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Prophylaxis and High-Risk Groups

Palivizumab (say "pah-lih-VIH-zu-mahb") is a monoclonal antibody that reduces hospitalizations due to RSV infection among children at high risk for severe disease. It is given in monthly intramuscular injections during the RSV season, which generally lasts from November through March in most locations in the United States.

American Academy of Pediatrics (AAP) Guidelines for Infants and Children at Risk for Severe Illness Due to RSV Infection

According to the 2012 American Academy of Pediatrics Red Book1, palivizumab prophylaxis may be considered for the following infants and children:

  • Infants born at 28 weeks' gestation or earlier if they are younger than 12 months of age during the start of RSV season. Once prophylaxis is initiated for this group, it should be maintained through the end of the RSV season.
  • Infants born at 29–32 weeks' gestation if they are younger than 6 months of age at the start of the RSV season. Once prophylaxis is initiated for this group, it should be maintained through the end of the RSV season.
  • Infants born at 32–35 weeks' gestation who are younger than 3 months of age at the start of the RSV season or who are born during RSV season if they have at least one of the following 2 risk factors: 1) infant attends child care; 2) infant has one or more older siblings younger than 5 years of age or other children younger than 5 years of age who live permanently in the same household. Multiple births younger than 1 year of age do not qualify as this risk factor.
  • Infants and children younger than 2 years with cyanotic or complicated congenital heart disease.
  • Infants and children younger than 2 years who have been treated for chronic lung disease within 6 months of the start of the RSV season.
  • Infants who have either congenital abnormalities of the airway or neuromuscular disease that compromises handling of respiratory secretions.

Consult the American Academy of Pediatrics Red Book (29th edition, 2012) for specific and latest recommendations, including the length of prophylaxis and eligibility criteria for prophylaxis of high-risk infants and young children.

Others at Risk for Severe Illness Due to RSV Infection

Increasingly, RSV infection is recognized as an important cause of respiratory illness in high-risk adults and the elderly. High-risk adults include those with chronic heart disease, chronic lung disease, or compromised immune systems; the elderly include those 65 or older, particularly if they reside in a long-term care facility or participate in other senior day-care programs.

Reference

  1. American Academy of Pediatrics. Respiratory Syncytial Virus. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.
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