The frequency of respiratory syncytial virus on congenital heart disease patients, its impacts, and efficacy of monoclonalantibody prophylaxis in reducing respiratuar sinsitial virus infection

Abstract

The risk of death, complications and severity of lower respiratory tract infections (LRTI) due to Respiratory Syncytial Virus (RSV) is higher in children who have congenital heart disease (CHD). The risk factors for hospitalization due to RSV and effectiveness of monoclonalantibody (palivizumab) for infants with CHD had been well studied in developed countries, whereas the knowledge about RSV and monoclonalantibody (palivizumab) is scarce in developing countries like Turkey We aimed to determine the incidence, risk factors and complications of RSV infections in infants with CHD. Our second goal was to determine the efficacy of monoclonalantibody (palivizumab) prophylaxis. Methods: The study population constituted of 419 patients less than 2 years of age with the diagnosis of LRTI. 241 (57%) of those patients had the diagnosis of CHD and they were hemodynamically unstable and required continuous medical therapy. 178 (43%) patients did not have CHD. RSV was diagnosed by Respi Strip in samples obtained with nasopharyngeal swab. Results: In CHD patients with LRTI, the rate of hospitalization due to RSV was 14% and the average length of stay was 9.9 days (5-17 days). 30% of these infants had to be treated in the pediatric intensive care unit and 18% required mechanical ventilation. These rates were significantly higher when compared with patients without CHD and who were infected with RSV (p=0.01). 15 mg/kg/dose monoclonalantibody (palivizumab) was applied monthly during RSV season to 29 CHD patients. The rate of in-patient treatment before prophylaxis was 59% and it reduced to 14% after prophylaxis (p=0.001). Only one patient with CHD died due to RSV infection (2%). Conclusion: RSV is an important virus leading to mortality and morbidity for infants with CHD, also in developing countries like Turkey. Prophylaxis with monoclonalantibody (palivizumab) is effective forthese patients. Since in 20% of infants with LRTI, the causative agent was RSV; this necessitates the utility of diagnostic methods for RSV to prevent useless antibiotic therapies and to enable isolation precautions to be taken more effectively.