In particular, prematurity, bronchopulmonary dysplasia and congenital heart disease are well known risk factors for severe RSV infection. In addition, it has been shown that patients with other conditions such as immunodeficiencies, Down’s syndrome and neuromuscular PI3K inhibitor diseases are also at significant risk of severe RSV disease according to a nationwide survey on the status of RSV infections in Japan conducted by Mori et al. [1], which is in agreement with other reports outside Japan 2 and 3. Both the innate and adoptive immune systems, and respiratory function in terms of anatomical, histological and physiological factors, influence the course of RSV infection in such
high risk groups find more in a complex manner. The humanized monoclonal antibody
Palivizumab specific for an epitope in the A antigenic site of the F protein of RSV was approved in Japan for prevention of severe RSV infections in premature babies, bronchopulmonary dysplasia and congenital heart disease, but at that time other high risk groups such as patients with immunodeficiencies, neuromuscular disorders, or chromosomal abnormalities were not included. Therefore, an application for additional indications for Palivizumab use in immunocompromised children and Down’s syndrome was submitted to the Ministry of Health, Labour and Welfare. After examination by the “Review Conference on Unlicensed and Adapted Medicine Highly Necessary for Medical Care”, this application was endorsed and a clinical trial was conducted. In August 2013, two new indications for Palivizumab use in children with immunocompromised conditions and Down’s syndrome were approved. This article reviews the literature related to RSV infections in immunodeficiencies and Down’s syndrome and outlines risk assessment for severe RSV infections. Based
on this review, clinical guidance for prevention of RSV infections through the use of Palivizumab Leukocyte receptor tyrosine kinase were formulated by expert opinion consensus for the purpose of determining the appropriate use of Palivizumab. Because of the heterogeneous nature and complexity of immunodeficiency disorders, however, these guidelines may not fully cover all of them equally well. Thus, it is necessary to personalize prophylaxis for the prevention of RSV infections based on the individual child’s immunity, risk of exposure to RSV, and anatomical and physiological condition of the respiratory system. Children with Down’s Syndrome or immunocompromised newborn babies, infants and children under the age of 24 months at the beginning of the RSV season have been recently added to those with an indication for the use of prophylactic Palivizumab. Here, we describe these new indications in the following sections.