Synagis® (palivizumab) for Prevention of RSV Infection
RSV is a type of virus that causes lung infections. In most people, an RSV infection may seem no worse than a bad cold, but in some children, particularly infants born prematurely, an infection with RSV can be quite severe. Although there is no vaccine for RSV, there is a treatment of monthly injections with antibodies (Synagis or palivizumab) that seems to benefit infants born prematurely, particularly those with chronic lung problems. Although it is apparent that infants with certain types of congenital heart diseases also have a much rougher time with RSV infections, it has not been conclusively shown that giving Synagis benefits them in the same way. For this reason, the American Academy of Pediatrics has not recommended using Synagis for children with heart disease unless they are also premature.
Background: The American Academy of Pediatrics and a leading group of academic physicians specializing in pediatric respiratory diseases have published two series of recommendations for using Synagis. The following is a combined summary of these two statements.
Patients who meet the following criteria should be considered candidates for SYNAGIS®:
For patients born between 32 and 35 weeks without CLD, the use of palivizumab should be reserved for those infants who are less than 6 months of age at the start of RSV season, with additional risk factors.
These factors include other underlying conditions which may predispose the patient to respiratory complications:
Patients who have CLD, are premature, or have both conditions, who meet the criteria in recommendations 1 and 2, and who also have asymptomatic acyanotic congenital heart disease may benefit from prophylaxis.
Although specific recommendations for immunocompromised patients cannot be made, children with severe immunodeficiencies may benefit from prophylaxis.
American Academy of Pediatrics. Prevention of respiratory syncytial virus infections: Indications for the use of palivizumab and update on the use of RSV-IGIV. Pediatrics 1998;102(5):1211-1216.
Meissner HC, Welliver RC, Chartrand SA et al. Immunoprophylaxis with palivizumab, a humanized respiratory syncytial virus monoclonal antibody for prevention of respiratory syncytial virus infection in high risk infants: a consensus opinion. Pediatr Infect Dis J l999; 18:223-31.
The Blue Cross Blue Shield Guidelines for the use of Synagis can be found here or athttp://www.bluecrossma.com/common/en_US/medical_policies/422%20RSV%20Immunoprophylaxis%20prn.pdf.
SYNAGIS is a registered trademark of MedImmune, Inc.