Management of Infections Caused by Respiratory Syncytial Virus (original) (raw)
Related papers
The Pediatric infectious disease journal, 2007
Risk factors for severe respiratory syncytial virus (RSV) disease include prematurity, congenital heart disease, chronic lung disease, and immunocompromised states. There is no consensus concerning the most effective therapy for severe RSV infection in high-risk patients. Palivizumab is approved for prevention of RSV disease, and ribavirin is approved for treatment of RSV infections but its efficacy in high-risk patients has not been conclusively established.
Revised recommendations concerning palivizumab prophylaxis for respiratory syncytial virus (RSV)
Italian Journal of Pediatrics, 2015
Respiratory Syncytial Virus infections are one of the leading causes of severe respiratory diseases that require hospitalization and, in some cases, intensive care. Once resolved, there may be respiratory sequelae of varying severity. The lack of effective treatments for bronchiolitis and the lack of vaccines for RSV accentuate the role of prevention in decreasing the impact of this disease. Prevention of bronchiolitis strongly relies on the adoption of environment and the hygienic behavior measures; an additional prophylactic effect may be offered, in selected cases, by Palivizumab, a humanized monoclonal antibody produced by recombinant DNA technology, able to prevent RSV infection by blocking viral replication. After many years the Italian Society of Neonatology, on the basis of the most recent scientific knowledge, has decided to revise recommendations for the use of palivizumab in the prevention of RSV infection.
Cureus, 2021
Respiratory syncytial virus (RSV) is a frequent cause of respiratory tract infections in children. Still, it can also cause seasonal outbreaks affecting persons of all ages, especially those with comorbidities or immunocompromised states. Ribavirin is one of the two approved therapies for the treatment of RSV respiratory tract infections. Unfortunately, its aerosolized formulation has been approved only in children, and the oral formulation is not frequently used to treat the infection. However, ribavirin has demonstrated morbidity and mortality benefit in immunocompromised patients. A 70-year-old female had started chemotherapy for a diagnosis of B-cell acute lymphoblastic leukemia (B-ALL). She developed an upper respiratory tract infection (URTI) along with positive RSV status. We started her on oral ribavirin therapy, which had to be stopped after five days of treatment due to an acute hemolytic reaction. She was re-initiated on oral ribavirin after cessation of medication for seven days and showed improvement. Therefore, ribavirin can be used in immunocompromised patients with RSV infection under proper supervision.
Review of palivizumab in the prophylaxis of respiratory syncytial virus (RSV) in high-risk infants
Biologics: targets & therapy, 2008
In respiratory syncytial virus (RSV) disease the balance between the innate and adaptive immune responses determines the expression of the pathological phenotype favoring the development of acute bronchiolitis, and in certain children the development of recurrent wheezing. While humoral antibody plays a major role in protection against disease, T-cell immunity targeted to viral proteins appears to terminate viral infection. At the moment, treatment modalities for acute RSV infection do not effectively modify the course of the disease, and RSV vaccine development has shown conflicting results. To date, however, passive immunoprophylaxis with monoclonal antibodies is the only strategy that has demonstrated consistent efficacy in reducing RSV hospitalizations in high-risk children. The potential benefit of new strategies for prevention and treatment of RSV infections should be evaluated with respect to both the acute infection as well as the chronic respiratory manifestations induced by RSV.
Journal of Paediatrics and Child Health, 2003
In 1998 the Food and Drug Administration approved palivizumab (Synagis) for the prevention of severe lower respiratory tract infection secondary to respiratory syncytial virus (RSV) in pediatric patients at high risk for developing disease that required hospitalization. In the immediate aftermath of that approval, two retrospective reviews were conducted on 4669 medical records of patients who received at least 1 dose of palivizumab during the 1998 to 1999 and 1999 to 2000 RSV seasons, respectively. These analyses captured data on rates of RSV hospitalization, length of hospital stay, intensive care unit admission and compliance with palivizumab administration. Two prospective US multicenter registry trials followed, during the RSV seasons of 2000 to 2001 and 2001 to 2002. The registries characterized the demographics and outcomes of a total of 7207 high risk infants and children who received prophylaxis for RSV, the risk factors for RSV hospitalization and the patterns and scope of palivizumab usage across 63 and 116 US health care sites, respectively. 1998 to 1999 palivizumab first season of general use. Nine US study sites engaged in a retrospective chart review of infants and children with a gestational age of <35 weeks and a chronologic age of <2 years at the time of their first palivizumab injection and who had received at least one dose between September 1998 and May 1999. Of the 1839 prophylaxed children with evaluable data, only 42 (2.3%) were hospitalized with confirmed RSV disease. Of those admitted with confirmed gestational ages, all were premature; the majority were either <28 weeks gestational age (WGA; 43%) or between 28 and 32 WGA (34%). 1999 to 2000 palivizumab second season of general use. During the 1999 to 2000 RSV season, 12 hospitals and university medical centers, representing a cross-section of US health care facilities, contributed to the second Palivizumab Study Group. The sites collected retrospective data from the charts of 2830 children, all of whom had received at least 1 injection of palivizumab between September 1999 and May 2000. Analysis of 2830 medical records revealed an admission rate of 2.4% (68 of 2830) for confirmed RSV infection, consistent with the overall hospitalization rate of 2.3% from the previous season. Palivizumab Outcomes Registry: 2000 to 2001. Sixty-three sites representing pediatric offices, freestanding clinics and hospital-based clinics participated in a prospective, multicenter, observational study to evaluate the scope of palivizumab usage in a cross-section of US infants. The centers collected outcomes data on RSV-related hospital admissions, injection history and adherence to a standardized palivizumab administration protocol. Of the 2116 infants enrolled 47% were born at <32 weeks gestation. Patients between 32 and 35 weeks gestational age accounted for another 45% of enrollees. Approximately 8% had a gestational age of >35 weeks. For the 2049 subjects with available follow-up data, the overall confirmed RSV hospitalization rate was 2.9%.
