Prevention of respiratory syncytial virus infections in high-risk infantsby monoclonal antibody (palivizumab)

Respiratory syncytial virus (RSV) is a major viral pathogen whichcauses serious respiratory illness in infants and children worldwide.Palivizumab (Synagis) is an anti-RSV monoclonal antibody administeredintramuscularly for the prevention of severe RSV respiratory diseasein high-risk infants and young children. The IMpact-RSV trial, thepivotal multicenter, randomized, placebo-controlled trial performedin the USA, Canada and the United Kingdom demonstrated an overall55% reduction in hospitalization rate due to RSV infection inpreterm infants (less than or equal to 35 weeks gestation)with and without chronic lung disease (CLD). Subgroup analysis in prematureinfants without CLD revealed an even greater reduction in RSV hospitalizationrates (78%). Adverse events were infrequent and did notdiffer between placebo and palivizumab groups. Injection site reactionswere infrequent and mild; no differences were observed between palivizumaband placebo subjects. Palivizumab does not interfere with administrationof other pediatric vaccines. Comprehensive parent education programsregarding prevention of infection, avoidance of risk factors forinfection, careful adherence to infection control policies, andrecognition of early symptoms of RSV infection remain important componentsof RSV prevention strategies. In light of the lack of effectivevaccines for this serious health risk, palivizumab offers the onlyoption for prophylaxis against RSV disease in high-risk infants.