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In the USA about half of all infants are infected with respiratory syncytial virus (RSV) during their 1st year of life and almost all are infected by the age of 3 years. The American Academy of Pediatrics1 has recommended that monthly intravenous injections of RSV immune globulin during the RSV season should be considered for infants with bronchopulmonary dysplasia who are receiving oxygen treatment or have done so in the previous six months and possibly for all infants born at or before 32 weeks’ gestation. Because of the obvious limitations imposed by monthly intravenous injections, a humanised monoclonal antibody to the fusion protein of RSV (MEDI-493) that can be given intramuscularly has been studied in a multicentre trial in the USA, Panama, and Costa Rica (Xavier Saez-Llorens and colleagues. Pediatric Infectious Disease Journal 1998;17:787–91).
The study included 65 children, 24 with bronchopulmonary dysplasia aged up to 24 months and 41 aged up to 6 months without bronchopulmonary dysplasia but born at or before 35 weeks’ gestation. They were given from one to five intramuscular injections of MEDI-493 at monthly intervals at dosages of 5, 10, or 15 mg/kg. The 15 mg/kg dose produced mean trough serum concentrations of MEDI-493 of around 70 μg/ml (target > 40 μg/ml). Two children receiving the 5 mg/kg dosage—but none on the higher dosages—were admitted to hospital with RSV infection. Three children had possible reactions, one with diarrhoea, fever, and increased respiratory symptoms, and two with mild, transient local erythema at the injection site. Ten children developed low litre antibodies to MEDI-493 that did not seem to be clinically important. MEDI-493 is much more potent than the RSV immunoglobulin preparation and appeared to be safe and effective at the 15 mg/kg dosage. These researchers conclude that it has several potential advantages over RSV immunoglobulin.
1 American Academy of Pediatrics, Committee on Infectious Diseases Committee on Fetus and Newborn. Respiratory syncytial virus immune globulin intravenous: indications for use.Pediatrics1997;99:645–50.
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