Bronchiolitis primary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
Effective measures for the primary prevention of bronchiolitis include | Effective measures for the primary prevention of bronchiolitis include washing hands, avoiding contact with patients with symptomatic [[respiratory infections]], and prevention of [[tobacco]] smoke exposure. These preventive measures are to prevent viral dissemination during the [[RSV]] season. In patients with a high risk of developing severe [[infection]], [[Immunization#Passive immunization|passive immunization]] with [[Palivizumab|palivizumab]] is recommended. | ||
==Primary Prevention== | ==Primary Prevention== | ||
===General measures=== | ===General measures=== | ||
There are steps that are | There are steps that are should be taken in order to prevent the spread of the infection. These steps include: | ||
*Covering | *Covering [[coughs]] and [[sneezes]] with a tissue or upper shirt sleeve, not your hands. | ||
*Washing [[hands]] often with soap and [[water]] for 20 seconds. | *Washing [[hands]] often with soap and [[water]] for 20 seconds. | ||
*Avoid close contact such as: kissing, shaking hands, sharing cups | *Avoid close contact such as: kissing, shaking hands, and sharing cups or eating utensils. | ||
*Cleaning contaminated surfaces (such as doorknobs) may help stop the spread of [[RSV]]. | *Cleaning contaminated surfaces (such as doorknobs) may help stop the spread of [[RSV]]. | ||
Parents of children at high risk for developing severe RSV disease should help their child by the following:<ref name="Respiratory Syncytial Virus Infection (RSV)">CDC https://www.cdc.gov/rsv/about/prevention.html Accessed on June 1, 2017 </ref> | Parents of children at high risk for developing severe [[RSV]] disease should help their child by the following:<ref name="Respiratory Syncytial Virus Infection (RSV)">CDC https://www.cdc.gov/rsv/about/prevention.html Accessed on June 1, 2017 </ref> | ||
*Avoid close contact with sick people. | *Avoid close contact with sick people. | ||
*Wash their hands often with soap and water. | *Wash their hands often with soap and water. | ||
*Avoid touching their [[face]] with unwashed hands. | *Avoid touching their [[face]] with unwashed hands. | ||
*Limit the time they spend in child-care centers or other potentially contagious settings, especially during fall, winter, and spring. This may help prevent infection and spread of the [[virus]] during | *Limit the time they spend in child-care centers or other potentially contagious settings, especially during fall, winter, and spring. This may help prevent infection and spread of the [[virus]] during [[RSV]] season. | ||
===Palivizumab prophylaxis=== | ===Palivizumab prophylaxis=== | ||
Recommendations are based on the 2009 AAP Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections.<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258 }} </ref> | Recommendations are based on the 2009 AAP Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections.<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258 }} </ref> | ||
*[[Prophylaxis]] is recommended in | *[[Prophylaxis]] is recommended in select patients with a high risk of severe bronchiolitis: | ||
:*Patients younger than 2 years of age who required medical therapy for [[Chronic obstructive pulmonary disease|chronic lung disease]] 6 months or less before the [[RSV]] season. | :*Patients younger than 2 years of age who required medical therapy for [[Chronic obstructive pulmonary disease|chronic lung disease]] 6 months or less before the [[RSV]] season. | ||
:*Patients younger than 2 years of age with [[congenital heart disease]]. | :*Patients younger than 2 years of age with [[congenital heart disease]]. | ||
::*Infants who are receiving [[congestive heart failure]] treatment. | ::*Infants who are receiving [[congestive heart failure]] treatment. | ||
::*[[ | ::*Infants with [[cyanotic heart disease]]. | ||
::* | ::*Infants with moderate to severe [[pulmonary hypertension]]. | ||
:*History of [[prematurity]]. | :*History of [[prematurity]]. | ||
::*[[Prophylaxis]] is recommended for [[premature infants]] with less than 32 weeks of [[gestation]] with or without [[COPD|chronic lung disease]] of prematurity. | ::*[[Prophylaxis]] is recommended for [[premature infants]] with less than 32 weeks of [[gestation]] with or without [[COPD|chronic lung disease]] of prematurity. | ||
