Severe Respiratory Syncytial Virus Bronchiolitis: Epidemiologic Variations Associated With the Initiation of Palivizumab in Severely Premature Infants With Bronchopulmonary Dysplasia.
Grimaldi, Marianne MD *; Gouyon, Beatrice MD +; Michaut, Francis MD +; Huet, Frederic MD *; Gouyon, Jean-Bernard MD *; the Burgundy Perinatal Network
Pediatric Infectious Disease Journal.
23(12):1081-1085, December 2004.
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Background: The efficacy of palivizumab prophylaxis after bronchopulmonary dysplasia (BPD) has been demonstrated in a single placebo-controlled trial. Concern has emerged about the degree of efficacy of palivizumab.
This study was designed to determine the efficacy of administration of palivizumab to premature infants with a gestational age <=32 weeks, a past history of BPD and younger than 6 months of age at the start of the epidemic.
Methods: Prospective observational study of respiratory syncytial virus (RSV) bronchiolitis requiring hospitalization in Burgundy (12 hospitals) from December 1 to April 30 of the next year during 3 successive epidemic seasons (1999-2000, 2000-2001 and 2001-2002). The regional perinatal database provided perinatal epidemiologic characteristics of the population as a whole and of cohorts of children at risk for severe RSV infection born between April 15 and January 31 of the following year. Palivizumab was used in the 2000-2001 and 2001-2002 periods only.
Results: The 3 epidemics included respectively 377, 310 and 328 children born during April 15 to January 31 of the following year. The 3 epidemics differed significantly by the proportion of severely premature infants with BPD (3.2% versus 0.7 and 0.3%). In the cohort of severely premature infants with BPD born in 1999-2000, 2000-2001 and 2001-2002, the hospitalization rate for RSV bronchiolitis decreased significantly from 12 of 26 to 2 of 17 and 1 of 26 (46.2% versus 11.8 and 3.8%; P < 0.01). Sixteen of 17 and 23 of 26 premature infants with a gestational age <=32 weeks and with BPD had been treated with palivizumab in the years 2000-2001 and 2001-2002.
Conclusions: This study strongly supports the efficacy of prevention of RSV bronchiolitis by palivizumab in severely premature infants with BPD.
(C) 2004 Lippincott Williams & Wilkins, Inc.