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• W4247789061 abstract "Many human viral diseases demonstrate seasonal patterns of circulation. This is true especially for viruses that spread through the respiratory route, such as respiratory syncytial virus (RSV). Unlike influenza virus, which arrives annually in a community from outside that community, RSV appears to circulate at low levels in a community during the off-season and then resurface to cause periods of peak activity. Numerous interactions including climate and human behavior (school-induced crowding, vacations, weather-induced increase in indoor living) appear to contribute to the cyclic nature of local RSV epidemics. Because one RSV illness may not confer protection against subsequent infection, a pool of previously infected infants, children, and adults remain at least partially susceptible and these individuals as well as those who have not been infected previously sustain the next season's RSV outbreak. For viruses, such as measles or varicella, which cause disease that can be controlled effectively by routine immunization, variation in activity from 1 year to another are of little consequence. In contrast, year to year, and geographic variation in onset of RSV circulation is problematic because of the need to plan for monthly immunoprophylaxis. If prophylaxis is initiated after widespread RSV circulation has begun, high-risk infants will not receive the benefit of protection. Conversely, early initiation or continuation of monthly immunoprophylaxis during a time when RSV is not widely circulating is not cost-effective and provides little benefit to the recipient. Optimal benefit from immunoprophylaxis will occur during the months when most RSV hospitalizations occur (peak outbreak months) and immunoprophylaxis will be the least cost-effective during the onset and offset months when RSV hospitalization rates are lowest. Decisions regarding the initiation and termination of monthly immunoprophylaxis are complicated by uncertainty in defining season onset and offset. Outside the times of seasonal activity, the risk of RSV hospitalization is low and the cost of immunoprophylaxis is difficult to justify. The definition of what constitutes seasonal activity is therefore important. One definition of seasonal RSV activity [used by National Respiratory and Enteric Virus Surveillance System (NREVSS)] is “the median date that indicates the first of 2 consecutive weeks a participating laboratory reports >10% of specimens testing positive by antigen detection and the last week of >10% positive tests preceding 2 consecutive weeks of <10% positive tests.” Whether this is the optimal definition for defining months of immunoprophylaxis is not clear. The use of percent positive RSV tests as the indicator of RSV activity can be problematic when used to determine timing of immunoprophylaxis. Use of Center for Disease Control and Prevention (CDC) data or local virology laboratory data in real time to determine the beginning and end of the RSV season is difficult because of the need for planning for administration of injections. The 2003 American Academy of Pediatrics (AAP) guidelines state, “In most seasons and most regions of the Northern Hemisphere, the first dose of palivizumab should be administered at the beginning of November and the last dose should be administered at the beginning of March which will provide protection into April.”1 This continues to be appropriate advice for the majority of the United States. Even in Southern areas of the United States with early onset and longer duration than other areas of the country, the average seasonal duration has been 15 weeks with a range of 13–20 weeks. For most areas of the United States, 5 monthly doses of palivizumab will provide >20 weeks of serum antibody level which should be protective and cover most of the RSV season even with variation in season onset and offset. Three reports in this Supplement describe geographic locations with atypical patterns of RSV circulation relative to the rest of the country. Extension of prophylaxis beyond 5 monthly doses should be done only after careful consideration of benefit and cost. The 2003 AAP guidelines also note that, “Decisions about the specific duration of prophylaxis should be individualized according to the duration of the RSV season. Pediatricians may wish to use RSV hospitalization data from their own region to assist in the decision-making process.”1" @default.
• W4247789061 created "2022-05-12" @default.
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• W4247789061 date "2007-11-01" @default.
• W4247789061 modified "2023-09-26" @default.
• W4247789061 title "Summary" @default.
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• W4247789061 doi "https://doi.org/10.1097/inf.0b013e318157dad7" @default.
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