RSV Management- MPR

RSV Management

RSV MANAGEMENT
Respiratory syncytial virus (RSV) causes annual outbreaks of respiratory illnesses in all age groups. RSV season starts in the fall and peaks in the winter, but the timing and severity of RSV season in a given community can vary from year to year. RSV infection can cause a variety of respiratory illnesses in infants and young children. The most common presentation in children is a cold-like illness, but lower respiratory infections such as bronchiolitis and pneumonia can also develop. Severe disease most commonly occurs in very young infants. Children are considered high risk if they have any of the following underlying conditions: prematurity; infants, especially age ≤6mos; age ≤2yrs with chronic lung disease or congenital heart disease; immunosuppression; neuromuscular disorders, including difficulty swallowing or clearing mucus secretions. Adults with RSV infection usually present asymptomatic or with mild symptoms. Symptomatic presentation is usually consistent with an upper respiratory tract infection (rhinorrhea, pharyngitis, cough, headache, fatigue, fever). Risk factors for severe illness in adults include: older age, especially age ≥65yrs; chronic lung or heart disease; immunosuppression. RSV can also exacerbate chronic medical conditions such as asthma, COPD, and CHF. This chart includes prophylactic therapies for RSV, such as vaccines and monoclonal antibodies, and an antiviral for the treatment of RSV infection.
Generic	Brand	Strength	Form	Dose
PROPHYLAXIS
Vaccines
respiratory syncytial virus vaccine (RSVpreF)	Abrysvo	0.5mL	soln for IM inj	Adults: Pregnant individuals (32–36wks gestational age) or ≥60yrs: 1 dose (0.5mL) IM once. Children: <18yrs: Not established.
respiratory syncytial virus vaccine, adjuvanted (RSVPreF3)	Arexvy	0.5mL	susp for IM inj	Adults: ≥60yrs: 1 dose (0.5mL) IM once. Children: Not established.
Monoclonal Antibody
palivizumab¹	Synagis	50mg/vial, 100mg/vial	liq soln for IM inj	Adults: Not indicated. Children: 15mg/kg IM once monthly before and during RSV season; start one month prior to RSV season. Cardiopulmonary bypass: give an additional dose as soon as possible after the procedure (even if sooner than a month after the last dose), then monthly thereafter. Divide doses >1mL into 2 inj sites.
TREATMENT
ribavirin^2,3	Virazole	6g/vial	pwd for reconstitution and aerosol inh	Adults: Not indicated. Children: Begin treatment preferably within first 3 days of infection. 20mg/mL as starting soln in drug reservoir for continuous aerosol administration for 12–18hrs/day for 3–7 days.
NOTES
Key:CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; IM = intramuscular; inh = inhalation; inj = injection; liq = liquid; pwd = powder; RSV = respiratory syncytial virus; soln = solution; susp = suspension ¹ Not established for treatment of RSV disease. Indications for use in pediatric patients include: with a history of premature birth (≤35 weeks gestational age) and who are ≤6mos of age at the beginning of RSV season; with bronchopulmonary dysplasia that required medical treatment within the previous 6mos and who are ≤24mos of age at the beginning of RSV season; with hemodynamically significant congenital heart disease and who are ≤24mos of age at the beginning of RSV season. ² The American Academy of Pediatrics (AAP) recommends the use of ribavirin to be based on clinical circumstances, patient factors and risks, and in patients with severe disease or those at risk for severe disease (eg, immunocompromised, hemodynamically significant cardiopulmonary disease). They also recommend its use in the immunocompromised or transplant high-risk groups with or without palivizumab. ³ Contraindicated in pregnancy
REFERENCES
Centers for Disease Control and Prevention. Respiratory Syncytial Virus Infection (RSV): For Healthcare Providers. Accessed June 20, 2033. https://www.cdc.gov/rsv/clinical/index.html. Eiland LS. Respiratory syncytial virus: diagnosis, treatment and prevention. J Pediatr Pharmacol Ther. 2009 Apr;14(2):75-85. doi: 10.5863/1551-6776-14.2.75. PMID: 23055894; PMCID: PMC3461981. Created 9/2023

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