Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Evaluation of Timeliness of Palivizumab Immunoprophylaxis Based on the Epidemic Period of Respiratory Syncytial Virus: 22 Year Experience in a Single Center

Respiratory Syncytial Virus 유행 시기에 따른 Palivizumab 예방요법시기의 적정성 평가: 22년간 단일기관 연구

  • Kim, Seung Yun (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Lee, Ko Eun (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Kang, Su Young (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Choi, Eun Hwa (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Lee, Hoan Jong (Department of Pediatrics, Seoul National University Children's Hospital)
  • 김승연 (서울대학교병원 소아청소년과) ;
  • 이고은 (서울대학교병원 소아청소년과) ;
  • 강수영 (서울대학교병원 소아청소년과) ;
  • 최은화 (서울대학교병원 소아청소년과) ;
  • 이환종 (서울대학교병원 소아청소년과)
  • Received : 2015.06.30
  • Accepted : 2015.09.09
  • Published : 2015.12.25
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Abstract

Purpose: This study aimed to analyze the epidemic period of RSV infection and evaluate the appropriate time of palivizumab immunoprophylaxis. Methods: From January 1991 to July 2012, nasopharyngeal (NP) aspirates were obtained from patients who visited Seoul National University Children's Hospital for respiratory symptoms. NP samples were used to detect respiratory viruses. Among them, we analyzed the positive number and detection rate of RSV infection in two-week interval. The beginning of RSV season was defined when RSV positive number was more than 4 and RSV detection rate was over 10%. From January 2007 to March 2014, we analyzed the starting time of palivizumab immunoprophylaxis for the infants at high risk. Results: The RSV detection rate was 2,013/21,698 (9.69%) over 22 years. The median RSV season was from $2^{nd}-3^{rd}$ week of October to $1^{st}-2^{nd}$ week of February. The earliest starting week was the 3rd week of July in year 2001, and the latest end week was the 3rd week of May in year 1990. Palivizumab immunoprophylaxis was initiated most frequently at the 3rd week of October (18.7%). However, the percentage of starting palivizumab on the 1st week of September has increased from 3.8% in the year 2007 to 14.1% in 2013. Conclusions: The year to year variability of RSV season exists. The starting time of palivizumab immunoprophylaxis should be adjusted based on the season of RSV epidemic.

목적: 본 연구는 respiratory syncytial virus (RSV) 유행 시기에 따른 palivizumab 투여 시기의 적절성을 분석함으로써 palivizumab 예방요법을 시작하는 시기의 적절성을 평가하고자 하였다. 방법: 1991년 1월부터 2012년 7월까지 서울대학교 어린이병원에서 호흡기 증상이 있는 소아의 호흡기 검체를 채취하여 RSV 항원 검사, 배양 검사 및 중합효소 연쇄 반응 검사를 시행하였으며 그 결과를 분석하였다. RSV 양성건수와 RSV 검출률을 2주 단위로 조사하였으며 중합효소 연쇄 반응 검사가 도입되기 전, 1991년 1월부터 2007년 10월까지는 RSV 항원 및 배양 검사로 바이러스를 검출하였고 이후에는 중합효소 연쇄 반응 검사 방법으로 검출하였다. RSV 유행 시기의 시작은 2주 동안 4건 이상의 검체에서 양성을 보이면서 RSV의 검출률이 10% 이상을 동시에 만족하는 시기로 정의하였다. 또한 2007년 1월부터 2014년 3월까지 2세 미만의 RSV 감염 고위험군을 대상으로 palivizumab의 예방요법 시작시기를 분석하였다. 결과: 22년간 RSV 검출률은 2,013/21,698 (9.69%)였으며 RSV 평균 유행기간은 10월 2-3주에서 2월 1-2주로 확인되었다. 가장 빨리 유행이 시작되었던 시기는 7월 셋째 주(2001년)이었고 가장 늦게 유행 시기가 끝났던 시기는 5월 셋째 주(1990년)였다. 가장 많이 palivizumab을 시작한 시기는 10월 셋째 주(18.7%)였으며, 9월 15일 이전에 palivizumab 예방요법을 시작하는 비율이 2007년 3.8%에서 2013년에는 14%로 증가하였다. 결론: RSV 유행 시기에는 해마다 차이가 있으며, palivizumab의 비용효과성을 증대시키기 위해 매해 RSV 유행이 시작하는 시점에 따라 palivizumab 투여 시작 시기와 투여 기간을 조절해야 할 것으로 사료된다.

