Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary
--Heart Murmurs: When to Refer
--How to Feed Infants with Heart Disease
--Syncope in the Pediatric Age-Group
--Asthma: Classification and Management
--Asthma Medication
--Exercise Induced Asthma (EIA)
--Home Monitoring: The Role of the Pediatrician
--Bronchiolitis

RSV – Incidence and Prevention: 2002

(References: 2000 Redbook; Dr. Guill)

Introduction: RSV infection is seen every year and remains one of the most difficult problems to prevent and treat in pediatrics.  There are 90,000 admissions (adults and children) and 1800 deaths attributable to RSV each year in the US.  Incubation period of infection: 4-6 days and it passes through respiratory secretions.

Season: RSV starts in the late fall and lasts for about 6 months- no immunity in subsequent years.  The Public Health Department of the state of Georgia determines the onset of RSV season in the state report that 50% of their reporting sites have greater than 10% of RSV tests come back positive.  In the year 2000, this date was November 3rd. 

Frequency of Infection: 50% of those susceptible get the infection each year; hospitalizations can vary from 11 to 43% of those who are high risk. 40% incidence of nosocomial infections.

Risk Factors for getting RSV: Prematurity, chronic lung disease, neurological disease in LBW infants, young siblings in house, multiple gestation, daycare, family history of atopy, bad cardiac disease, parental smoking; most severe infections usually under 6 months of age.

Prevention: Standard infection control techniques: hand washing by parents and child caregivers; isolate infants from people with URIs; avoid secondary smoke inhalation; avoid crowds and day care centers; consider Synagis: A humanized mouse monoclonal antibody that is given IM once a month for the entire RSV season.

Who Should Receive Synagis? Dose: 15 mg/kg

• Infants and children younger than 2 years of age with chronic lung disease (CLD) who have required medical therapy (such as oxygen or medications) within 6 months before RSV season.
• Prematurity: indications vary with gestational ages and with risk factors:
  • 24-28 weeks of gestation: prophylaxis up to 1 year of age; give prior to the start of RSV season.  Treat longer if risk factors.(see above)
  • 29-32 weeks of gestation: prophylax up to 6 months of age; give prior to the start of RSV season ; longer if risk factors
  • 33-35 weeks of gestation: up to 6 months of age; give prior to the start of RSV season based on risk factors.

Who Should Not Receive Synagis? Children with cyanotic heart diesease; it is OK to give it if child has acyanotic heart disease and meet the criteria above.  Does not interfere with vaccines.

Uncertain or “May Benefit”: PICU or inpatients; emphasize hand washing; immunocompromised or immunsuppressed not clear-cut indication.

How arranged at MCG: Call Cathy at 1-2635 and give her name, medical record number, diagnosis, number of weeks of gestation.  Based on her criteria, she will make the appointment in the Synagis clinic currently Friday PM.

Updated 9/01

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004