REVIEW  RESPIRATORY SYNCYTIAL VIRUS IN INFANTS 

Minerva Pediatrica 2018 December;70(6):589-99

DOI: 10.23736/S0026-4946.18.05316-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Respiratory syncytial virus prophylaxis and the “special population”

Virginia MIRRA ^{1, 2}, Nicola ULLMANN ^{1, 2} ✉, Claudio CHERCHI ^{1, 2}, Alessandro ONOFRI ^{1, 2}, Maria G. PAGLIETTI ^{1, 2}, Renato CUTRERA ^{1, 2}

¹ Unit of Paediatric Pulmonology and Respiratory Intermediate Care, Academic Department of Paediatrics, Paediatric Hospital “Bambino Gesù” Research Institute, Rome, Italy; ² Unit of Sleep and Long-term Ventilation, Academic Department of Paediatrics, Paediatric Hospital “Bambino Gesù” Research Institute, Rome, Italy

Bronchiolitis is the most frequent airway infection in the first 2 years of life, and the respiratory syncytial virus (RSV) is the most frequently responsible virus. In selected high-risk groups, RSV may cause severe respiratory disease leading to hospitalization, need for mechanical ventilation, and even death. These high-risk groups include children with congenital heart disease, infants with neuromuscular impairment, cystic fibrosis, Down Syndrome, immunodeficiency syndromes and others specific conditions. In these high-risk populations defined in literature as “special population”, a 3- to 10-fold increase in the rate of RSV hospitalization has been observed, justifying RSV specific prophylaxis with palivizumab, a monoclonal antibody that binds a viral glycoprotein epitope and blocks the link between RSV and target cell. Evidence of safety and efficacy of RSV prophylaxis in these populations is lacking. Given the low incidence of these conditions, randomized clinical trials are not feasible. The purpose of this paper is to give an update from the literature of various conditions at higher risk to develop severe RSV infection, and to offer an overview of the efficacy of palivizumab in preventing RSV infection in these specific populations.

KEY WORDS: Respiratory syncytial viruses - Palivizumab - Down syndrome - Heart diseases - Immunologic Deficiency Syndromes