Palivizumab is effective but too expensive, and vaccines are unavailable as yet

Bronchiolitis due to respiratory syncytial virus is predictable, occurring during the dark winter in temperate climates and the rainy season in tropical countries. In the United Kingdom around 20% of admissions for infections of the lower respiratory tract in children are due to respiratory syncytial virus. The annual incidence of hospital admissions related to respiratory syncytial virus is 28.3 per 1000 for infants, and 1.3 per 1000 for children aged 1-4 years.1 Interestingly, the number of laboratory reports for respiratory syncytial virus shows a marked downward trend in England and Wales from 1990 to 2003 (figures 1 and 2). Although changes in clinical or laboratory practice may be an influence, data from primary care show a fall in acute respiratory infections over the same years.2 This is fortunate, as treating respiratory syncytial virus bronchiolitis remains a good example of therapeutic nihilism—nothing works except oxygen. Adrenaline, bronchodilators, steroids, and ribavirin all confer no real benefit. So if cure does not work, how are we doing with prevention?