Help protect premature babies and high at risk infants from RSV

RSV is the most common cause of lower-respiratory-tract infection in infancy or childhood. RSV causes cold-like symptoms that can trigger chronic breathing difficulties if the lungs become involved. RSV occurs in seasonal outbreaks, usually through autumn to winter. In Australia the risk of catching an RSV infection is at its highest from May to October.

Prevalence and Risk
RSV is highly contagious. Approximately one-half of all infants are infected with the RSV during the first year of life and nearly all children have been infected at least once by the time they reach their second birthday.

Up to 90 per cent of bronchiolitis hospitalisations and up to 50 per cent of hospital admissions caused by winter pneumonia are caused by RSV.

Diseases of the respiratory system account for the highest proportion of all admissions to hospital in children aged 1-14 years, according to the latest data from the Australian Institute of Health and Welfare.

Babies born prematurely as well as those with chronic lung disease or congenital heart disease are at the highest risk of severe disease and hospitalization due to RSV. While adults and healthy children can normally cope with the mild cold-like symptoms of an infection, at risk infants are at a high risk of being admitted into hospital. In babies who are born prematurely or who have lung or heart complications, RSV may cause life-threatening conditions requiring intensive care.

Why are premmie babies most at risk for RSV infection?
Pre-term infants are at the highest risk for serious RSV infection and related hospitalisation. Premature infants have underdeveloped lungs, which can be a contributing factor to increased risk for RSV disease and cardiopulmonary complications.

Infants with a congenital heart disease (structural or functional defect in the heart that is present at birth) or a chronic lung disease are also at increased risk of developing severe RSV disease, hospitalisation and death.

Other risk factors for severe RSV disease include low birth weight (less than 2500 grams or 5.5 pounds) and a compromised immune system.

Other contributing factors are exposure to tobacco smoke, having school-age siblings, attending daycare and living in crowded conditions

Effects on Families
Parents of infants born preterm experience an enormous amount of emotional trauma, stress and grief dealing with the complications surrounding the early arrival of their child and the lengthy hospital stay that follows. The average duration of hospitalisation for these premature infants is seven weeks. In addition they have to live with ongoing health concerns and problems with their children. The readmission of the at risk infant due to RSV presents considerable further burdens, both emotionally and financially, to these families; and to the public health system. These infants are at risk of intensive care admission, long term lung damage and in rare cases death. For families in regional areas the cost of readmission is considerably higher. Thus they live in fear of their child being readmitted to hospital and isolate their child from the rest of the community to prevent this occurring. For those with other children another hospital stay will mean more disruption for the whole family with siblings often failing to understand why mum is away so much of the time.

Susan, mum to Connor born at 26 weeks and now 2 years old explains “I am at the doctors with Connor whenever he has the slightest cough to ensure that he is okay and live in constant fear of him being sick. I have become germ phobic and very aware of sick people in shopping centres etc. – I have never placed Connor in a shopping trolley and I keep antibacterial handwash in my purse at all times. I tend to keep Connor more isolated during the winter / flu season which is detrimental to him both developmentally and socially. I know the majority of people think I am overly protective but any mum in a similar position would do the same to protect their child. The greatest issue to our family has been the isolation factor and watching Connor having to miss out on many fun events and parties. This just breaks my heart .”

RSV in Australia?
There is currently no vaccination available for RSV. One medicine has been registered in Australia to prevent serious lower respiratory tract disease caused in children at high risk of severe RSV infection. This medication is called Palivizumab. However, the medication is currently not funded by the Federal Government making it very costly to the Public Health System or parents wanting their children to receive it. The costs range up to $1000 per injection (depending on the size of the baby or child) and the injections should be given over at least a 6 month period. Thus the cost per year for the first two years of a high risk child’s life are in the region of $16,000. Such a high cost makes the medication unreachable for most parents of preterm or seriously ill children with chronic lung disease or heart conditions.

Sources:
Surveillance of viral pathogens in Australia: respiratory syncytial virus. Paul Roche, Stephen Lambert, Janeane Spencer. Communicable Diseases Intelligence: Vol 27, No 1. 2003

Australia's Children: their health and well-being 2002. Fadwa Al-Yamin, Meredith Bryant, Hilary Sargeant. Australian Institute of Health and Welfare Canberra. AIHW Cat. No. PHE 36. Canberra: AIHW.

Report of the Australian Paediatric Care Registry (ANZPIC): 2003, 2004, 2005.