Synagis for RSV

Which Children Should Receive Synagis for RSV Prevention and Why?

Pediatrician giving crying baby injection in examination room
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Definition - Synagis for RSV

Synagis (pavivizumab) is a shot used to prevent infections with respiratory syncytial virus (RSV.) The shot is used primarily during the winter months when RSV occurs.

What is Respiratory Syncytial Virus (RSV)?

The respiratory syncytial virus (RSV) is a viral infection which may only cause cold symptoms in older children. Yet younger children and those at high risk such as premature babies, can develop serious and even life threatening infections with these viruses.

In this setting, RSV can cause not only croup, ear infections, and pneumonia, but bronchiolitis - an inflammation of the lungs with wheezing and difficulty breathing due to swelling and mucous production in the small airways of the lungs.  Since there is not a cure for bronchiolitis, preventing RSV is the primary way to reduce the risk.

Ordinarily, RSV is a bother but not a huge concern. It is the leading cause of upper respiratory infections in babies, and the majority of children have an infection with this virus by the time they are age 2.  For children who are born prematurely, or have other medical conditions, RSV can be very serious.  It's estimated that 125,000 children are hospitalized with the infection each year, and it is the number one reason for babies born prematurely to need readmission to the hospital.

What is Synagis (Palivizumab)?

Synagis (palivizumab) is a monoclonal antibody against RSV.

Just as our immune system manufacture antibodies to fight off bacteria and viruses which enter our bodies, Synagis is a "man-made" antibody designed to attack the RSV virus in much the way our own antibodies attack other viruses.  This medication can prevent over half of infections with RSV in high risk children.

Who Should Get Synagis Shots and When?

Children who are considered high risk for RSV infections should receive monthly Synagis shots during the RSV season.  The season typically lasts from November through April. But who is considered to be at high risk?

Children at High Risk for RSV

Children considered to be high risk for complications from RSV include those who have heart, lung, and neuromuscular diseases, as well as those who are born prematurely. Recommendations include:

  1. Infants and children under the age of 2 who have required treatment for chronic lung disease, such as oxygen, bronchodilators, diuretics, or steroids within 6 months of the start of RSV season.
  2. Certain children who are younger than 2 years with congenital heart disease, including congestive heart failure, pulmonary hypertension, and cyanotic heart disease.
  3. Certain infants born before 35 weeks with congenital abnormalities of the airway or neuromuscular disease.
  4. Infants born at or before 28 weeks gestation and who are less than 12 months old at the start of RSV season, which means that these preemies will need Synagis for at least one RSV season.
  1. Infants born at 29 to before 32 weeks, 0 days gestation and who are less than 6 months old at the start of RSV season.
  2. Infants born at 32 weeks, 0 days to 35 weeks gestation and who are less than 3 months old at the start of RSV season, or who are born during RSV season and have siblings less than 5 years old or attend daycare.

Where to Get Synagis

Because Synagis is so expensive, it is unlikely that you will be able to get your child's Synagis shots from your pediatrician. Instead, your pediatrician will probably refer you to a 'Synagis clinic' or a home health agency for the Synagis shots.

The neonatal intensive care unit NICU might also set up your child's Synagis shots before you leave the nursery if your child was born prematurely.

Keep in mind that it can take some time to get the Synagis shots approved by your insurance company, so start early if your child is in a high risk group and needs Synagis this RSV season.

What You Need To Know About Synagis

  • Once you start Synagis during an RSV season, you typically complete the season, even if your child outgrows his risk factor for needing it. For example, if your 31 week preemie started his Synagis shots when he was 5 months old in November, you wouldn't stop them in December just because he was now 6 months old. If your child's risk factor was attending daycare and your child is now staying home, you might, however, wish to talk to your pediatrician about whether or not you need to continue your infant's Synagis shots.
  • During a typical RSV season, kids get their last RSV shot in March, which provides protection into April. The timing of the last shot may vary though, depending on whether or not experts are still seeing a lot of children with RSV into early or late April.
  • Some experts consider multiple births, crowded living conditions, family history of asthma, and low birth weight, to be additional risk factors to use when considering which 32 to 35 week preemies should get Synagis.

Preventing Infections

Synagis does a good job of preventing many RSV infections - but not all. In addition, some children become very ill with RSV despite not fitting the criteria for Synagis.  Practicing infection prevention is important whether or not your child receives the shot, but is not always obvious.

Learn the proper technique of hand washing to reduce the risk of infection.  This may seem easy and obvious, but studies tell us that most people could improve their technique - and hence lower the risk to their children.

Avoiding crowds and crowded conditions, especially during the winter, is simply a good idea.  There are infections in addition to RSV which can likewise be very serious in some children.

Sources:

American Academy of Pediatrics Policy Statement. Revised Indications for the Use of Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous for the Prevention of Respiratory Syncytial Virus Infections. PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1442-1446.

Andabaka, T., Nickerson, J., Rojas-Reyes, M., Rueda, J., Bacic Vrca, V., and B. Barsic. Monoclonal antibody for reducing the risk of respiratory syncytial virus infection in children. Cochrane Database of Systematic Reviews. 2013. 4:CD006602.

Homaira, N., Rawlinson, W., Snelling, T., and A. Jaffe. Effectiveness of Palivizumab in Preventing RSV Hospitalization in High Risk Children: A Real-World Perspective. International Journal of Pediatrics. 2014. 2014:571609.

Lavoie, P., Solimano, A., Taylor, R., Kwan, E., Claydon, J., Turvey, S., and N. Marr. Outcomes of Respiratory Syncytial Virus Immunoprophylaxis in Infants Using an Abbreviated Dosing Regimen of Palivizumab. JAMA Pediatrics. 2016. 179(2):174-6.

Red Book. 28th Edition. American Academy of Pediatrics. 2009 Report of the Committee on Infectious Diseases.

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