Treatment and prevention of severe respiratory syncytial virus infection in young children

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In the 40 years since its discovery, respiratory syncytial virus (RSV) has been recognized as the most important cause of lower respiratory tract infection in young children worldwide. Despite its enormous health-care impact, therapy and prevention strategies remain inadequate. The safety and clinical effectiveness of ribavirin, the only licensed antiviral agent against RSV, are still under scrutiny. A vaccine against RSV has not been developed because of the fear of causing enhanced pulmonary disease, particularly in the very young seronegative infant. Maintenance of high-titer RSV neutralizing antibodies via monthly high-dose infusions of an RSV-enriched polyclonal immunoglobulin may significantly decrease the incidence and severity of RSV illness in preterm children with and without underlying pulmonary disease and in children with severe congenital heart disease. Licensure of this by the US Food and Drug Administration is still pending. Its success with prophylaxis has encouraged the development of humanized RSV monoclonal antibodies. Monoclonal antibodies have the dual advantage that they are directed specifically against the RSV fusion protein, and that they can be used at much smaller doses. Clinical pediatric trials are just beginning.

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