437. Improving the Timing of Palivizumab Immunoprophylaxis: Can Use of Local Respiratory Syncytial Virus (RSV) Prevalence Help Define the Season?
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Palivizumab-RSV surv IDSA Poster 2013 FINAL.pdf (616.7 kB)
  • Background:

    A maximum of 5 monthly doses of PLZ is recommended for prophylaxis of severe RSV infection in high risk children during the “RSV season.”  Peak RSV activity varies annually and by geographical region.  Inaccurate timing of PLZ administration can result in unnecessary use of costly resources and/or increase the risk of RSV-related hospitalization in high risk children.  Historically, monthly PLZ administration was initiated on October 1stindependent of local RSV prevalence at Children’s Medical Center Dallas (CMCD).  During the 2011-12 RSV season, a multidisciplinary team developed a policy for administering PLZ as defined by the clinical RSV testing data from the CMCD clinical virology laboratory.  The objective of this study is to describe the outcomes of the multidisciplinary approach to determine the onset and offset of RSV immunoprophylaxis. 

    Methods:

    A retrospective, observational review of electronic medical records was performed to evaluate the multidisciplinary approach for determining PLZ administration based on local clinical RSV data.   All patients who received ≥ 1 dose of PLZ during the 2010-11 and 2011-12 RSV seasons were included.  Gestational age, birth weight, indication for PLZ, subsequent number of PLZ doses per season and RSV-related hospitalizations during both RSV seasons were extracted and compared.

    Results: During the 2010-11 and 2011-12 RSV seasons, 290 and 312 patients received PLZ, respectively.  In 2011-12, PLZ immunoprophylaxis was initiated on November 1st, approximately 1 month later than the previous season.   Despite the later start date, there were no RSV-related hospitalizations in patients who met criteria for PLZ before the onset of the 2011-12 RSV season.  There were fewer patients who received PLZ in the 2010-11 season and no significant difference in the percent of subsequent RSV-related hospitalizations in patients receiving PLZ in the succeeding 2011-12 season (4.1% vs. 3.5%).  The number of patients who received >5 doses reduced from 57 (19.7%) to 14 (4.5%) during respective seasons accounting for an estimated cost savings of approximately $92,000.

    Conclusion:

    A multidisciplinary approach for determining the timing of PLZ administration that is guided by local RSV prevalence can be used to reduce the number of excessive doses administered to individual patients.

    Sean Nguyen, PharmD, BCPS1, Drewry Nickerson, PharmD1, Andrea Ronchi, MD2, Christopher D. Doern, PhD3, Roy Heyne, MD4,5, Jane D. Siegel, MD4 and Pablo J. Sanchez, MD, FIDSA6, (1)Pharmacy, Children's Medical Center Dallas, Dallas, TX, (2)Clinical Sciences and Community Health, Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, (3)Pathology, Children's Medical Center Dallas, Dallas, TX, (4)Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, (5)Children's Medical Center Dallas, Dallas, TX, (6)University of Texas Southwestern Medical Center, Dallas, TX

    Disclosures:

    S. Nguyen, None

    D. Nickerson, None

    A. Ronchi, None

    C. D. Doern, None

    R. Heyne, None

    J. D. Siegel, None

    P. J. Sanchez, NIH: Grant Investigator, Research grant
    Abvie: Scientific Advisor, Speaker honorarium
    Glaxo-Smith-Kline: Grant Investigator, Research grant

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