::*For patients born with 28 weeks of [[gestation]] or less, [[prophylaxis]] is recommended for their first [[RSV]] season | ::*For patients born with 28 weeks of [[gestation]] or less, [[prophylaxis]] is recommended for their first [[RSV]] season, regardless of the age of the patient. If [[prophylaxis]] is started, it should continue through the full [[RSV]] season. | ||
::*For patients born with 29 to 32 weeks of [[gestation]], [[prophylaxis]] is recommended for patients are born 6 months or less before the [[RSV]] season. If | ::*For patients born with 29 to 32 weeks of [[gestation]], [[prophylaxis]] is recommended for patients are born 6 months or less before the [[RSV]] season. If [[prophylaxis]] is started, it should continue through the full [[RSV]] season. | ||
::*For patients born with 32 to 35 weeks of [[gestation]], [[prophylaxis]] is recommended in patients who are born 3 months before the [[RSV]] season or during the [[RSV]] season and 1 of the following risk factors which may require hospitalization due to bronchiolitis: | ::*For patients born with 32 to 35 weeks of [[gestation]], [[prophylaxis]] is recommended in patients who are born 3 months before the [[RSV]] season or during the [[RSV]] season and who have 1 of the following risk factors which may require hospitalization due to bronchiolitis: | ||
:::*Infants with school-aged siblings. | :::*Infants with school-aged siblings. | ||
:::*Infants who attend to child care centers. | :::*Infants who attend to child care centers. | ||
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====Dosage==== | ====Dosage==== | ||
*15 mg/kg monthly doses to a maximum of 5 doses | *15 mg/kg monthly doses to a maximum of 5 doses is the recommended regimen for patients born before 32 weeks of gestation, [[congenital heart disease]] with significant hemodynamic consequences, or chronic lung disease. | ||
*15 mg/kg monthly doses to a maximum of 3 doses | *15 mg/kg monthly doses to a maximum of 3 doses is the recommended regimen for patients born between 32 and 35 weeks of [[gestation]] who meet the criteria for [[prophylaxis]]. | ||
Recommendations for the prevention of bronchiolitis are based on the 2006 American Academy of Pediatrics Practice Guidelines for the Diagnosis and Management of Bronchiolitis.<ref name="pmid17015575">{{cite journal| author=American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis| title=Diagnosis and management of bronchiolitis. | journal=Pediatrics | year= 2006 | volume= 118 | issue= 4 | pages= 1774-93 | pmid=17015575 | doi=10.1542/peds.2006-2223 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17015575 }} </ref> | Recommendations for the prevention of bronchiolitis are based on the 2006 American Academy of Pediatrics Practice Guidelines for the Diagnosis and Management of Bronchiolitis.<ref name="pmid17015575">{{cite journal| author=American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis| title=Diagnosis and management of bronchiolitis. | journal=Pediatrics | year= 2006 | volume= 118 | issue= 4 | pages= 1774-93 | pmid=17015575 | doi=10.1542/peds.2006-2223 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17015575 }} </ref> | ||
*Infants should not be exposed to [[tobacco]] as it has been shown that it increases the risk of [[RSV]] infection. | *Infants should not be exposed to [[tobacco]] as it has been shown that it increases the risk of [[RSV]] infection. | ||
*[[Breastfeeding]] lowers the risk of lower tract | *[[Breastfeeding]] lowers the risk of [[lower respiratory tract infections|lower respiratory tract infections]] in infants because of ingestion of immune factors such as [[immunoglobulins]] A and G. | ||
*The use of alcohol-based rubs or [[antimicrobial]] soaps to maintain correct hand hygiene in health care workers is important to prevent [[nosocomial]] dissemination of the [[disease]] when dealing with hospitalized patients. | *The use of alcohol-based rubs or [[antimicrobial]] soaps to maintain correct hand hygiene in health care workers is important to prevent [[nosocomial]] dissemination of the [[disease]] when dealing with hospitalized patients. | ||
Revision as of 16:57, 8 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]
Overview
Effective measures for the primary prevention of bronchiolitis include washing hands, avoiding contact with patients with symptomatic respiratory infections, and prevention of tobacco smoke exposure. These preventive measures are to prevent viral dissemination during the RSV season. In patients with a high risk of developing severe infection, passive immunization with palivizumab is recommended.