Biologics Targets Therapy, 2007
Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children less than 1 year of age and causes substantial morbidity. Although there is not currently a vaccine available to prevent RSV infection, prophylaxis with the humanized monoclonal antibody palivizumab has been shown to reduce the rate of RSV hospitalization in premature infants and those infants with chronic lung disease or congenital heart disease. Because palivizumab has not been shown to have a beneficial clinical effect on established RSV disease such as reducing the rate of mechanical ventilation and mortality in children afflicted with RSV, there has been considerable debate as to the cost-benefit ratio of administering palivizumab according to international guidelines. Palivizumab has demonstrated a favorable side-effect profile in clinical trials without the development of anti-palivizumab antibodies. Future studies are needed to determine whether palivizumab, or other more potent monoclonal antibodies which are currently undergoing clinical trials, will reduce the long-term sequelae of RSV infection such as the development of wheezing and asthma.
Respiratory syncytial virus infections in infants
Seminars in Pediatric Infectious Diseases, 1999
Respiratory syncytial virus (RSV) is an important pathogen that causes bronchiolitis and pneumonia in infants, young children, and elderly adults throughout the world. This virus causes approximately 90,000 hospitalizations and 4,500 deaths in the United States each year from lower respiratory tract disease primarily among children with underlying cardiac, pulmonary, or immunologic disorders. In the temperate zones, the virus circulates from late October until late April or May, with a peak usually in mid-January to mid-February. Diagnosis usually is by latex agglutination, enzyme-linked immunosorbent assay (ELISA), fluorescent antibody, or tissue culture of nasal secretions. The nosocomial infection rate may be as high as 22 to 50 percent. Various treatment modalities have been used along with supportive care. The first medication to be approved for treatment of RSV infection was the antiviral ribavirin. Ribavirin's use has been accompanied by controversy concerning its efficacy versus cost. Intravenous human IgG with high titer against RSV (RSVIG) has been used to treat patients, including those considered at high risk; it was found to be safe but not efficacious. However, RSVIG has been successful in preventing RSV disease and is now available for immunoprophylaxis in high-risk children, primarily premature infants or those with bronchopulmonary dysplasia (BPD). MEDI-493 or palivizumab (Synagis; Med-Immune, Inc, Gaithersburg, MD), a new humanized monoclonal antibody, also has been studied in a prophylactic trial with 1,500 premature infants and young children with BPD. A 55 percent reduction in hospital admissions resulted when compared with placebo. This prophylactic modality has been approved recently by the Food and Drug Administration (FDA). The use of vaccines for prevention of RSV disease has been fraught with obstacles. Various studies using RSV subunit F and G vaccines are in progress. Live, attenuated vaccines also are under investigation. Copyright 9 1999 by W.B. Saunders Company R espiratory syncytial virus (RSV) is a member of the Paramyxovirideae family. It is an enveloped, singlestranded RNA virus. At least two serotypes are known to exist: group A, considered the more virulent, and group B.l,2 This virus has two major proteins, F (fusion) and G (attachment) glycoproteins. These are the major targets for neutralizing antibodies. The F glycoprotein is more conserved among strains, and certain epitopes are widely conserved. ~ Epidemiology RSV causes yearly epidemics of respiratory illness that include a lower respiratory tract illness (LRI) called bronchiolitis. RSV is From the Children'
Early ribavirin treatment of respiratory syncytial viral infection in high-risk children
The Journal of Pediatrics, 1990
A 3-year prospective, blinded, multicenter study was done to assess the efficacy of early ribavirin intervention in mild respiratory syncytial virus illness in children with bronchopulmonary dysplasia or with congenital heart disease. A cohort of 178 children younger than 36 months of age with bronchopulmonary dysplasia or congenital heart disease were followed. Forty-seven infants whose respiratory syncytial virus infection resulted in mild symptoms of _<72 hours' duration received ribavirin (n = 20) or water placebo aerosol (n = 27) either in a hospital or at home. Outcome measures included respiratory and analog score, room air oxygen, saturation, and oxygen flow needed to maintain saturation at _>91%. No difference in age, gender, family size, passive smoking, baseline oxygen saturations in room air, or duration of symptoms before treatment was found between groups. After 3 days of therapy, ribavirin produced a greater rate of improvement of analog scores (p = _~ 0.001), lower oxygen requirements (p = 0.01), and higher oxygen saturation (p = 0.01). Respiratory scores and total hospital days did not differ significantly between the groups. Treatment failure occurred in 2 of 20 children (10%) in the ribavirin group versus 5 of 27 children (18%) in the placebo group, a nonsignificant difference. No child required assisted ventilation or had an adverse reaction. We conclude that early ribavirin therapy may help to reduce morbidity from respiratory syncytial virus infection in high-risk young children.