A 6-month-old infant presents in December with wheezing, tachypnea, subcostal retractions, and SpO2 of 90%. This is the first episode of wheeze. There is no fever. CXR shows hyperinflation and peribronchial cuffing. Nasopharyngeal aspirate NPA-PCR confirms RSV infection. Which of the following has been shown to reduce RSV-related severe bronchiolitis hospitalizations as prophylaxis in high-risk infants?
- A Monthly ribavirin inhalation during RSV season
- B RSV live attenuated intranasal vaccine given at 6 weeks
- C Prophylactic oral azithromycin during RSV season
- D Monthly intramuscular palivizumab (anti-RSV monoclonal antibody) for high-risk infants ✓
Explanation
Palivizumab (humanized monoclonal antibody against RSV F-protein) given monthly IM during the RSV season (October-March in northern hemisphere) has proven efficacy in reducing RSV hospitalizations by ~55% in high-risk groups: premature infants <29 weeks, infants with hemodynamically significant CHD, and infants with chronic lung disease of prematurity. Ribavirin is no longer recommended as prophylaxis. No RSV live vaccine is currently approved for infants (though maternal RSVpreF vaccine and the monoclonal antibody nirsevimab are newer options). Azithromycin has no proven role in RSV prophylaxis.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.