TREATMENT AND PREVENTION OF SEVERE RESPIRATORY SYNCYTIAL VIRUS-INFECTION IN YOUNG-CHILDREN

In the 40 years since its discovery, respiratory syncytial virus (RSV) has been recognized as the most important cause of lower respiratory tract infection in young children worldwide. Despite its enormous heal th-care impact, therapy and prevention strategies remain inadequate. T he safety and clinical effectiveness of ribavirin, the only licensed a ntiviral agent against RSV, are still under scrutiny. A vaccine agains t RSV has not been developed because of the fear of causing enhanced p ulmonary disease, particularly in the very young seronegative infant. Maintenance of high-titer RSV neutralizing antibodies via monthly high -dose infusions of an RSV-enriched polyclonal immunoglobulin may signi ficantly decrease the incidence and severity of RSV illness in preterm children with and without underlying pulmonary disease and in childre n with severe congenital heart disease. Licensure of this by the US Fo od and Drug Administration is still pending. Its success with prophyla xis has encouraged the development of humanized RSV monoclonal antibod ies. Monoclonal antibodies have the dual advantage that they are direc ted specifically against the RSV fusion protein, and that they can be used at much smaller doses. Clinical pediatric trials are just beginni ng.