Respiratory Syncytial Virus

Brian Wingrove, PA-C

RSV follows a predictable trend in Georgia by showing up in late September, generally peaking in December and January, with most cases resolving by mid to late spring.  There are still sporadic cases throughout the year especially in the southern part of the state.  RSV takes its name from the method of propagation of the virus in the respiratory tract.  The virus invades cells causing death and then spreads to adjacent cells causing sloughing of the dead cells that are called syncitia.  It is these syncytial blockages in the airway that create the symptoms of wheezing, difficulty breathing and hypoxemia that can lead to respiratory distress and failure.

For the most fragile of our pediatric patients, prophylaxis exists in the form of a monthly injection called palivizumab.  Because humans create a very limited antibody response to RSV, palivizumab is a monoclonal antibody. It does not prevent infection with RSV, but gives infants the ability to fight the virus.  There are guidelines on who would most benefit from receiving RSV prophylaxis that are issued by the American Academy of Pediatrics Committee on Infectious Disease.  These were last revised in 2014.  Infants born before 29 weeks gestational age and are less than 12 months of age at the start of RSV season, defined as October 1 by Georgia Medicaid CMOs, qualify for prophylaxis.  Infants with hemodynamically significant cardiac disease, congenital airway anomalies, or neuromuscular disease who are less than 12 months of age at the start of RSV season also qualify. The final category of candidates for RSV prophylaxis is a bit broader and can be complicated.  These are children who are less than 24 months of age who were born at less than 32 weeks gestational age and required supplemental oxygen for more than 28 days, and have required medical therapy for their lung disease in the 6 months prior to the start of RSV season.

RSV infection is notoriously difficult to treat and is challenging for all clinicians and families to deal with. Take the time to consider RSV prophylaxis with palivizumab for young infants who fall into the right categories.  Many times the late preterm babies (29-32 weeks GA) can qualify if they meet the oxygen requirement criteria.


See Brian Wingrove, PA-C speak at the GAPA 2020 Summer Conference in Sandestin, Florida July 13-17.

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