Keywords

References

  1. Michaud CM, Murray CJ, Bloom BR. Burden of disease--implications for future research. Jama 2001;285:535-9. https://doi.org/10.1001/jama.285.5.535
  2. Paes BA, Mitchell I, Banerji A, Lanctot KL, Langley JM. A decade of respiratory syncytial virus epidemiology and prophylaxis: translating evidence into everyday clinical practice. Can Respir J 2011;18:e10-9. https://doi.org/10.1155/2011/493056
  3. Korea Centers for Disease Control and Prevention. The prevalence of the respiratory viruses in the patients with acute respiratory infections, 2012. Public Health Weekly Report 2013;6:6.
  4. Frogel MP, Stewart DL, Hoopes M, Fernandes AW, Mahadevia PJ. A systematic review of compliance with palivizumab administration for RSV immunoprophylaxis. J Manag Care Pharm 2010;16:46-58.
  5. Johnson S, Oliver C, Prince GA, Hemming VG, Pfarr DS, Wang SC, et al. Development of a humanized monoclonal antibody (MEDI-493) with potent in vitro and in vivo activity against respiratory syncytial virus. J Infect Dis 1997; 176:1215-24. https://doi.org/10.1086/514115
  6. Romero JR. Palivizumab prophylaxis of respiratory syncytial virus disease from 1998 to 2002: results from four years of palivizumab usage. Pediatr Infect Dis J 2003;22:S46-54.
  7. The IMpact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics 1998;102:531-7. https://doi.org/10.1542/peds.102.3.531
  8. The Korean Pediatric Society. [Immunoprophylaxis for Respiratory Syncytial Virus]. In: Lee HJ, ed. Immunization Guideline. 7th ed. Seoul: The Korean Pediatric Society; 2012: 231-3.
  9. Panozzo CA, Fowlkes AL, Anderson LJ. Variation in timing of respiratory syncytial virus outbreaks: lessons from national surveillance. Pediatr Infect Dis J 2007;26:S41-5. https://doi.org/10.1097/INF.0b013e318157da82
  10. Mullins JA, Lamonte AC, Bresee JS, Anderson LJ. Substantial variability in community respiratory syncytial virus season timing. Pediatr Infect Dis J 2003;22:857-62. https://doi.org/10.1097/01.inf.0000090921.21313.d3
  11. Respiratory syncytial virus--United States, July 2007-June 2011. MMWR Morb Mortal Wkly Rep 2011;60:1203-6.
  12. McGuiness CB, Boron ML, Saunders B, Edelman L, Kumar VR, Rabon-Stith KM. Respiratory syncytial virus surveillance in the United States, 2007-2012: results from a national surveillance system. Pediatr Infect Dis J 2014;33:589-94. https://doi.org/10.1097/INF.0000000000000257
  13. Tatochenko V, Uchaikin V, Gorelov A, Gudkov K, Campbell A, Schulz G, et al. Epidemiology of respiratory syncytial virus in children $\leq$2 years of age hospitalized with lower respiratory tract infections in the Russian Federation: a prospective, multicenter study. Clin Epidemiol 2010;2:221-7.
  14. Fjaerli HO, Farstad T, Bratlid D. Hospitalisations for respiratory syncytial virus bronchiolitis in Akershus, Norway, 1993-2000: a population-based retrospective study. BMC Pediatr 2004;4:25. https://doi.org/10.1186/1471-2431-4-25
  15. Hsu CH, Lin CY, Chi H, Chang JH, Hung HY, Kao HA, et al. Prolonged seasonality of respiratory syncytial virus infection among preterm infants in a subtropical climate. PLoS One 2014;9:e110166. https://doi.org/10.1371/journal.pone.0110166
  16. Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IGIV. American Academy of Pediatrics Committee on Infectious Diseases and Committee of Fetus and Newborn. Pediatrics 1998;102:1211-6. https://doi.org/10.1542/peds.102.5.1211
  17. Lambert M. AAP issues updated guidance on palivizumab prophylaxis for RSV infection. Am Fam Physician 2014;90: 867-8.
  18. Subramanian KN, Weisman LE, Rhodes T, Ariagno R, Sanchez PJ, Steichen J, et al. Safety, tolerance and pharmacokinetics of a humanized monoclonal antibody to respiratory syncytial virus in premature infants and infants with bronchopulmonary dysplasia. MEDI-493 Study Group. Pediatr Infect Dis J 1998;17:110-5. https://doi.org/10.1097/00006454-199802000-00006
  19. Weinberger DM, Warren JL, Steiner CA, Charu V, Viboud C, Pitzer VE. Reduced-dose schedule of prophylaxis based on local data provides near-optimal protection against respiratory syncytial virus. Clin Infect Dis 2015;61:506-14. https://doi.org/10.1093/cid/civ331
  20. Weigl JA, Puppe W, Schmitt HJ. Seasonality of respiratory syncytial virus-positive hospitalizations in children in Kiel, Germany, over a 7-year period. Infection 2002;30:186-92. https://doi.org/10.1007/s15010-002-2159-1
  21. Korea Centers for Disease Control and Prevention. Weakly occurrence of acute respiratory tract infection with 8 respiratory viruses in Korea patients. Available from: http://www.cdc.go.kr/kcdchome.
  22. Park KH, Shin JH, Lee EH, Seo WH, Kim YK, Song DJ, et al. Seasonal variations of respiratory syncytial virus infection among the children under 60 months of age with lower respiratory tract infections in the capital area, the Republic of Korea, 2008-2011. J Korean Soc Neonatol 2012;19:195-203. https://doi.org/10.5385/jksn.2012.19.4.195