Q&A: Innoculate against RSV

Premature babies born younger than 35 weeks’ gestation are especially at high risk for severe RSV disease.

The hospital arranged for my babies to receive the Synagis injection. What is it for, and is it really necessary? My twins were born at 33 weeks. The injection is very expensive and might not be covered by medical aid... And with two babies, I pay for two.

Email your question for our experts to: sharing@ypbmagazine.com

Please note that experts unfortunately cannot respond to each question personally. The answers provided on these pages should not replace the advice of your doctor.

PROF. LUBBE ANSWERS: Synagis is an injection against the respiratory syncytial virus (RSV) disease, given to high-risk babies once a month throughout the RSV season. RSV can be compared to flu in older children and adults, but due to prematurity, this can be life threatening in preterm babies. The season is usually between autumn and spring. The injection is not a vaccine but protects the baby through virus-fighting antibodies.

WHO SHOULD GET SYNAGIS?

Premature babies are often at risk of lung conditions, especially if they were born before 35 weeks and are younger than 6 weeks when the RSV season begins. RSV is the leading cause of rehospitalisation in babies younger than 1 year. So, these antibodies are given to them when they have certain lung or heart conditions, such as BPD (chronic lung disease as a result of prematurity and ventilator pressure). The criteria that are regarded as placing babies in the high risk category include:

■ Preterm babies born at or before 35 weeks who are 6 months or younger when the RSV season starts.

■ BPD that required medical treatment during the last 6 months in babies who are 24 months or younger when the RSV season starts.

■ Babies born with certain types of heart disease who are 24 months or younger when the RSV season starts.

Other factors that may increase the risk for contracting RSV include being around other children at day care, family history of wheezing or asthma, exposure to tobacco smoke and air pollutants, prematurity or low birth weight due to multiple (twin or triplet) births, low birth weight, crowded living conditions, pre-school or school-aged siblings, a weakened immune system or a serious lung infection and repeated doctor’s visits or hospitalisation. Premature babies born before 35 weeks’ gestation – when lungs are fully developed – are especially at high risk for severe RSV. Compared to a full-term baby, the preterm baby has only 34 percent of the lung volume (60 mL versus 180 mL), and only 26 percent of the lung surface area. Symptoms of RSV include coughing or wheezing that does not stop, a stuffy or runny nose, fast or troubled breathing, a fever, bluish colour around the mouth or fingernails, spread-out nostrils and/or a caved-in chest when breathing, lower appetite, mild sore throat and trouble sleeping.

HOW AND WHEN IS SYNAGIS ADMINISTERED?

Protecting the preterm baby against severe RSV for about a month, Synagis should be given to at-risk babies every 28 to 30 days during the RSV season. Synagis is usually administered in the baby’s thigh muscle by a healthcare provider, such as the neonatal intensive care staff or your doctor. The first injection should be administered before the RSV season starts, and the schedule should continue till the end of the RSV season. If the baby contracts RSV during this time, they should still get the injection throughout the RSV season to prevent severe disease from new RSV infections. The aim of these infections is to keep preterm graduates out of hospital.

POTENTIAL SIDE EFFECTS

The listed side effect is severe allergic reaction, which may occur after any dose. Severe allergic reaction could include: severe rash, hives, or itching skin; swelling of the lips, tongue, face or throat; and difficulty swallowing or difficult, rapid or irregular breathing; bluish colour of the skin, lips or fingernails; muscle weakness or floppiness; and unresponsiveness.

HOW CAN YOU PREVENT RSV?

RSV is usually contagious for three to eight days, but infants with a weakened immune system can be contagious for up to four weeks. Prevent RSV by thorough hand washing before touching a baby (parents and others), good cough and sneezes hygiene, and no smoking near your baby (not even outside your house). Wash toys and bedding often; don’t share eating utensils; disinfect high-traffic hard surfaces, such as doorknobs; keep your baby away from crowds, young children and anyone who is ill. And give your baby Synagis injections during the RSV season if they fall in the high-risk category. Medical aids usually pay for Synagis injections, but if the premmie was a ”healthy” infant that did not need longterm oxygen, they may regard it as an unnecessary prophylaxis. Therefore, you must ensure that your doctor writes a good motivation letter to prove that your little ones are in a high-risk category and require the injections to prevent them from getting ill and being readmitted to hospital. ●