Preventing respiratory syncitial virus bronchiolitis

Except in very high risk infants there is no cost effective prophylatic agent

Winter in the United Kingdom—wet, cold, miserable, and, yet again, the season for respiratory syncitial virus (RSV) bronchiolitis. About 3% of each year's birth cohort are admitted with bronchiolitis every winter in Europe, Australasia, and North America (20 000 infants in the UK, of whom 600 need ventilation1). Traditionally certain groups of infants are considered to be at high risk of developing more severe RSV bronchiolitis. These high risk groups include infants born prematurely (insufficient transfer of maternal RSV IgG) and those with chronic lung disease of prematurity, other underlying cardiorespiratory disease, or immunodeficiency. However the great majority of infants admitted are previously normal babies. The treatment of RSV bronchiolitis has had a chequered history, and, despite initial enthusiasm, it is now widely accepted that bronchodilators, steroids, and ribavirin have no overall significant benefit.2 This therapeutic nihilism makes paediatricians uneasy, and if we have no treatment, then surely prevention must be the answer.

Pooled hyperimmune RSV intravenous immunoglobulin (RSV IVIG, Respigam) was licensed by the Food and Drug Admininstration in 1996 after …