Background Certain patient groups are deemed as ‘high-risk’ of developing severe and fatal RSV infection including premature infants with CLD and CHD. Palivizumab has been reported to be safe and effective in reducing RSV bronchiolitis hospitalisation and reducing serious complications among ‘high-risk’ children.

Aims To audit the local palivizumab usage practice in preterm infants with CLD and study the impact on infants receiving and not receiving palivizumab as per local criteria.

Design and methods All preterm infants eligible for palivizumab as per Joint Committee on Vaccination and Immunisation (JCVI) were identified from the database for 2011/12 and 2012/13 winter seasons and all infants who actually received palivizumab were also identified. Data was collected from case notes for bronchiolitis needing hospitalisation and respiratory support.

Results 24 infants received palivizumab during the winter seasons of 2011–2013, a further 2 infants were identified that met the CLD JVCI criteria but were not immunised. None of the infants meeting local criteria but not the JCVI criteria required hospitalisation or escalation of care.

Eight infants (32%), who met JCVI criteria, were automatically funded by prior agreement with commissioners for palivizumab. Sixteen (64%), not meeting JCVI criteria, were funded through Individual Funding Requests to the Primary Care Trust. Around 50% infants received palivizumab in special community clinic while rest received as in-patient.

Conclusion A careful case to case based discussion can help in judicious usage of palivizumab in high-risk patients and could be more cost-effective than a blanket criterion for its usage in all high-risk patients.

References

1. Department of Health, Immunisation Against Infectious Disease, Respiratory Syncytial Virus, Chapter 27a, accessed from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/239274/Green_Book_updated_110913.pdf, accessed 09.10.13

2. Müller-Pebody B, Edmunds WJ, Zambon MC, et al. Contribution of RSV to bronchiolitis and pneumonia-associated hospitalizations in English children, April 1995–March 1998. Epidemiol Infect. 2002;129(1):99–106