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Adherence to respiratory syncytial virus prophylaxis guidelines increasing
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Health care providers seem to be getting the message about the importance of respiratory syncytial virus prophylaxis, but in some cases they are still overprescribing this therapy, according to a study published online.
Kecia N. Carroll, MD, MPH, of Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues from the CDC, Cincinnati Children’s Hospital Medical Center and University of Rochester School of Medicine and Dentistry, prospectively looked at data from three counties where children were prospectively enrolled in the CDC-funded New Vaccine Surveillance Network. The counties were located in Nashville, Tenn., Rochester, N.Y., and Cincinnati.
The researchers assessed adherence to AAP recommendations in 1998, 2003 and 2006 in children with prematurity or chronic lung disease. They reported that of the 1,557 children included the study, 57 were defined as “eligible,” according to AAP guidelines, and 40 of these received palivizumab (Synagis, MedImmune), according to their parents.
Carroll and colleagues said the percentage of eligible children who actually received palivizumab soared from the beginning of the study in 2001 to the end of the study in 2007 (from 33% to 83%). Although these results were encouraging, the researchers said 25 infants who did not meet eligibility criteria also received palivizumab.
Study limitations worth noting included that receipt of palivizumab was defined by parental report; the data were derived from different health care settings that captured most hospitalizations but only selected outpatient visits; and of these, two study sites only reported 4 years of data, according to the investigators.
Also, the researchers said that they did not assess interventions that may have increased or modified palivizumab adherence.
“This study demonstrates increased adherence to recommendations for palivizumab over time, 2001 to 2007, for eligible children with chronic lung disease or prematurity, which is encouraging. Studies investigating the effectiveness of RSV immunoprophylaxis are ongoing,” Carroll told Infectious Diseases in Children.
Disclosure: The study was supported by the CDC. Some of the study researchers reported receiving research funding from MedImmune. Dr. Carroll reports no relevant financial disclosures.
Perspective
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H. Cody Meissner, MD
Respiratory syncytial virus (RSV) remains one of the most common infections of early childhood, even though the current rates of hospitalization attributable to RSV among children in the first 12 months of life may not be as high as those reported during the palivizumab (Synagis, MedImmune) clinical trials conducted in the late 1990s.
The vast majority of RSV hospitalizations continue to occur among healthy, term infants with no underlying risk factors, so the overall impact of prophylaxis on the burden of RSV disease in the United States has been modest. However, for children with prematurity, pre-existing pulmonary or cardiac disease, RSV infection remains an important cause of hospitalization early in life, even though no reproducible data have shown an impact of prophylaxis on reduction in mortality or subsequent airway disease.
Recommendations from the American Academy of Pediatrics have evolved to maximize the greatest benefit of this costly intervention to those children at increased risk. Reports such as this from the CDC-funded New Vaccine Surveillance Network emphasize two observations. First, there are infants who qualify for prophylaxis under the current guidelines who do not receive prophylaxis. Second, there are infants who receive prophylaxis who do not meet the eligibility criteria. We are reminded that the pediatrician’s task is twofold: to identify eligible infants and be certain they receive prophylaxis and to be certain that infants who do not satisfy eligibility criteria do not receive prophylaxis.
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