The annual incidence of hospital admissions related to respiratory syncytial virus is 28
The annual incidence of hospital admissions related to respiratory syncytial virus is 28.3 per 1000 for babies, and 1.3 per 1000 for children aged 1-4 years.1 Interestingly, the number of laboratory reports for respiratory syncytial disease shows a marked downward tendency in England and Wales from 1990 to 2003 (numbers ?(numbers11 and ?and2).2). actual benefit. So if cure does not work, how are we performing with prevention? Open Fluvastatin in a separate windowpane Fig 1 Laboratory reports of respiratory syncytial disease received from the Communicable Disease Monitoring Centre and microbiology laboratories of the Health Protection Agency, by day of specimen in 2003-4 and recent years. Data for 2003-4 are provisional, and extreme caution should be exercised in interpreting a tendency for the most recent weeks Open in a separate windowpane Fig 2 Four weekly laboratory reports to the Communicable Disease Monitoring Centre of infections due to respiratory syncytial disease in England and Wales, by day of statement, 1990-2003 Passive immunisation with the monoclonal antibody palivizumab is an option for high risk babies. The impact respiratory syncytial virus study, a double blind, placebo controlled, randomised study, showed that palivizumab was safe and decreased admissions related to respiratory syncytial disease in babies at high risk.3 The American Academy of Pediatrics revised its recommendations for passive immunisation against respiratory syncytial disease in 2003.4 Current recommendations are that palivizumab should be considered for premature infants born at less than 32-5 weeks’ gestation or infants younger than 2 years, with chronic lung Fluvastatin disease. In the United States around 100 000 babies a yr receive palivizumab. The current NHS guidelines have been formulated from the joint committee on vaccination and immunisation of the Division of Health. They note that palivizumab seems safe, well tolerated, and effective in reducing admissions to hospital, but it remains very expensive, at a cost of around 2500 for five doses over the season for respiratory syncytial virus. In the United Kingdom, studies on readmission rates with respiratory syncytial disease bronchiolitis display that palivizumab is definitely cost effective only in babies created prematurely with chronic lung disease receiving oxygen at home.5 The cost-benefit ratio will shift against palivizumab even more if it becomes clear that admissions for bronchiolitis due Mouse monoclonal to HSP70 to respiratory syncytial virus are falling in parallel with laboratory reports. Recently, a further study of palivizumab in babies with cardiac disease has been completed, but data on admission, morbidity, and mortality and a detailed cost benefit analysis are required before it can be regularly recommended with this human population.6 The reality is that except in the richest nations for very small subgroups of individuals, palivizumab is Fluvastatin too expensive to have any impact on overall respiratory syncytial virus admissions. Developing an effective and safe respiratory syncytial disease vaccine remains a worldwide priority.7 Forty years have passed since the formalin inactivated respiratory syncytial virus vaccine was first used, with younger vaccinated children experiencing more severe respiratory syncytial virus disease and increased mortality.8 A successful respiratory syncytial virus vaccine needs to prevent severe lower respiratory tract disease, hospitalisation, and death. It must protect against both group A and B strains. It would need to be given after birth, to prevent main illness with respiratory syncytial disease in babies. However, neonatal immunisation poses problems. Neonates and young babies may be unable to develop adequate antibody or T cell reactions to vaccination. Also, maternally derived antibodies may interfere with the immunisation response. Several vaccine strategies are currently under development. Firstly, maternal immunisation in the third trimester aims to boost serum neutralising antibodies passively transferred from mother to baby. This would protect young babies, who are most susceptible to severe respiratory syncytial disease disease. A second generation, purified F protein (PFP-2) subunit vaccine was safe with no enhanced disease in babies when 35 pregnant women were immunised in the Fluvastatin third trimester. The women experienced a moderate immunogenic response. The babies had higher counts of immunoglobulin G antibodies against respiratory syncytial disease at birth, 2 weeks, and 6 months of age.9 This strategy would not guard infants created prematurely. Currently, purified F protein vaccines cannot be used in main immunisation of babies because of limited immunogenicity. Second of all, main immunisation with live attenuated genetically revised viruses is definitely another approach. A live attenuated vaccine should induce local and systemic immunity much like crazy type respiratory syncytial disease. It should be effective actually in the presence of maternal antibodies. One interesting candidate vaccine consists of live attenuated, chilly passaged, temperature sensitive mutants of respiratory syncytial virus. It has been studied in healthy adults, Fluvastatin respiratory syncytial disease seropositive children, and respiratory.