Health Policy & Advocacy

Preterm Infants RSV Burden the Who, What, and Why

Stephanie M. Blake, DNP NNP-BC RN

The Centers for Disease Control and Prevention surveillance data reveals that respiratory syncytial virus (RSV) is the leading viral cause of death in infants under 1 year old, with nearly nine times the mortality rate of influenza. RSV also is the most common cause of lower respiratory tract infections and bronchiolitis in infants and children. Nearly all children become infected with RSV at least once by the time they are 2 years old, with the peak incidence occurring between 2–3 months of age. In the United States, RSV accounts for approximately 125,000 hospitalizations and 250 infant deaths every year. To give greater perspective in 2014 the percentage of preterm infants born between 28 to 31 weeks gestation in the U.S. was 0.91 or roughly 36,000 babies.

As it stands today there is no antiviral drug or vaccine available for the prevention of RSV. Palivizumab (Synagis), manufactured by MedImmune, is a monoclonal antibody used as prophylaxis to prevent serious lower respiratory tract disease caused by RSV in children. In 2015 the World Health Organization (WHO) deemed RSV vaccine development a top priority, and estimates vaccine availability within the next 5–10 years. In July 2014, the American Academy of Pediatrics (AAP) Committee on Infectious Diseases (COID) concluded that the “limited clinical benefit” for infants after 29 weeks gestation together with the associated high cost of the immunoprophylaxis no longer supported the routine use of palivizumab. Prior to the 2014 AAP guideline change the 2009 AAP palivizumab guidelines provided prophylaxis for infants before 32 weeks gestation with chronic conditions as well as for those infants before 35 weeks gestation that met certain environmental criteria putting them at increased RSV risk.  

Currently prophylaxis is only approved and recommended for a small subset of preterm infants, leaving most infants born after 29 weeks gestation without access to therapy at increased risk for RSV disease. In the recently published report of the Sentinel 1 study supported by AstraZenica, researchers reported on RSV-confirmed hospitalizations among preterm infants born between 29–35 weeks not receiving palivizumab during the 2014–2015 season. For a sub-group of infants born between 29–32 weeks they found that 75% of RSV-confirmed hospitalizations occurred before 6 months of age. When admitted for RSV at < 3 months, 68% of these infants were admitted to the ICU with 44% requiring invasive mechanical ventilation. The results of this observational study confirm the vulnerability of infants born between 29 and 32 weeks gestation to the RSV virus.

October is national RSV month and The National Coalition for Infant Health (NCIH) is committed to educating parents of premature infants on the dangers of RSV. The NCIH advocates for all premature infants from birth through 2 years of age. The NCIH has just released a new video “The Gap Baby: An RSV Story” depicting the consequences of the new guidelines on this vulnerable population and their families. The take home message is quite clear; until health insurance coverage offers better protection for premature infants, RSV “gap babies” will continue to struggle. Watch the new NCIH video.

References

American Academy of Pediatrics, Committee on Infectious Diseases and Bronchiolitis Guideline Committee. (2014). Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics, 134(6), 415-420.

Anderson, E. J., Krilov, L. R., DeVincenzo, J. P., Checchia, P. A., Halasa, N., Simoes, E. A., … Ambrose, C. S. (2016). SENTINEL1: An observational study of respiratory syncytial virus hospitalizations among US infants born at 29 to 35 weeks’ gestational age not receiving immunoprophylaxis. American Journal of Perinatology. DOI: 10.1055/s-0036-1584147

Hamilton, B. E., Martin, J. A., Osterman, M. J. K., Curtain, S. C., &  Mathews, T. J. (2015). National Vital Statistics Report, 64.

National Coalition for Infant Health. www.infanthealth.org. Accessed October, 2016.

Paes, B. A., Mitchell, I., Banerji, A., Lanctot, K. L., & Langley, J. M. (2011). A decade of respiratory syncytial virus epidemiology and prophylaxis: Translating evidence into everyday clinical practice. Canadian Respiratory Journal, 18, 10-19.

Piedimonte, G., & Perez, M. K. (2014). Respiratory syncytial virus infection and bronchiolitis.  Pediatrics in Review, 35, 519-530.

Synagis Package Insert. Gaithersburg, MD: MedImmune; April 2013. www.medimmune.com/docs/default-source/pdfs/prescribing-information-for-synagis.pdf

Thompson, W. W., Shay, D. K., Weintraub, E., Brammer, L., Cox, N., Anderson, L. J., & Fukuda, K. (2013). Mortality associated with influenza and respiratory syncytial virus in the United States. Journal of the American Medical Association, 289, 179-186.

Yamina, D., Jones, F. K., DeVincenzo, J. P., Gertlerb, S., Kobilerf, O., Townsend, J. P., & Galvinib, A. P. (2016). Vaccination strategies against respiratory syncytial virus. PNAS. DOI: 10.1073/pnas.1522597113

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