Question!
Which of the following is true about palivizumab (aka Synagis)?
- A. It’s a vaccine
- B. It’s injected once per RSV season to eligible infants
- C. It’s associated with decreased mortality in infants hospitalized with RSV
- D. All of the above
- E. None of the above
Quick facts!
- Palivizumab (Synagis) is a monoclonal antibody indicated for the prevention of serious lower respiratory tract disease caused by RSV in certain pediatric patients.
- Synagis has been shown to modestly (but significantly) reduce hospitalizations caused by RSV in high-risk patients, but there is no measurable effect on mortality.
- Synagis is not a vaccine and does not provide long-lasting immunity. It is administered as a monthly injection (max of 5 doses), providing antibodies that last for 28-30 days at a time. Monthly prophylaxis should be discontinued in anyone hospitalized with RSV.
RSV in Rhode Island
Ongoing monitoring of RSV activity indicated a substantial increase in RSV cases in September and October, with cases currently at the levels usually seen in December (pre-pandemic) and similar to late summer/early fall activity in 2021, when early prophylaxis was advised.
RIDOH recommends that providers offer Synagis to eligible patients as soon as possible, then continue once monthly dosing (not to exceed 5 doses).
Synagis Administration
In Rhode Island, Synagis is administered at a patient’s home–not in our clinic! (The goal is to not expose high-risk infants to RSV.)
For clinic patients, there are two parts to obtaining Synagis: medication access (coordinated through our clinical pharmacist) and home nursing services (coordinated through our nursing staff).
Whenever possible, W&I’s NICU will give the first dose of Synagis before the anticipated discharge of an eligible infant (usually 2-4 days prior to discharge).
Indications
AAP guidelines for Synagis prophylaxis:
- Infants 29 weeks and 0 days gestation or less, and less than 1 year old as of the designated start date for prophylaxis.
- Infants less than 32 weeks and 0 days gestation with chronic lung disease (greater than 21% inspired oxygen for at least 28 days after birth) and less than 1 year old at start date.
- Infants less than 32 weeks and 0 days gestation with chronic lung disease (greater than 21% oxygen for at least 28 days after birth) and between 1 and 2 years old at start date who require ongoing medical treatment for chronic lung disease (supplemental oxygen, diuretic or steroid therapy).
- Infants under 1 year old at start date with hemodynamically significant congenital heart disease (consultation with a cardiologist is recommended).
- Infants with pulmonary abnormalities or neuromuscular disease that compromises respiratory secretions.
- Infants under 2 years of age with profound immunocompromise.