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Passive immunisation of infants at risk for bronchiolitis: Given the susceptibility of infants to RSV-induced bronchiolitis, the high morbidity and mortality of the disease and the unavailability of a vaccine, extensive effort has gone into development of options for passive immunisation. Intravenous immunoglobulin enriched for anti-RSV and humanised monoclonal antibodies have been studied and shown to have an effect, with most interest and enthusiasm focused on the latter in the form of palivizumab (Synagis). This product can reduce hospitalisation rates of susceptible infants by 50%, and by 75-80% if one restricts use to the most-susceptible (e.g. <28 week preterm infants with BPD). For those who have subsequently developed disease despite treatment, the severity of disease has been reduced in terms of shortened length of stay (by 74%) and cost of the admission. These impressive outcomes have resulted in paediatricians in various countries routinely prescribing palivizumab for high risk infants, however health-economic studies from New Zealand, the UK and USA conclude that even in these developed countries current cost of the product makes it unaffordable. In South Africa the listed price of Synagis is between R4000 and R7000 per dose (50 or 100mg per ml respectively), and with the recommended regimen of 15mg/Kg/month throughout the high-risk season one can appreciate the health-economists' view. Read more: Pediatr Int 2002;44:421-30 and 475-80 Ir Med J 2002;95:167-9 Pediatr Pulmonol 2002;34:262-6 Arch Pediatr Adolesc Med 2002;156:1251-5 J Paediatr Child Health 2002;38:352-7 Curr Opin Infect Dis 2001;14:323-8 |