Original Article

Respiratory Syncytial Virus: Seasonal Data for Regions of Florida and Implications for Palivizumab

Authors: Jay Bauman, PharmD, Mark Eggleston, PharmD, MBA, Niki Oquist, MD, Frank Malinoski, MD, PhD

Abstract

Background: The aims of this study are to define the length of the respiratory syncytial virus (RSV) season throughout Florida and evaluate the American Academy of Pediatrics (AAP) guidelines on the administration of palivizumab in light of the Florida data.


Methods: We retrospectively analyzed four seasons of monthly RSV surveillance data housed on the Florida Department of Health website for regional trends in RSV outbreaks.


Results: RSV circulated year round in Florida, with December being the peak month for RSV activity statewide. Regional virology data showed consistent patterns throughout the observation period, and all regions experienced widespread RSV activity for at least seven months of the year. The southeast region experienced the longest RSV seasons (10–12 mo), with year round outbreaks observed during 2000 to 2001 and 2001 to 2002.


Conclusions: Local RSV surveillance provides meaningful data to guide decisions on the administration of palivizumab. Reliance on current AAP guidelines for RSV prophylaxis would result in under-protection of at-risk children in all regions within the state of Florida.


Key Points


* The Florida Department of Health maintains a statewide surveillance network for collection of RSV virology data.


* Local surveillance data for Florida indicate that RSV is present year-round throughout the state, and the southeast region experiences the longest seasons.


* The current American Academy of Pediatrics (AAP) guidelines on the prophylactic use of palivizumab are not suitable for any region of Florida and, if adopted, would result in underdosing of all children in the state.


* Dosing of palivizumab in Florida should be guided by results of local virology data.

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References

1. Glezen WP, Taber LH, Frank AL, et al. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child 1986;140:543–546.
 
2. Mullins JA, Lamonte AC, Bresee JS, et al. Substantial variability in community respiratory syncytial virus season timing. Pediatr Infect Dis J 2003;22:857–862.
 
3. McLaurin K, Leader S. Growing impact of RSV hospitalizations among infants in the US, 1997–2002. Pediatric Academic Societies’ Meeting, May 14–17, 2005, Washington, DC.
 
4. Leader S, Kohlhase K. Recent trends in severe respiratory syncytial virus (RSV) among US infants 1997 to 2000. J Pediatr 2003;143(Suppl 5):S127–S132.
 
5. Sigurs N, Gustafsson PM, Bjarnason R, et al. Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13. Am J Respir Crit Care Med 2005;171:137–141.
 
6. Leidy NK, Margolis MK, Marcin JP, et al. The impact of severe respiratory syncytial virus on the child, caregiver, and family during hospitalization and recovery. Pediatrics 2005;115:1536–1546.
 
7. Connor EM, and the IMpact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics 1998;102:531–537.
 
8. Feltes TF, Cabalka AK, Meissner C, et al. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 2003;143:532–540.
 
9. American Academy of Pediatrics. Respiratory Syncytial Virus. In: Pickering, LK, eds. Redbook: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village: American Academy of Pediatrics, 2006, pp 560–566.
 
10. American Academy of Pediatrics. Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Pediatrics 2003;112:1442–1446.
 
11. Canadian National Advisory Committee on Immunization. Statement on the recommended use of monoclonal anti-RSV antibody (palivizumab). Can Commun Dis Rep 2003;29:1–15.
 
12. Tulloh RM, Feltes TF. The European forum for clinical management: prophylaxis against the respiratory syncytial virus in infants and young children with congenital cardiac disease. Cardiol Young 2005;15:274–278.
 
13. Halstead DC, Jenkins SG. Continuous non-seasonal epidemic of respiratory syncytial virus infection in the southeast United States. South Med J 1998;91:433–436.
 
14. Wheeler K. Improving public health practice through respiratory syncytial virus (RSV) surveillance. Epi Update March 12, 2004.
 
15. Weigl JA, Puppe W, Meyer CU, et al. RSV-prevention in children guided by a web-based early warning system. Klin Padiatr 2005:;217:47–52.
 
16. Terletskaia-Ladwig E, Enders G, Schalasta G, et al. Defining the timing of respiratory syncytial virus (RSV) outbreaks: an epidemiological study. BMC Infectious Diseases 2005;5:20. Available at http://www.biomedcentral.com/1471-2334/5/20. Accessed April 3, 2007.
 
17. Afghani B, Ngo T, Leu SY, et al. The effect of an interventional program on adherence to the American Academy of Pediatrics guidelines for palivizumab prophylaxis. Pediatr Infect Dis J 2006;25:1019–1024.
 
18. Centers for Disease Control and Prevention. Brief report: respiratory syncytial virus activity—United States, 2005-2006. MMWR Morb Mortal Wkly Rep 2006;55:1277–1279.
 
19. Molinari-Such M, Garcia I, Garcia L, et al. Respiratory syncytial virus-related bronchiolitis in Puerto Rico. P R Health Sci J 2005;24:137–140.
 
20. Centers for Disease Control and Prevention. Brief report: respiratory syncytial virus activity—United States, 2003-2004 season. MMWR Morb Mortal Wkly Rep 2004;53:1159–1160.
 
21. Washburne JF, Bocchini JA Jr, Jamison RM. Summertime respiratory syncytial virus infection: epidemiology and clinical manifestations. South Med J 1992;85:579–583.
 
22. Monto AS, Johnson KM. A community study of respiratory infections in the tropics, 1: description of the community and observations on the activity of certain respiratory agents. Am J Epidemiol 1967;86:78–92.
 
23. Simoes EAF, Carbonell-Setrany X. Impact of severe disease caused by respiratory syncytial virus in children living in developed countries. Pediatr Infect Dis J 2003;22(Suppl 5):S13–S20