The respiratory syncytial virus
(RSV) is a common cause of bronchiolitis
in children, and it can cause swelling and mucus production in the small breathing tubes of your child's lungs. Infants aged two to twelve months are the most likely to become infected and usually begin having the symptoms of a common cold, with a runny nose and mild cough. Over the next few days the cough worsens and your child may develop fever, wheezing and difficulty breathing.
RSV infections are also a common cause of hospitalizations and visits to the Pediatrician and emergency room in children, especially younger infants. Having an infection with RSV may also make it more likely that your child will develop problems with wheezing later in life.
Although infants and children of all ages can develop an RSV infection, those children that are most at risk of serious complications include infants born prematurely (less than 35 weeks), infants with chronic lung disease (CLD) or bronchopulmonary dysplasia (BPD), immune system problems, neuromuscular disorders, cystic fibrosis and infants with congenital heart disease.
Although there is no cure or vaccine for RSV, it is possible to prevent infection in high risk children with prophylaxis by giving them antibodies against RSV. This was first done by giving high risk children Intravenous Gamma Globulin (IVIG), and the the more specific RSV-IVIG (Respigam).
The latest medicine used for prophylaxis is Synagis, which is a monoclonal antibody against RSV and unlike Respigam, Synagis is not a blood product and so does not have any risk of transmitting blood borne infections.
Also unlike Respigam which can only be given by IV, Synagis can be given intramuscularly as a shot. Adverse effects of Synagis include fever and redness, swelling, or pain at the site of the injection. Synagis can be given with other childhood vaccines, unlike Respigam, after which you can not give an MMR or Chickenpox vaccine for 9 months.
Synagis is given as a monthly injection at the start of and during RSV season (usually November to April). It is very expensive (over $900 for a 100mg vial), but is covered by Medicaid and most insurance companies.
The American Academy of Pediatrics guidelines for which children should receive RSV prophylaxis include:
- Children less than two years of age with chronic lung disease.
- Premature infants who were born at less than 28 weeks and who are less than twelve months old at the start of RSV season.
- Premature infants who were born between 29-32 weeks and who are less than six months old at the start of RSV season.
- Premature infants who were born between 32-35 weeks and who are less than six months old at the start of RSV season and who have 2 or more risk factors, such as multiple births, exposure to passive smoking, day care attendance, sharing a bedroom with a sibling, or having a sibling that attends school.
A recently updated guideline from the American Academy of Pediatrics, Revised Indications for the Use of Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous for the Prevention of Respiratory Syncytial Virus Infections, made some minor changes to the previous recommendations, which now state that:
- Prophylaxis with palivizumab (Synagis) is appropriate for infants and young children with hemodynamically significant congenital heart disease.
- Because of the large number of infants born after 32 to 35 weeks gestation and because of the high cost, immunoprophylaxis should be considered for this category of preterm infants only if 2 or more risk factors are present.
- High-risk infants should not attend child care during the RSV season when feasible, and exposure to tobacco smoke should be eliminated.