Immunoprophylaxis With RespiGam
H. Cody Meissner, MD*Margaret B. Rennels, MD
Sarah S. Long, MD
Larry K. Pickering, MD¶
For the American Academy of Pediatrics
Committee on Infectious Disease, 2003–2004
* Division of Pediatric Infectious Disease
Tufts-New England Medical Center
Boston, MA 02111
Department of Pediatrics
University of Maryland
Baltimore, MD 21201
St Christopher’s Hospital for Children
Section of Infectious Disease
Philadelphia, PA 19134
¶ National Immunization Program
Centers for Disease Control and Prevention
Atlanta, GA 30333
To the Editor.—
Guidelines for immunoprophylaxis with RespiGam and palivizumab for prevention of respiratory syncytial virus (RSV) infection in high-risk infants and children have been issued and updated by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases and Committee on Fetus and Newborn.1,2 Prais et al3 reported results of a survey conducted in 11 hospitals in Israel during one RSV season and noted that most of the infants admitted to the pediatric intensive care unit with a severe RSV infection were not premature, did not have chronic lung disease, and were not candidates for RSV prophylaxis as defined by the AAP guidelines. The authors concluded that, because current AAP guidelines for immunoprophylaxis will not alter RSV-induced hospitalizations significantly, "new risk-stratified guidelines for RSV prophylaxis are indicated."
The majority of infants and children who require hospitalization due to RSV bronchiolitis or pneumonia are recognized widely not to be high-risk infants but to be infants born at term without underlying lung or cardiac disease.4,5 The rate of RSV-induced hospitalization in a high-risk infant is considerably higher (generally >10 times) than the hospitalization rate for a term child with normal heart and lung development. However, because there are so many more healthy infants than high-risk infants, most admissions due to RSV will be among healthy infants and children. The AAP guidelines regarding RSV immunoprophylaxis are not designed to have a significant impact on total RSV disease burden, including hospitalization. Rather, appropriate immunoprophylaxis will reduce the RSV hospitalization rate by 
50% among a small, select group of high-risk infants and children, in whom morbidity from RSV is greater. Only a relatively small number of total RSV hospitalizations will be prevented by targeting high-risk infants, and this is unlikely to result in more than a slight decrease in overall RSV-induced hospitalizations. Indications for wider use of immunoprophylaxis would be prohibitively expensive for the health care system. Other examples of recommendations for selective immunoprophylaxis of a particular high-risk population include group B streptococcal prophylaxis and meningococcal immunization. Ultimately, development of a safe and effective RSV vaccine will be required to dramatically decrease the overall burden of disease and cost to society associated with RSV infections.
In addition, recommendations issued by the Committee on Infectious Diseases primarily are intended for children in the United States. In many instances, the guidelines will be applicable to children in other countries, but individual pediatricians and recommending bodies in each country are responsible for determining the appropriateness of the recommendations for their setting.
REFERENCES
- American Academy of Pediatrics, Committee on Infectious Diseases and Committee on Fetus and Newborn. Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IGIV.
Pediatrics.1998; 102
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[Abstract/Free Full Text] - American Academy of Pediatrics. Respiratory syncytial virus. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003;523–528
- Prais D, Schonfeld T, Amir J; Israeli Respiratory Syncytial Virus Monitoring Group. Admission to the intensive care unit for respiratory syncytial virus bronchiolitis: a national survey before palivizumab use.
Pediatrics.2003; 112
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–552
[Abstract/Free Full Text] - Meissner HC, Groothuis JR. Immunoprophylaxis and the control of respiratory syncytial virus disease.
Pediatrics.1997; 100
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[Free Full Text] - Meissner HC. Uncertainty in the management of viral lower respiratory tract disease.
Pediatrics.2001; 108
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[Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
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