THE PREVENTION OF THE RESPIRATORY SYNCYTIAL VIRUS INFECTION IN INFANTS

Respiratory Syncytial Virus (RSV) is a ubiquitous and highly contagious virus belonging to the Paramyxoviridae family. RSV is the most common cause of bronchiolitis and hospitalization during the first year of life and it might be associated with an increased risk of recurrent wheeze, asthma as well as with decreased respiratory function in school-aged children. The treatment of RSV bronchiolitis is primarily supportive and no specific etiological therapy is routinely used, thus prevention plays an essential role. Since there is currently no vaccine against RSV, preventive strategies are based on environmental prophylaxis together with passive immunization using a monoclonal antibody (palivizumab) in selected patients prone to develop severe RSV disease.Environmental prophylaxis is essentially based on frequently and correctly done handwashing, cleaning of contaminated surfaces and avoidance of direct contact with people with cold-like symptoms. Parental smoking should be avoided as tobacco smoke exposure has been associated with an increased risk and severity of bronchiolitis. Finally, breastfeeding for at least six months decreases the morbidity of these children and should be encouraged. Moreover, preventive strategies should be adopted in the management of hospitalized infants to minimize the incidence of RSV nosocomial infections. These measures include cohorting of RSV positive cases, handwashing, using gloves, gowns and masks in case of contact with infected infants, cleaning of surfaces, stethoscopes and other medical instruments. Palivizumab is a humanized monoclonal antibody specific for the surface fusion F protein of the RSV virus that blocks viral replication. It has been shown to reduce the hospitalization rate and death in patients with coexisting conditions (prematurity, congenital heart disease, chronic lung disease, immunodeficiency) at high risk of severe RSV infection. In the following paragraphs we report the most updated evidences for the environmental prophylaxis and we summarize current recommendations about targeted palivizumab immunisation and ongoing trials on RSV vaccine development.