to prevent RSV illness were studied in 23 high-risk infants in a phase I trial. IVIG with an RSV neutralizing antibody titer of 1:1,100 in 5% solution was given monthly over a 2-to 4-h period in a clinical setting during the RSV season. The first group (n = 7) received 500 mg/kg of body weight, the second group (n = 9) received 600 mg/kg, and the third group (n = 7) received 750 mg/kg. Serum was drawn prior to infusion and 2, 14, and 30 days after infusion. Total immunoglobulin G and RSV A2 and RSV neutralizing antibody levels were obtained after the first IVIG infusion. Two children developed mild reversible pulmonary edema (group receiving 600 mg/kg per dose), and one developed hives and wheezing during one infusion (group receiving 500 mg/kg per dose). Twelve children developed subsequent RSV infection during two RSV seasons (November to April) over a 2-year follow-up period; 9 of 12 developed infection during the infusion year. Eleven illnesses were mild; one child died of progressive RSV illness (group receiving 500 mg/kg per dose). A cumulative infusion effect was not observed. IVIG appears safe and feasible in an outpatient setting, and at 750 mg/kg per dose, a target RSV antibody level of 21:100 was achieved.Respiratory syncytial virus (RSV) is the most common cause of serious respiratory illness in young children (2, 8). Children at greatest risk of serious or fatal RSV lower respiratory tract illness include those with bronchopulmonary dysplasia and congenital heart disease (10-12, 21, 22). Because the level of morbidity is so great in these populations, prevention of serious RSV lower respiratory tract illness is an important goal.It is unlikely that a live vaccine will be available in the near future to prevent high-risk young children from developing serious RSV infection. Vaccine development is proceeding cautiously because of the problem in developing a live vaccine which is safe, stable, and immunogenic and to avoid the serious pulmonary complications seen 20 years ago with the use of a formalin-inactivated vaccine (18

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Section: Discussionmentioning

confidence: 97%

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Groothuis

Levin

Rodríguez

et al. 1991

Antimicrob Agents Chemother

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“…The longer period of follow up was chosen as we wished to document the full impact of RSV infection, and it is well appreciated that some young children will be readmitted on more than one occasion with proven RSV infection 16. Although in older children and adults, reinfections with RSV are less severe with each successive occurrence,17 this is not so with young children requiring supplementary oxygen 18. In such patients, the risk for severe disease remains high, even with their second and third infection, and persists while the child's lung disease is sufficiently severe that they require supplementary oxygen 18.…”

Section: Discussionmentioning

confidence: 99%

“…Although in older children and adults, reinfections with RSV are less severe with each successive occurrence,17 this is not so with young children requiring supplementary oxygen 18. In such patients, the risk for severe disease remains high, even with their second and third infection, and persists while the child's lung disease is sufficiently severe that they require supplementary oxygen 18. In a recently reported retrospective cohort study,15 it was shown that children with CLD had high rates of RSV hospitalisation until 24 months of age, whereas after the first year of life, children with congenital heart disease or prematurity have rates no higher than that of children at low risk who were less than 12 months old.…”

Section: Discussionmentioning

confidence: 99%

“…The lower figure was based on a multicentre assessment of infants regardless of comorbidities,21 and the higher figure based on an assessment of high risk infants in a single institution 22. The costs, however, were only calculated for a single season, which is likely to be an underestimate of the impact of RSV infection,18 and they ignored certain types of health service utilisation also likely to generate extra cost 23. The Avon perinatal follow up study has shown that preterm compared to term infants are not only on average six times more likely to be readmitted and require more outpatient attendances, but have more frequent GP consultations and see their health visitors more often for non-routine visits 23.…”

Section: Discussionmentioning

confidence: 99%

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Health care utilisation of infants with chronic lung disease, related to hospitalisation for RSV infection

Greenough

Cox²,

Alexander³

et al. 2001

Archives of Disease in Childhood

174

152

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Aims-To compare the use of health care resources and associated costs between infants with chronic lung disease (CLD) who had or had not an admission with a proven respiratory syncytial virus (RSV) infection. Methods-Review of community care, outpatient attendances, and readmissions in the first two years after birth. Patients: 235 infants (median gestational age 27 weeks) evaluated in four groups: 45 infants with a proven RSV admission (RSV proven); 24 with a probable bronchiolitis admission; 60 with other respiratory admissions; and 106 with non-respiratory or no admissions. Results-The RSV proven compared to the other groups required more frequent and longer admissions to general paediatric wards and intensive care units, more outpatient attendances and GP consultations for respiratory related disorders, and had a higher total cost of care. Conclusion-RSV hospitalisation in patients with CLD is associated with increased health service utilisation and costs in the first two years after birth.

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“…Those with underlying cardiac disease included two patients with a ventricular septal defect, while only one had evidence of pulmonary hypertension. No patient pre- 11 ~,n~£. Patients who presented with features other than bronchiolitis are described in Table 3.…”

Section: Resultsmentioning

confidence: 99%

Atypical Extrapulmonary Presentations Of Severe Respiratory Syncytial Virus Infection Requiring Intensive Care

Njoku

Kliegman

1993

Clin Pediatr (Phila)

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The patterns and nature of a four-month epidemic of severe respiratory syncytial virus (RSV)-associated disease were analyzed using presenting, demographic, clinical, and therapeutic data. Of 218 infants with RSV infection admitted to Rainbow Babies and Childrens Hospital, 49 (22.4%), most born prematurely, entered the pediatric intensive care unit (PICU). Fluorescent antibody and/or enzyme-linked immunosorbent assay documented RSV infection. PICU patients underwent airway stabilization; 53.5% were intubated and evaluated for sepsis. Patients with positive bacterial cultures received antibiotics; 18% were given ribavirin. Patterns of infection included hypothermia, septic shock appearance, apnea, pneumonia, and wheezing due to bronchiolitis. The average age difference between patients with hypothermia (23.3 days) and those with pneumonia (11.2 months) was statistically significant. There were no significant differences in average age, gestational age at birth, number intubated, worst pH and PCO2, duration of intensive care, or treatment modalities between infants with bronchopulmonary dysplasia who received ribavirin and those who did not.

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Severe Respiratory Syncytial Virus Infection in Older Children

Cited by 12 publications

References 21 publications

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Health care utilisation of infants with chronic lung disease, related to hospitalisation for RSV infection

Atypical Extrapulmonary Presentations Of Severe Respiratory Syncytial Virus Infection Requiring Intensive Care

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