Consider Treating Now to Prevent Hospitalization for Severe RSV: AAP

By Linda Carroll

August 16, 2021

(Reuters Health) - With respiratory syncytial virus (RSV) surging now instead of in the fall, the American Academy of Pediatrics has issued interim guidance suggesting that treatment with palivizumab to prevent hospitalization in at-risk children start early in areas where the virus has been sharply rising.

The current surge may be due to lifting of nonpharmacologic interventions instituted in March 2020 to combat COVID-19. In the fall and winter - when many were masking and social distancing and schools were closed - the number of RSV infections in the U.S. fell rapidly and dramatically, the guidance notes.

Along with the rising number of infections, there have been corresponding increases in emergency department visits and hospitalizations of infants and children, especially those who were preterm or who have chronic lung disease of prematurity, certain types of hemodynamically significant congenital heart disease, certain immunodeficiency states, or pulmonary abnormalities or neurological and neuromuscular conditions that impair ability to clear secretions from the upper airway.

The AAP provided the guidance because "this year there were large numbers of RSV cases being reported in June, July and August, which is outside of the typical respiratory virus season," said coauthor Dr. Mary Caserta, a professor of pediatric infectious diseases at the University of Rochester. "Seeing that, it was reasonable to recommend prophylactic treatment with palivizumab, a humanized monoclonal antibody."

The new guidance, published in Pediatrics, does not say all pediatricians in the U.S. should start giving palivizumab to every at-risk child right now, Dr. Caserta said. "Pediatricians should work together with other health care experts in their area to determine what the rates are," she explained. "We are not (necessarily) recommending five doses. We are suggesting that pediatricians keep track of the activity in their area and gauge month to month what needs to be done. We want to cover these children during the period of highest risk."

Typically, babies at high risk are given five doses of the prophylactic treatment from November through March, said Dr. Andrew Ting, an assistant professor of pediatric pulmonology at the Icahn School of Medicine at Mount Sinai in New York.

Dr. Ting wonders what will happen if there is a resurgence of the virus in fall and winter. Will the treatment go beyond five doses, for example?

He can see scenarios such as monthly doses August through December. "Or maybe just August and September and restart in November," he said. "If RSV numbers are still high from now through December into January 2022, I guess there would be a recommendation for - and hopefully insurance approval of - an additional three months."

SOURCE: Pediatrics, online August 1, 2021.