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 Most infants and children
overcome RSV infections, which are often asymptomatic and therefore unnoticed. However,
those with more serious infections may be susceptible to the development of long-term
pulmonary sequelae. Recurring Respiratory Problems
Reactive airway disease and pulmonary function deficits are two conditions known to strike
those who have suffered from RSV bronchiolitis in their first year of life, even in
children whose initial illness did not require hospitalization.10 Wheezing and
asthma have also been identified in children 10 years after suffering an RSV lower
respiratory tract infection in infancy. 11 This
susceptibility to asthma and wheezing may have been caused by the early infection damaging
the growing lung. However, genetics may also play a role in predisposing patients with RSV
to the development of recurring respiratory problems.11
Two major hypotheses have been proposed to explain the association between lower
respiratory tract infections such as RSV during infancy and subsequent respiratory
abnormalities such as asthma and chronic obstructive pulmonary disease.10
These two possibilities, however, while contrasting, are not necessarily mutually
exclusive.
According to various prospective studies involving children who had experienced RSV
infection as infants, the following RSV sequelae have been reported11-21:
- recurrent wheezing; cough
- asthma; impaired oxygenation
- pulmonary dysfunction
- bronchial reactivity
- acute respiratory disease
- hyperinflation
- variable airways obstruction
RSV Risk Factors
It is important to note that there is a broad spectrum of RSV infection ranging from mild
to severe to fatal, and it is not known whether RSV sequelae follow mild RSV infections,
as most prospective studies follow cases of infants who were hospitalized for moderate to
severe RSV infection.11-21
In hospitalized patients with moderate to severe cases of RSV bronchiolitis infection,
physicians should consider early treatment with an antiviral agent to reduce the risk of
long-term sequelae.
Those infants and young children most at risk for severe RSV infection include:
- Those with a history of prematurity
- Infants less than six weeks of age
- Those with congenital heart disease
- Those with chronic lung conditions including bronchopulmonary dysplasia and cystic
fibrosis
- Those who suffer from immunodeficiency (e.g., HIV, AIDS, cancer, transplants)
Can Early Treatment Make a Difference?
If viral infections early in life cause long-term sequelae, RSV can be considered a prime
candidate by virtue of high incidence in early infancy.10 But is there
anything that can help decrease the risk of long-term sequelae? Some studies confirm a
decreased overall incidence of bronchitis in ribavirin-treated patients but do not
maintain that subsequent diagnosis of reactive airway disease is reduced due to such
antiviral treatment.22 However, recent prospective and retrospective studies23-25
indicate that aggressive medical intervention and early treatment with a broad-spectrum
antiviral may reduce the morbidity from RSV disease.
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| AUTHORS: |
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Fergie et al at Driscoll
Children's Hospital in Corpus Christi, Texas
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| METHODS: |
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Assessed the pulmonary health status at two
years following hospital discharge of 30 ribavirin-treated infants with RSV bronchiolitis
(1994-1995 RSV season) |
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Compared this status with 28
matched infants whose treatment at the same hospital excluded ribavirin |
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| RESULTS: |
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 |
For Full Prescribing Information For VIRAZOLEŽ
(click here).
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| AUTHORS: |
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Rodriguez et al at the Children's National
Medical Center and George Washington University, Washington, D.C. |
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| METHODS: |
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Previously healthy, preterm infants and infants
with chronic pulmonary disease were assessed for the prevalence of subsequent reactive
airway disease (RAD) for up to 7 years |
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| RESULTS: |
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19 patients (13 ribavirin, 6 placebo) completed
pulmonary function tests (PFTs) |
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53% (7 of 13) of ribavirin-treated patients
showed normal or mildly abnormal PFTs between years
5 and 7 |
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In contrast, all placebo recipients (6 of 6)
showed moderate to severe abnormalities in their PFTs (P=0.043) |
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On methacholine challenge, there was more
reactivity in placebo than ribavirin patients (P=0.036) |
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| CONCLUSION: |
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Weighted severity scores suggest long-term
beneficial effect of ribavirin |
For Full Prescribing Information For VIRAZOLEŽ
(click here).
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| AUTHORS: |
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Hiatt et al at Baylor College of Medicine,
Houston, Texas |
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| METHODS: |
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Enrolled 94 RSV-positive, previously
healthy, full-term or premature infants with no previous history of lower respiratory
infections 42 of 94 infants returned at 6 and 12 months after hospitalization for PFTs |
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| RESULTS:
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VmaxFRC was significantly higher in ribavirin
recipients at the end of hospitalization and 12 months after discharge (P<0.01). This suggests a long-term beneficial effect of
ribavirin. |
For Full Prescribing Information For VIRAZOLEŽ
(click here).
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| AUTHORS: |
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Long et al in Rochester, New York |
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| METHODS: |
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54 of 60 children hospitalized with RSV lower
respiratory tract infection and enrolled in a placebo-controlled trial of ribavirin
participated in a long term follow-up study. |
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Children (and their parents) were seen every 1
to 2 years by the study team to note any respiratory illnesses, allergy symptoms,
household smoking, height, weight, oximetry measurements, spirometry tests, oxygen
saturation, and pulmonary function tests. |
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| RESULTS: |
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No detection of any long term adverse effects
or benefits resulting from rapid and effective treatment of RSV infection in infancy. |
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No significant differences in
rates, severity or timing of recurrent LRTI, or in measures of pulmonary function in
ribavirin-treated or placebo-treated groups. |
For Full Prescribing Information For VIRAZOLEŽ
(click here).
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| AUTHORS: |
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Krilov et al at 6 institutions in the U.S. |
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| METHODS: |
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100 patients hospitalized with RSV infection
were assesssed using medical records and current PFTs and pulmonary status questionaires |
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| RESULTS: |
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Less "bronchitis" over the interval
years in the ribavirin treated patients (13 of 33) vs. those who did not receive ribavirin
(44 of 67, P<0.01) No difference in incidence of RAD (15 of 33 ribavirin vs. 36
of 67 no ribavirin) |
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No significant differences in the results of
the PFTs in the two groups |
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No evidence of adverse long term effects of
ribavirin therapy |
For Full Prescribing Information For VIRAZOLEŽ
(click here).
|
Despite evidence that ribavirin-treated patients have been shown to experience fewer
subsequent wheezing illnesses following RSV infection, it is still debatable whether
ribavirin antiviral therapy for treating RSV has a significant effect on long-term
pulmonary morbidity.
The benefit of ribavirin therapy in infants with RSV needs to be further explored by
the medical community, and ongoing studies of ribavirin are underway. However, the
findings do underscore the importance of the physician's role in effectively
identifying and treating RSV infections early, which may reduce the severity of long-term
sequelae.
The RSV Info Center will update you on any new clinical data regarding treatment with
ribavirin and other agents as the information becomes available.
For Full Prescribing Information
For VIRAZOLEŽ
(click here).
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Recurring Respiratory Problems
RSV Risk Factors
Can Early Treatment Make A Difference?
Prescribing Information |
