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AAP releases interim guidance on preventing RSV during delayed season

August 10, 2021

Editor's note: The guidance has been updated since this article was published. Please see the guidance document.

An atypical summer spike in respiratory syncytial virus (RSV) has prompted the AAP to recommend clinicians consider using palivizumab for high-risk infants in affected areas.

“We are seeing this unusual RSV activity,” said Mary T. Caserta, M.D., FAAP, a member of the AAP Committee on Infectious Diseases who led creation of the interim guidance. “Because of this change, the Academy supports the use of palivizumab in regions having a significant number of cases, similar to a typical winter season.”

A typical RSV season runs from fall through spring with a peak in February. However, RSV activity was low from May 2020 to early March 2021, possibly due to COVID-19 mitigation measures. Instead, some parts of the country have seen rising rates over the last several months, prompting a health advisory from the Centers for Disease Control and Prevention (CDC).

“RSV infections in July and August are quite remarkable for most of the country,” said Dr. Caserta, professor of pediatrics at the University of Rochester Medical Center. “We are definitely seeing cases and hospitalizations.”

The AAP interim guidance on administration of palivizumab during this delayed season is the same as for a typical season: Consider administering the humanized monoclonal antibody in up to five monthly doses to prevent RSV in high-risk infants and children in areas experiencing high rates of the virus.

Eligible children include premature infants, especially those born at less than 29 weeks’ gestation, infants with chronic lung disease of prematurity, infants with certain types of hemodynamically significant congenital heart disease, infants and young children with certain immunodeficiency states, and infants with pulmonary abnormalities or neurological and neuromuscular conditions that impair ability to clear secretions from the upper airway.

Clinicians should reassess the need for palivizumab at least monthly.

An eligible child who received fewer than five doses of palivizumab earlier this year could receive additional doses, Dr. Caserta said.

To determine whether their community is experiencing an RSV spike, pediatricians can consult local infectious disease and pulmonology specialists and public health officials as well as monitor the CDC’s National Respiratory and Enteric Virus Surveillance System.

About 58,000 children under the age of 5 years are hospitalized each year due to RSV, and 100 to 500 die from the virus, according to the CDC.

Symptoms of RSV in children under 6 months include irritability, poor feeding, lethargy and/or apnea with or without fever, the agency said in its June alert. Infants and young children may experience rhinorrhea, decreased appetite, cough, sneezing, fever and wheezing.

The CDC recommends clinicians test for RSV in patients with these symptoms or acute respiratory illness who test negative for SARS-CoV-2. They should report laboratory-confirmed RSV cases as well as clusters of respiratory illness to their state and local health departments.

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