Recent Trends in RSV Immunoprophylaxis: Clinical Implications for the Infant

 

 Permissions and Reprints

Abstract

Respiratory syncytial virus (RSV) remains the leading cause for hospitalizations in infants worldwide, resulting in significant health and financial burden. Since 1998, the humanized monoclonal antibody palivizumab remains the only available option licensed for the prevention of severe RSV disease in high-risk children, namely premature infants and those with chronic lung disease and congenital heart disease. In 2014, the American Academy of Pediatrics modified the recommendations on the use of RSV prophylaxis in these high-risk children, and limited its use to premature infants born at < 28 weeks' gestational age (wGA). Following this last guidance update, studies have confirmed that premature infants of 29 to 34 wGA remain at high risk for severe RSV disease, especially those of younger chronologic age. New and more cost-effective strategies are being developed that would help alleviate both the health and financial burden associated with severe RSV disease.

• References

• 1 Shi T, McAllister DA, O'Brien KL. , et al; RSV Global Epidemiology Network. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet 2017; 390 (10098): 946-958
  CrossrefPubMedSearch in Google Scholar
• 2 Stockman LJ, Curns AT, Anderson LJ, Fischer-Langley G. Respiratory syncytial virus-associated hospitalizations among infants and young children in the United States, 1997-2006. Pediatr Infect Dis J 2012; 31 (01) 5-9
  CrossrefPubMedSearch in Google Scholar
• 3 García CG, Bhore R, Soriano-Fallas A. , et al. Risk factors in children hospitalized with RSV bronchiolitis versus non-RSV bronchiolitis. Pediatrics 2010; 126 (06) e1453-e1460
  CrossrefPubMedSearch in Google Scholar
• 4 Mejias A, Dimo B, Suarez NM. , et al. Whole blood gene expression profiles to assess pathogenesis and disease severity in infants with respiratory syncytial virus infection. PLoS Med 2013; 10 (11) e1001549
  CrossrefPubMedSearch in Google Scholar
• 5 McLellan JS, Chen M, Leung S. , et al. Structure of RSV fusion glycoprotein trimer bound to a prefusion-specific neutralizing antibody. Science 2013; 340 (6136): 1113-1117
  CrossrefPubMedSearch in Google Scholar
• 6 Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics 1998; 102 (03) 531-537
  CrossrefPubMedSearch in Google Scholar
• 7 Feltes TF, Cabalka AK, Meissner HC. , et al; Cardiac Synagis Study Group. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 2003; 143 (04) 532-540
  CrossrefPubMedSearch in Google Scholar
• 8 Blanken MO, Rovers MM, Molenaar JM. , et al; Dutch RSV Neonatal Network. Respiratory syncytial virus and recurrent wheeze in healthy preterm infants. N Engl J Med 2013; 368 (19) 1791-1799
  CrossrefPubMedSearch in Google Scholar
• 9 Rajah B, Sanchez PJ, Garcia-Maurino C, Leber A, Ramilo O, Mejias A. Impact of the updated guidance for palivizumab prophylaxis against respiratory syncytial virus infection: a single center experience. J Pediatr 2017; 181: 183-188
  CrossrefPubMedSearch in Google Scholar
• 10 Wozniak PS, Sanchez PJ, Rajah B. , et al. Impact of the Revised Guidelines for Respiratory Syncytial Virus Prophylaxis: Morbidity Persists After Two Seasons. Infectious Diseases Society of America 54th Annual Meeting ID Week; 2016; New Orleans, LA.; 2016
  PubMedSearch in Google Scholar
• 11 Anderson EJ, Krilov LR, DeVincenzo JP. , et al. SENTINEL1: an observational study of respiratory syncytial virus hospitalizations among U.S. infants born at 29 to 35 weeks' gestational age not receiving immunoprophylaxis. Am J Perinatol 2017; 34 (01) 51-61
  Thieme ConnectPubMedSearch in Google Scholar
• 12 Kong AM, Krilov LR, Fergie J. , et al. The 2014-2015 national impact of the 2014 American Academy of Pediatrics guidance for respiratory syncytial virus immunoprophylaxis on preterm infants born in the United States. Am J Perinatol 2018; 35 (02) 192-200
  Thieme ConnectPubMedSearch in Google Scholar
• 13 Goldstein M, Krilov LR, Fergie J. , et al. Respiratory syncytial virus hospitalizations among U.S. preterm infants compared with term infants before and after the 2014 American Academy of Pediatrics guidance on immunoprophylaxis: 2012-2016. Am J Perinatol 2018; 35 (14) 1433-1442
  Thieme ConnectPubMedSearch in Google Scholar
• 14 Mejias A, Garcia-Maurino C, Rodriguez-Fernandez R, Peeples ME, Ramilo O. Development and clinical applications of novel antibodies for prevention and treatment of respiratory syncytial virus infection. Vaccine 2017; 35 (03) 496-502
  CrossrefPubMedSearch in Google Scholar
• 15 Simoes E. Phase 3, Randomized, Double-blind, Placebo-controlled Trial Evaluating the Efficacy and Safety of Suptavumab, for the Prevention of Medically attended RSV Infection in Preterm Infants. 2018 Respiratory Syncytial Virus Symposium; 2018; Ashville, NC.; 2018
  PubMedSearch in Google Scholar
• 16 Domachowske JB, Khan AA, Esser MT. , et al. Safety, tolerability and pharmacokinetics of MEDI8897, an extended half-life single-dose respiratory syncytial virus prefusion f-targeting monoclonal antibody administered as a single dose to healthy preterm infants. Pediatr Infect Dis J 2018; 37 (09) 886-892
  CrossrefPubMedSearch in Google Scholar