PREVENTION OF RESPIRATORY SYNCYTIAL VIRUS-INFECTIONS - INDICATIONS FOR THE USE OF PALIVIZUMAB AND UPDATE ON THE USE OF RSV-IGIV

The Food and Drug Administration recently approved the use of palivizu mab (pale-vizhu-mab), an intramuscularly administered monoclonal antib ody preparation. Recommendations for its use are based on a large, ran domized study demonstrating a 55% reduction in the risk of hospitaliza tion attributable to respiratory syncytial virus (RSV) infections in h igh-risk pediatric patients. Infants and children with chronic lung di sease (CLD), formerly designated bronchopulmonary dysplasia, as well a s prematurely born infants without CLD experienced a reduced number of hospitalizations while receiving palivizumab compared with a placebo. Both palivizumab and respiratory syncytial virus immune globulin intr avenous (RSV-IGIV) are available for protecting high-risk children aga inst serious complications from RSV infections. Palivizumab is preferr ed for most high-risk children because of ease of administration (intr amuscular), lack of interference with measles-mumps-rubella vaccine an d varicella vaccine, and lack of complications associated with intrave nous administration of human immune globulin products. RSV-IGIV, howev er, provides additional protection against other respiratory viral ill nesses and may be preferred for selected high-risk children including those receiving replacement intravenous immune globulin because of und erlying immune deficiency or human immunodeficiency virus infection. F or premature infants about to be discharged from hospitals during the RSV season, physicians could consider administering RSV-IGIV for the f irst month of prophylaxis. Most of the guidelines from the American Ac ademy of Pediatrics for the selection of infants and children to recei ve RSV-prophylaxis remain unchanged. Palivizumab has been shown to pro vide benefit for infants who were 32 to 35 weeks of gestation at birth . RSV-IGIV is contraindicated and palivizumab is not recommended for c hildren with cyanotic congenital heart disease. The number of patients with adverse events judged to be related to palivizumab was similar t o that of the placebo group (11% vs 10%, respectively); discontinuatio n of injections for adverse events related to palivizumab was rare.