In contrast, some Choosing Wisely campaigns suggest that routine viral testing is not indicated when children are admitted with lower respiratory tract infections, potentially underestimating the number of breakthrough admissions in more recent studies

In contrast, some Choosing Wisely campaigns suggest that routine viral testing is not indicated when children are admitted with lower respiratory tract infections, potentially underestimating the number of breakthrough admissions in more recent studies. Conclusion RSV is the most common cause of paediatric respiratory hospitalisations. this review will inform recommendations for best practices regarding palivizumab use for childhood RSV infection as well as research priorities in RSV vaccine development. Methods and analysis We will conduct a systematic review of primary population-based studies that examine the incidence of palivizumab breakthrough infections in children, published between 1997 to present. In collaboration with a research librarian, four electronic databases (MEDLINE, Embase, Cochrane Library, Web of Science) and additional sources will be searched. Study screening and quality assessment will be performed in duplicate. Data will be extracted by one reviewer, with partial and random verification by a second reviewer. The primary outcomes to assess breakthrough RSV infection will be hospitalisation, length of stay and the need for intensive care unit admission and mechanical ventilation in children receiving palivizumab. The secondary outcome will be RSV-associated mortality. We will conduct a meta-analysis using pooled effectiveness data, and include subgroup analyses by patient comorbidities and drug compliance. Sensitivity analyses for risk of bias and study design will also be performed. Ethics and dissemination This systematic review will only include data from previously published literature and is therefore exempt from ethics approval. Final results will be disseminated through Rabbit polyclonal to CDKN2A peer-reviewed publication and presented at academic conferences and scientific meetings engaging paediatric researchers and healthcare providers. Should findings from this review necessitate updates to current clinical practice guidelines, we intend to establish a working group to engage relevant health administrators and decision makers. PROSPERO registration number CRD42019122120. strong class=”kwd-title” Keywords: community child health, respiratory infections, palivizumab, Respiratory syncytial virus Strengths and limitations of this study Our proposed meta-analysis integrates multiple statistical techniques Cefmenoxime hydrochloride for a comprehensive evaluation of palivizumab effectiveness. Using a two-fold approach to quality assessment, this review considers the quality of both individual study methodology and individual outcomes as a body of evidence. This review will provide an up-to-date assessment of palivizumab effectiveness and findings will inform existing and new clinical guidelines. Knowing the burden of respiratory syncytial virus (RSV)-related hospital care will support future economic analyses of RSV vaccines. Introduction Respiratory syncytial virus in children Human respiratory syncytial virus (RSV) infects almost all children within the first 2?years of life. Typically, RSV infection manifests as the common cold; however, some children develop acute lower respiratory infections (ALRI), a leading cause of childhood morbidity and mortality.1 Globally, RSV accounts for approximately 33.1?million annual ALRI episodes in children.2 Across North America, the rates of RSV-associated paediatric hospitalisations remain high.3 Although supportive care is commonly used to manage RSV symptoms,4 no existing treatment for RSV infection has been demonstrated to be effective.5 Palivizumab Palivizumab is an expensive monoclonal antibody that binds to a RSV surface glycoprotein, the fusion protein and inhibits virus-cell membrane fusion; thereby inhibiting RSV replication.6 7 Despite its promising mechanism of action, the clinical evidence for palivizumab is limited to demonstrated effectiveness within select population groups in developed countries, where palivizumab is affordable and available.8 Moreover, some animal and human studies have demonstrated RSV resistance to palivizumab.9 10 In an effort to mitigate the burden of childhood RSV, attention has been directed towards preventative strategies. Current clinical recommendations from the American Academy of Paediatrics (AAP), which may differ from other jurisdictions, indicate for all high risk infants to receive palivizumab: preterm infants with chronic lung disease (CLD), preterm infants without CLD of prematurity or congenital heart disease (CHD), infants with haemodynamically significant CHD, children with anatomic pulmonary abnormalities or neuromuscular disorder and profoundly immunocompromised children.11 Why is it important to do this review? To date, there have been two reviews on the effectiveness of palivizumab12 13; however, both are limited in scope. The 2013 review includes only randomised controlled trials,12 and synthesised findings from a very small number of studies. The 2014 review excluded prospective studies and registries with end dates in 2013.13 Moreover, both existing reviews limited the study population to AAP-defined high risk infants. Care of infants with prematurity has changed remarkably since the original Cefmenoxime hydrochloride palivizumab trials were conducted with far less use of Cefmenoxime hydrochloride invasive ventilation and complete repair of CHD now occurs at a much younger age. Therefore, recent retrospective studies are of potential value to assessing real-world effectiveness in the modern.