Criteria for RSV Prophylaxis
Monthly Palivizumab injections during RSV season (October-February) for babies with significant heart abnormalities or chronic lung disease, criteria updated annually, and emerging evidence for universal DS recommendation
Overview
Note: the criteria changes are updated annually.
Clinics run across hospital sites by a neonatal sister or a community sister. Infants who are identified as needing RSV prophylaxis (sometimes referred to as Synergis) will be contacted to come in for these clinics, usually starting from October of that year. Assistance from Principal Pharmacist W&C, Royal Free London, Bleep 1412, Ext 36443.
Information for Parents
RSV prophylaxis is not a vaccine per se. Still, an immunoglobulin is administered to babies just before the winter season (around October) to prevent them from contracting RSV (respiratory syncytial virus), which causes Bronchiolitis. The baby is given an injection every month they get an injection to cover the RSV season (winter period). The immunoglobulin is called Synergis or Palivizumab. Normally, infants only need one course during the first year of life; sometimes, they get it two years in a row.
RSV is one of the viruses that causes bronchiolitis and is predominantly seen from October to February each year. Most children get it and are ok, but many do get admitted, especially if they have an underlying serious medical condition or were born very prematurely or have lung disease.
After infancy, it does not cause such big issues, more like a cough and cold, but not bronchiolitis, which is mainly something in the first year of life, maybe up to 18 months or so.
We have criteria based on extensive evidence, as they are worldwide studies. They have produced yearly criteria for which children should receive immunoglobulin therapy, i.e. monthly injections, to try and prevent them catching RSV during their first winter.
It is usually given to babies with Down Syndrome who have a significant heart abnormality, meaning they have a significant right-to-left shunt (ie blood going the wrong way/shunting) and are usually on medications too. Other reasons could be, for example, on respiratory grounds in a baby with chronic lung disease or an ongoing daily oxygen requirement. It is rarely given after the first year.
Further Research and Information
In the "green book", immunisation guidance can be found here: Respiratory syncytial virus.
Please note this advice changes yearly and needs updating and checking each year.
At the time of writing this pathway, some research indicates that all children with DS should have Palivizumab due to their increased risk of bronchiolitis/LRTI, hospital admissions and morbidity, accompanied by this, even without congenital heart disease or chronic lung disease. This needs further local and national evaluation and discussion with Public Health England. Paes B, Mitra S.
Palivizumab for children with Down Syndrome: is the time right for a universal recommendation?
Archives of Disease in Childhood Published Online First: 27 December 2018.