Prevention of respiratory syncytial virus infection with palivizumab.

Respiratory syncytial virus (RSV) infects virtually all children by the age of 2 yrs. Premature infants with chronic lung disease (CLD) are at risk of greater morbidity due to RSV infection. However, these infants represent a small proportion of all infants admitted to hospital with RSV infection, and hospitalization rates for this group appear to have decreased over the past decade. Prophylaxis against RSV infection has recently become available in the form of palivizumab, a humanized monoclonal antibody preparation. The IMpact trial demonstrated a 39% relative risk reduction in hospital admissions for RSV in cases in which palivizumab was administered to premature infants with CLD. However, palivizumab is a very expensive drug and cost-effectiveness analyses do not support its use in the majority of premature infants with or without CLD. The only group in which palivizumab should even be considered for use is premature infants with chronic lung disease at home on oxygen during their first respiratory syncytial virus season. In this group of infants, a detailed postlicensing audit needs to be performed to determine efficacy.