Medical Abbreviation: A Closer Look at RSV

RSV is a virus infection that causes a serious respiratory tract illness. It produces a variety of symptoms involving different areas of the respiratory tract including; nasal passageways, eyes, throat and lungs. In a large majority of people, RSV appears the same as a cold; sneezing, cough and runny nose. However, for high risk infants, the elderly and those with compromised respiratory, cardiac, or immune system disorders, it can be very scary and even life threatening.

RSV is the most common cause of lower respiratory infection and viral death in children under the age of five. Two-thirds of all infants are infected with the RSV virus in their first year of life. Each year the RSV disease results in more than 125,000 hospitalizations, and approximately 2,000 of those infants die. RSV kills more than ten times as many children under the age of one as the flu.

Approximately 300,000 infants are born prematurely each year in the United States. The American Academy of Pediatrics has repeatedly stated that infants who are at the highest risk of developing RSV are those who were born before 36 weeks gestation, and/or have chronic lung disease, heart disease, or a compromised immune system. The RSV virus is highly contagious and is spread by direct or close physical contact, and typically occurs between the months of October and April.

Symptoms of progressing RSV infections include the following:

• Difficult or rapid breathing
• Wheezing
• Irritability and restlessness
• Poor appetite
• Bluish coloring around the lips and fingernails (sign of decreased oxygen levels in the blood)
• High Fever

Standards do exist for diagnosing RSV. Treatment varies depending on the presenting symptoms. Hospitalization can be required in order to administer intravenous fluids, breathing treatments or respiratory support (including ventilation support for those with respiratory failure). Antibiotics do not work because of the viral nature of the infection. In severe cases, Ribavin may be administered via breathing treatments.

There are two products, Respigam and Synagis, which have been approved by the Food and Drug Administration to help prevent RSV in children under the age of two who were born prematurely or who have Bronchopulmonary Dysplasia. Respigam was on the market first. It is an immunoglobin that is most often administered via an IV line. It begins to work quickly but its effect only lasts for about three weeks. Therefore, patients have to return monthly for about five months to keep their immunity levels up.

Synagis (palivizumab) was approved by the Food and Drug Administration in 1998. It is a humanized monoclonal antibody administered via intramuscular injection once a month during the RSV season. In 2003, the FDA expanded the label for the use of Synagis in the United States for young children with hemodynamically significant congenital heart disease.

There is some controversy of who should receive Synagis. There are a couple of differing guidelines used to determine which patients qualify for the injection. What is most often lost in this equation is the ability for parents to get insurance coverage for their injections. Often times parents are left without knowing what to do and they have to foot the bill. The cost for a Synagis injection can range from $1,500 to $5,500 per injection. That’s a total per RSV season of $10,500 to $38,500 per child.

If you have questions regarding the guidelines for Synagis administration or have a case that involves RSV, please contact our office for assistance.

References:

American Academy of Pediatrics. RSV: A Serious Threat to Infants and Children. Retrieved November 2007 from www.aap.org/advocacy/releases/rev.htm.

American Lung Association Respiratory Syncytial Virus Fact Sheet. Retrieved November 2007 from www.lungusa.org.

MedImmune. Risk Factors for Severe RSV Disease. Retrieved November 2007 from www.rsvprotection.com/risk_factors.

MedImmune. Synagis Retrieved November 2007 from www.medimmunue.com/products/synagis/index.asp.