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Seasonal Respiratory Syncytial Virus Prophylaxis Based on Predetermined Dates Versus Regional Surveillance Data

Paes, Bosco A. FRCPC*; Craig, Carole MSc; Pigott, Wendy MHSc; Latchman, Andrew FRCPC*


In the article on page e360, volume 32, issue 9 of The Pediatric Infectious Disease Journal there are several errors. The legend for Figure 2 should read “Comparison of RSV season duration to RSV prophylaxis periods, City of Hamilton area (2007 to 2008 to 2010 to 2011 seasons).” In the fifth paragraph of the Discussion, the reference cited for the IMpact trial should be reference 6. The sentence should read “With regard to the number of estimated doses provided per patient during the entire RSV season, the current provincial method and the local fixed-date method consistently estimated 6 injections per season, which is higher than the cutoff of 5 prescribed doses as evidenced in the IMpact randomized trial.6” In the second to last paragraph of the article both reference citations are incorrect, the first sentence should read “The strengths of our study are that RSV isolate data were confined to children 0–18 years of age, which reduces the testing pattern effect on the percent positivity estimate, thereby providing more accuracy for the pediatric population compared with available reports which incorporate positive RSV tests across all age groups.11,12” And the third sentence should read “The selected periods of immunity after the respective doses were carefully derived from the pharmacokinetic analyses of palivizumab6–10 and utilized constructively to calculate the number of doses required per RSV season.” The reference list at the end of the article also requires updates to references 5 through 12. Please see the corrected reference list below:

5. Law BJ, Langley JM, Allen U, et al. The Pediatric Investigators Collaborative Network on Infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J. 2004;23:806–814.

6. 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;102:531–537.

7. Feltes TF, Cabalka AK, Meissner HC, et al.; Cardiac Synagis Study Group. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr. 2003;143:532–540.

8. Sáez-Llorens X, Moreno MT, Ramilo O, et al.; MEDI-493 Study Group. Safety and pharmacokinetics of palivizumab therapy in children hospitalized with respiratory syncytial virus infection. Pediatr Infect Dis J. 2004;23:707–712.

9. Subramanian KN, Weisman LE, Rhodes T, et al.; MEDI-493 Study Group. Safety, tolerance and pharmacokinetics of a humanized monoclonal antibody to respiratory syncytial virus in premature infants and infants with bronchopulmonary dysplasia. Pediatr Infect Dis J. 1998;17:110–115.

10. Robbie GJ, Zhao L, Mondick J, et al. Population pharmacokinetics of palivizumab, a humanized anti-respiratory syncytial virus monoclonal antibody, in adults and children. Antimicrob Agents Chemother. 2012;56:4927–4936.

11. Centers for Disease Control and Prevention. Respiratory syncytial virus activity - United States, July 2008-December 2009. MMWR Morb Mortal Wkly Rep. 2010;59:230–233.

12. Panozzo CA, Stockman LJ, Curns AT, et al. Use of respiratory syncytial virus surveillance data to optimize the timing of immunoprophylaxis. Pediatrics. 2010;126:e116–e123.

The Pediatric Infectious Disease Journal. 32(12):e436, December 2013.

The Pediatric Infectious Disease Journal: September 2013 - Volume 32 - Issue 9 - p e360–e364
doi: 10.1097/INF.0b013e31829479d3
Original Studies

Background: In Ontario, Canada, the respiratory syncytial virus (RSV) prophylaxis period onset is defined by a fixed-date set provincially each year and offset by local hospital RSV admission activity. Inaccurate timing can result in inadequate or more costly prophylaxis.

Methods: RSV positivity (2002/03 to 2010/11) was obtained from a local database. RSV activity was described: season start/end dates, duration and optimum number of palivizumab doses required compared with doses administered for the final 4 RSV seasons (2007 to 2011). Three prophylaxis period-setting methods were evaluated for seasons 2007/08 to 2010/11: 1) the provincial method currently in use, 2) a local fixed-date method based on laboratory data accrued from the previous 5 seasons and 3) an exploratory prospective method based on surveillance of laboratory data. These were compared with the observed RSV seasons.

Results: The local RSV pattern closely reflects provincial seasonality. The local median season duration was 125 days (range 90–181). Median season onset and offset dates were December 19 and April 16, respectively. The prophylactic period definitions corresponded similarly, but the provincially set and local fixed-date methods provided longer immunity periods than required for the actual RSV season and involved the administration of more than 5 palivizumab doses compared with the prospective method.

Conclusions: The provincial prophylactic period aligned with the local fixed-date and prospective methods. However, the adoption of any of the first 2 strategies merits close observation to minimize excess healthcare expenditure. The prospective surveillance of laboratory isolates should be further explored as a preferred option to better define prophylactic periods.

From the *Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; and Surveillance Unit, Public Health Services, Hamilton, Ontario, Canada.

Accepted for publication March 28, 2013.

B.A.P. has received investigator-initiated research funds from AbbVie Corporation and is on the speaker’s bureau; A.L. has received honoraria from AbbVie Corporation. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Bosco A. Paes, FRCPC, McMaster University, Department of Pediatrics (Neonatal Division), Room HSC-3A, 1280, Main Street West, Hamilton, Ontario L8S 4K1, Canada. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.