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Abstract

EditorialRecent data indicate that the number of children cared for respiratory syncytial virus (RSV) infections in hospitals is in the range of 50,000 to 100,000 per year in the United States [3]. Major risk factors include apart from prematurity specifically below 29 weeks, congenital heart defects, Down syndrome and further congenital anomalies. The American Academy of Pediatrics recommended in 2014 a restriction of Palivizumab prophylaxis to preterm infants of < 29 weeks of gestation and those with a high-risk course postnatally and higher gestational ages apart from specific indications resulting from congenital anomalies including congenital heart defects [1].In the current issue of the Klinische Pädiatrie, a group from Bosnia-Herzegovina published data on the effects of prophylactic immunization with Palivizumab on the occurrence of RSV infection in preterm neonates and other high-risk children [6].Main data of the present study indicate that out of 101 children about 49 % were preterm neonates, 40 % had a congenital heart defect and 11 % exhibit individual risk factors. The authors showed clearly that out of 101 children, who were treated prophylactically with Paliviziumab, none was hospitalized due to RSV infection. Despite the small number of the enrolled infants and older children, the data indicate that also under conditions of a reduced economical state of the National Health Service, the prophylaxis is working adequately.However, there still remain some questions open with respect to efficacy of Palivizumab. 1. The number of preterm neonates being enrolled in the trial was relatively low, thus, giving only a restricted measurement of effectiveness of Palivizumab. 2. The data have to be interpreted with caution, since the effects of Palivizumab have been restricted to somewhat less than 50 % of preterm neonates, the further treated children of the group are either affected by congenital heart disease or by other disorders, e. g. neurologic problems, cardiopulmonary anomalies among others.In a recently published multicenter analysis enrolling pediatric hospitals from the Northern as well as from the Southern hemisphere (United States, Canada, Italy, The Netherlands and Australia), infants were enrolled, if they were born prematurely ( < 36 weeks of gestation) and were younger than 24 months. In the second year of life, only infants with the diagnosis of bronchopulmonary dysplasia (BPD) or related pulmonary disorders were enrolled [3]. Out of more than 1,000 preterm neonates enrolled in this study, about 900 were able to be identified as the group with adequate data available. Main results of this study include that Palivizumab was used in about 430 infants, whereas it was not given in 415 neonates serving as controls. RSV was identified in 47 % on occasion of either outpatient or hospitalized care in enrolled children with respiratory symptoms. RSV was identified in a total of 403 neonates, the effect of Palivizumab for intensive care admission was a risk reduction 58 % (CI 43-69 % on the 95 % level)...