Appendix 16 - Criteria for RSV prophylaxis
Note: the criteria changes and is updated annually.
Clinics run across hospital sites by neonatal sister or community sister. Infant is identified as needing RSV prophylaxis (sometimes referred to as Synergis) will be contacted to come in for these clinics usually starting from October of that year. Assistance from Principal Pharmacist W&C, Royal Free London, Bleep 1412 Ext 36443.
Information for parents
RSV prophylaxis is not a vaccine as such but an immunoglobulin that is given to babies just before the winter season (around October) to prevent the baby getting RSV (respiratory syncytial virus) which causes Bronchiolitis. The baby is given an injection every month they get an injection to cover the RSV season (winter period). The immunoglobulin is called Synergis or Palivizumab. Normally infants only need one course during the first year of life, sometimes they get it two years in a row.
RSV is one of the viruses that causes bronchiolitis and is predominantly only seen from October to February each year. Most children get it and are ok but many do get admitted, especially if they have an underlying medical serious condition or were born very prematurely or have lung disease.
After infancy, it does not cause such big issues, more like a cough and cold but not bronchiolitis which is mainly something in the first year of life, maybe up to 18m or so.
We have criteria based on extensive evidence as they are worldwide studies. They have produced yearly criteria for which children should receive immunoglobulin therapy, i.e. monthly injections, to try and prevent them catching RSV during their first winter.
It is usually given in babies with Down Syndrome who have a significant heart abnormality, meaning they have a significant right to left shunt (ie blood going wrong way / shunting) and are usually on medications too. Other reasons could be for example on respiratory grounds in a baby with chronic lung disease or an ongoing daily oxygen requirement. It is rarely given after the first year.
Further research and information:
In the “green book” immunisation guidance can be found here: PLEASE NOTE THIS ADVICE CHANGES YEARLY AND NEEDS UPDATING AND CHECKING YEARLY.
At the time of writing this pathway, some research indicates that all children with DS should have Palivizumab due to their increased risk of bronchiolitis/LRTI, hospital admissions and morbidity accompanied with this, even without congenital heart disease or chronic lung disease. This needs further local and national evaluation and discussion with Public Health England. Paes B, Mitra S.
Palivizumab for children with Down Syndrome: is the time right for a universal recommendation?
Archives of Disease in Childhood Published Online First: 27 December 2018.