Best practice in the prevention and management of paediatric respiratory syncytial virus infection

Abstract

Respiratory syncytial virus (RSV) infection is ubiquitous with almost all infants having been infected by 2 years of age and lifelong repeated infections common. It is the second largest cause of mortality, after malaria, in infants outside the neonatal period and causes up to 200,000 deaths per year worldwide. RSV results in clinical syndromes that include upper respiratory tract infections, otitis media, bronchiolitis (up to 80% of cases) and lower respiratory tract disease including pneumonia and exacerbations of asthma or viral-induced wheeze. For the purposes of this review we will focus on RSV bronchiolitis in infants in whom the greatest disease burden lies. For infants requiring hospital admission, the identification of the causative respiratory virus is used to direct cohorting or isolation and infection control procedures to minimize nosocomial transmission. Nosocomial RSV infections are associated with poorer clinical outcomes, including increased mortality, the need for mechanical ventilation and longer length of hospital stay. Numerous clinical guidelines for the management of infants with bronchiolitis have been published, although none are specific for RSV bronchiolitis. Ribavirin is the only licensed drug for the specific treatment of RSV infection but due to drug toxicity and minimal clinical benefit it has not been recommended for routine clinical use. There is currently no licensed vaccine to prevent RSV infection but passive immunoprophylaxis using a monoclonal antibody, palivizumab, reduces the risk of hospitalization due to RSV infection by 3978% in various high-risk infants predisposed to developing severe RSV disease. The current management of RSV bronchiolitis is purely supportive, with feeding support and oxygen supplementation until the infant immune system mounts a response capable of controlling the disease. The development of a successful treatment or prophylactic agent has the potential to revolutionize the care and outcome for severe RSV infections in the world's most vulnerable infants.

Delivery of ALX-0171 by inhalation greatly reduces respiratory syncytial virus disease in newborn lambs

“…In severe RSV infections, the only approved antiviral treatment is the nucleoside analog Virazole (ribavirin), which is delivered by inhalation. However, due to concerns for potential teratogenicity and minimal evidence of benefit, it is not recommended for routine use in infants but may be considered for use in select patients with documented, potentially life-threatening RSV infection 6 . In the prevention of RSV infections, palivizumab (Synagis®, MedImmune), a humanized monoclonal antibody (IgG) against the F-protein of RSV, has been approved for use in high risk infants; however, due to high costs associated with palivizumab prophylaxis, a limited effect on RSV hospitalizations on a population basis, a lack of measurable effect on mortality and a minimal effect on subsequent wheezing, use of palivizumab is restricted to certain high-risk pediatric populations 7 …”

Respiratory Syncytial Virus Infection in Infants

“…Особую угрозу РСВ представляет для больных из групп риска тяжелого течения РСВИ. Нозокомиальная инфекция ассоциируется с худшим прогнозом, включая летальные исходы, потребностью в ИВЛ и более длительным пребыванием в стационаре [21].…”

“…В зарубежной практике имеется жидкая фор-ма препарата, официально зарегистрированная для ингаляци-онного лечения РСВИ. Однако, учитывая высокую вероятность супрессии костного мозга, канцерогенность и тератогенность препарата, с 2015 г. не рекомендовано его широкое примене-ние, особенно в неонатологической практике [21].…”

“…Применение данных препаратов оправданно только в слу-чае отягощенного семейного анамнеза по атопии и бронхи-альной астме, в сочетании с предшествующими эпизодами бронхообструктивного синдрома, а также при проведении дифференциальной диагностики с вирусиндуцированной астмой. Рекомендовано назначать их коротким курсом, и после улучшения оксигенации крови, снижения оксидатив-ного стресса и/или лабораторного подтверждения РСВИ их следует отменить [21].…”

“…Учитывая их нега-тивное влияние на рост и минеральную плотность ткани, эксперты считают, что от данных препаратов при РСВИ не-обходимо отказаться [21,22].…”