The Brazilian Society of Pediatrics (SBP) and pharmaceutical company AstraZeneca released today (17) a campaign to reinforce the prevention of respiratory syncytial virus (RSV) cases in premature babies and with health conditions considered at risk for this infection. The virus is primarily responsible for cases of bronchiolitis and pneumonia in babies and is also associated with a higher frequency of hospitalizations for respiratory syndromes in this group.
The president of the Scientific Department of Immunizations at SBP, Renato Kfouri, explained that there is still no vaccine to prevent this virus, but the Unified Health System (SUS) has provided, since 2013, another form of prevention: monoclonal antibodies, which are antibodies artificial aids that can be given to babies monthly during the period of greatest circulation of the virus.
“They have the function of binding to the virus and preventing its adhesion to the respiratory epithelium (mucosa). It’s prevention, it’s immunization, but it’s not a vaccine. It’s a slightly different concept. We offer a ready-made artificial antibody for the individual”, differentiates Kfouri, since, in vaccines, the prevention strategy is to stimulate the human body to produce the antibodies.
antibodies
Monoclonal antibodies against RSV are present in the drug palivizumab, which AstraZeneca provides for both private and public health in Brazil.
The Ministry of Health predicts that these antibodies should be offered to premature children up to 29 weeks and younger than 1 year, or to children up to 2 years of age with chronic lung disease of prematurity, congenital heart disease, or demonstrated hemodynamic repercussions. As determined by the National Supplementary Health Agency (ANS), health plans must also cover the drug in these same cases.
With the campaign, the Brazilian Society of Pediatrics intends to make pediatricians aware of the importance of prescribing these antibodies in cases where it is recommended. Kfouri adds that parents and guardians of premature children can also raise this issue in consultations or seek the pediatrician accompanying the baby, if the prescription has not been made.
“These premature babies are not always linked to a premature follow-up service. They are often accompanied by pediatricians from the public network, from the SUS, from private offices, and it is often necessary to update and train this professional.”
Special cares
The campaign features photos of premature babies dressed as warriors to remind them that these children go through difficult times right after birth and need special care to strengthen their bodies’ defenses. “Losing a premature baby, after a lot of struggle, to a preventable, preventable respiratory disease, is very sad.”
In addition to artificial antibodies, prevention of respiratory syncytial virus in premature babies must also be done with non-pharmacological care, which must be reinforced during periods of greater circulation of the virus.
These measures include breastfeeding whenever possible, proper hand hygiene (use of alcohol-based hand rub and germicidal soaps), wearing a mask, preventing the child from breathing in cigarette smoke, delaying entry into day care centers and nurseries, and avoiding visits.
“A more vulnerable baby is as if we had an immunocompromised person at home, someone with cancer, someone with a transplant. The premature baby has a lowered immunity and therefore is more vulnerable not only to RSV”, explains Kfouri, who reinforces the importance that the family members of these children take all the vaccines available in their schedule in the National Immunization Program and, therefore, do not transmit other vaccine-preventable diseases to babies.
virus circulation
Like most respiratory-transmitted diseases, RSV circulates mainly in autumn and winter, but this seasonality can also be affected by factors such as humidity and even rainfall. In Brazil, the period of greatest circulation of this virus usually begins in February in the North, in March in the Northeast, Midwest and Southeast, and in April in the South.
The circulation period usually lasts about four months, and the SBP specialist says it is recommended to start immunization with palivizumab one month before this window, administering the drug once a month for up to five months. As antibodies arrive ready-made in children’s bodies, the immune system does not learn to produce them and, for this reason, the drug needs to be administered once a month.
With the covid-19 pandemic, the prevalence of SARS-CoV-2 over other viruses and the preventive measures taken to contain its circulation, other diseases were affected, which includes RSV. The virus had its circulation practically interrupted in periods of greater social isolation and returned in an atypical way in 2021, causing an increase in cases even after September, when it should have been on the decline. Even so, data from the InfoGripe system show that RSV may have caused more cases of severe acute respiratory syndrome (SARS) in the age group under 1 year than covid-19, throughout 2021.
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