The onset of winter brings an unwelcome visitor, the common cold. For most of us cold viruses are a nuisance, a minor inconvenience. For premature infants, colds caused by Respiratory Syncytial Virus (RSV) are much more than a minor annoyance; they can be a life-threatening illness leading to hospitalization and an increased risk of life-long respiratory complications in the form of asthma. In the United States, RSV is the most common cause of pneumonia and bronchiolitis in infants less than one year of age (CDC 2010).
By the age of two years, most children have had at least one RSV infection. Yearly outbreaks occur in a seasonal pattern beginning, in the northern hemisphere, in late October or November and ending in spring. During those months 0.5 to 2% of infected infants require hospitalization (CDC 2010). Fortunately a monoclonal antibody, Palivizumab, has been developed and has markedly reduced the incidence of RSVP in vulnerable populations. Palivizumab is given to high risk infants monthly during the RSV season. Across North America, a variety of programs have been developed to distribute Palivizumab to eligible infants. Eligibility is based on risk factors and includes infants with chronic lung disease, those born before 35 weeks gestation and those with any significant congenital heart disease (AAP 2009).
There a many challenges in developing an RSV program, including identifying and tracking eligible infants, obtaining parent consent for treatment and communicating treatment status to primary care providers following discharge from hospital. Innovative strategies are needed to implement comprehensive and complex programs and these strategies can be applied to a number of health care issues well beyond RSV. In the January/February issue of Neonatal Network: The Journal of Neonatal Nursing, a series of three articles describes the nation-wide RSV prophylaxis program developed in Canada and includes a tool kit which other health care providers may find helpful in the fight to prevent RSV in young infants. The tool kit provides helpful information to reduce RSV infections in hospital settings as well as strategies for families that are caring for vulnerable infants. Other helpful tools include sample letters for caregivers, tracking tools and injection records as well as an overview of the Canadian RSV program. By bringing attention to the significant human costs of RSV infection, it is hoped that programs here and in other parts of the world can be strengthened and the impact of this disease further diminished.
American Academy of Pediatrics Committee on Infectious Diseases (2009). Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections
Centre for Disease Control (2010) Respiratory Syncytial Virus Infection (RSV). Accessed Nov 23, 2012 from http://www.cdc.gov/rsv
Pediatrics Vol. 124 No. 6 pp. 1694 -1701