New RSV Guidance From The American Academy of Pediatrics

A new set of interim guidance regarding the respiratory syncytial virus or RSV for high risk children has been released by The American Academy of Pediatrics in response to the ongoing outbreak of respiratory syncytial virus or RSV.

The updated guidance ins focused on both inpatient and outpatient settings and has highlighted the need to improve the emergency readiness of many facilities on a daily basis in order to prevent interruption of continuous care for the children afflicted.

The AAP has indicated according to PharmacyTimes:

• “[T]he organization supports providing eligible infants with more than 5 consecutive doses of palivizumab for those in regions with intense and widespread RSV circulation.”
• “Palivizumab is a monoclonal antibody that helps prevent severe lung infections, which can be provided to eligible infants throughout the 2022-2023 RSV season, the AAP said.”
• “Infants who are eligible for palivizumab include some pre-term infants who are in their first RSV seasons as well as other infants with certain chronic conditions.”
• “Other ways to prevent RSV can include keeping infants away from large groups, secondhand smoke, and secondhand smoke. The AAP also recommends washing hands thoroughly to help keep infants safe.”

The organization went on to point out that there is no cure presently for RSV, and traditional treatments for respiratory conditions such as antibiotics and steroids are ineffective.

The AAP wrote,

“As of mid-November 2022, RSV activity in the United States is high in all regions, with substantial numbers of hospitalizations and illnesses. The Centers for Disease Control and Prevention (CDC) monitors RSV activity in the United States in collaboration with state and county health departments and commercial and clinical laboratories. These data are available from the National Respiratory and Enteric Virus Surveillance System (NREVSS). Recommendations are published for determining the timing of the onset and offset of RSV seasonal activity based on the levels of viral detection and vary depending on whether antigen or molecular testing is used for surveillance.”

In addition to suggesting that families be vaccinated against COVID-19 and influenza, which can help prevent the most severe disease and hospitalization, Sean O’Leary, MD, MPH, FAAP, chair of the AAP Committee on Infectious Diseases, said in a statement“For most children, treating RSV at home is similar to treating a bad cold.”

“In children older than 6 months, acetaminophen or ibuprofen can help with low-grade fevers,” he said. “If your child seems to be struggling to breathe, such as if they seem to be breathing too fast or their chest is sucking in with each breath, you should call your pediatrician right away.”

The group also noted that referrals to hospitals should be reserved only for children with illnesses of a severe nature or associated medical conditions that require a higher level of care to prevent Emergency Room overcrowding, long wait times and delayed care according to Pharmacy Times.

The AAP added that children with “medical complexity” and special health care needs are impacted by “surge events.”

The AAP suggested that under the circumstances there should be “no delays” in the management of chronic pediatric diseases, immunizations or routine pediatric care and that staff who typically assist with adult medicine can be cross trained to provide care to pediatric patients.

It is possible that even more Palivizumab monoclonal antibody treatments may be recommended in the future according to the AAP. The statement explained, “ If RSV disease activity persists at high levels in a given region through the fall and winter, the AAP supports providing more than 5 consecutive doses of palivizumab to eligible children.”

The organization added, “Although there is a paucity of data on the provision of more than 5 consecutive doses, there is no evidence of increased frequency or severity of adverse events with later doses in a 5-dose series nor with doses beyond 5 doses in the few published studies. Given this information, together with the known efficacy of palivizumab and unpredictable epidemiology of RSV since the summer of 2021, the AAP recommends programmatic consideration of providing more than 5 consecutive doses of palivizumab depending on the duration of the current RSV surge in a given region of the country.”

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