Primary Prevention
General measures
There are steps that are should be taken in order to prevent the spread of the infection. These steps include:
- Covering coughs and sneezes with a tissue or upper shirt sleeve, not your hands.
- Washing hands often with soap and water for 20 seconds.
- Avoid close contact such as: kissing, shaking hands, and sharing cups or eating utensils.
- Cleaning contaminated surfaces (such as doorknobs) may help stop the spread of RSV.
Parents of children at high risk for developing severe RSV disease should help their child by the following:[1]
- Avoid close contact with sick people.
- Wash their hands often with soap and water.
- Avoid touching their face with unwashed hands.
- Limit the time they spend in child-care centers or other potentially contagious settings, especially during fall, winter, and spring. This may help prevent infection and spread of the virus during RSV season.
Palivizumab prophylaxis
Recommendations are based on the 2009 AAP Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections.[2]
- Prophylaxis is recommended in select patients with a high risk of severe bronchiolitis:
- Patients younger than 2 years of age who required medical therapy for chronic lung disease 6 months or less before the RSV season.
- Patients younger than 2 years of age with congenital heart disease.
- Infants who are receiving congestive heart failure treatment.
- Infants with cyanotic heart disease.
- Infants with moderate to severe pulmonary hypertension.
- History of prematurity.
- Prophylaxis is recommended for premature infants with less than 32 weeks of gestation with or without chronic lung disease of prematurity.
- For patients born with 28 weeks of gestation or less, prophylaxis is recommended for their first RSV season, regardless of the age of the patient. If prophylaxis is started, it should continue through the full RSV season.
- For patients born with 29 to 32 weeks of gestation, prophylaxis is recommended for patients are born 6 months or less before the RSV season. If prophylaxis is started, it should continue through the full RSV season.
- For patients born with 32 to 35 weeks of gestation, prophylaxis is recommended in patients who are born 3 months before the RSV season or during the RSV season and who have 1 of the following risk factors which may require hospitalization due to bronchiolitis:
- Infants with school-aged siblings.
- Infants who attend to child care centers.
- Infants who have either congenital abnormalities of the airway or neuromuscular disease that compromises handling of respiratory secretions.
Dosage
- 15 mg/kg monthly doses to a maximum of 5 doses is the recommended regimen for patients born before 32 weeks of gestation, congenital heart disease with significant hemodynamic consequences, or chronic lung disease.
- 15 mg/kg monthly doses to a maximum of 3 doses is the recommended regimen for patients born between 32 and 35 weeks of gestation who meet the criteria for prophylaxis.
Recommendations for the prevention of bronchiolitis are based on the 2006 American Academy of Pediatrics Practice Guidelines for the Diagnosis and Management of Bronchiolitis.[3]
- Infants should not be exposed to tobacco as it has been shown that it increases the risk of RSV infection.
- Breastfeeding lowers the risk of lower respiratory tract infections in infants because of ingestion of immune factors such as immunoglobulins A and G.
- The use of alcohol-based rubs or antimicrobial soaps to maintain correct hand hygiene in health care workers is important to prevent nosocomial dissemination of the disease when dealing with hospitalized patients.
References
- ↑ CDC https://www.cdc.gov/rsv/about/prevention.html Accessed on June 1, 2017
- ↑ Committee on Infectious Diseases (2009). "From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections". Pediatrics. 124 (6): 1694–701. doi:10.1542/peds.2009-2345. PMID 19736258.
- ↑ American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis (2006). "Diagnosis and management of bronchiolitis". Pediatrics. 118 (4): 1774–93. doi:10.1542/peds.2006-2223. PMID 17015575.