Fast Five Quiz: Respiratory Syncytial Virus

Supatida Tengsupakul, MD


September 24, 2019

The Centers for Disease Control and Prevention note that the 2014 AAP guideline for palivizumab prophylaxis recommends 5 monthly doses of palivizumab (15 mg/kg intramuscularly) during RSV season for the following:

  • Infants born at or before 29 weeks' gestation and who are < 1 year chronological age when RSV season begins

  • Infants < 12 months of age diagnosed with chronic lung disease of prematurity (defined as birth before 32 weeks' gestation and requiring > 21% oxygen for ≥ 28 days after birth) or infants < 24 months of age with chronic lung disease of prematurity who continue to require medical therapy, such as oxygen, diuretic, or steroid, within 6 months of onset of RSV season

  • Infants < 12 months of age with hemodynamically significant congenital heart disease or moderate to severe pulmonary hypertension, or children < 24 months of age undergoing heart transplant during RSV season

  • Infants < 12 months of age with pulmonary anatomical abnormalities or neuromuscular disorders impairing the ability to clear secretions

  • Children < 24 months of age with profound immunosuppression during RSV season

Birthweight and nutrition source are not factors in the consideration of prophylaxis; not all infants require RSV prophylaxis.

Palivizumab prophylaxis is not recommended in the following circumstances:

  • Infants with chronic lung disease who do not require oxygen supplementation or medical therapy during the second year of life

  • Infants with hemodynamically insignificant cardiac disease, such as secundum atrial septal defect, small ventricular septal defect, patent ductus arteriosus, pulmonic stenosis, uncomplicated aortic stenosis, and mild coarctation of the aorta

  • Infants with cardiac lesions adequately corrected by surgery, unless they require medication for congestive heart failure

  • Infants with mild cardiomyopathy, unless they require medication for congestive heart failure

  • Infants with cystic fibrosis

  • Infants with trisomy 21

Monthly palivizumab prophylaxis should be discontinued in any child with outpatient RSV infection or breakthrough RSV hospitalization as the risk of reinfection leading to hospitalization within the same season is very low (< 0.5%).

Learn more about choosing candidates for RSV prophylaxis.


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