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Government considers immunising children against RSV

By Lilian Anekwe

Government advisors are to consider introducing an immunisation programme against respiratory syncytial virus, Pulse can reveal.

An advisory group is to examine the potential of a programme for children at high risk from the infection after NHS-funded research found the policy would be cost-effective.

The group is to examine the evidence for use of palivizumab - a monoclonal antibody designed to provide passive immunity against RSV and either prevent the illness or reduce its severity.

The new research, compiled as part of a Health Technology Assessment, examined the clinical and cost-effectiveness of use of palivizumab against RSV in children.

An analysis of two randomised controlled trials of the clinical effectiveness of prophylaxis with palivizumab found it was associated with a 45% reduction in the hospitalisation rate for RSV in children with congenital heart disease. Hospital admissions were reduced by 55% in immunised preterm infants and children with chronic lung disease.

The HTA research team examined existing economic evaluations and concluded that ‘use of palivizumab was unlikely to be cost-effective in all children, but continued use of palivizumab for particularly high-risk children may be justified'.

Infants under 6 weeks old, those with chronic lung disease, congenital heart disease or immunodeficiency, and those born before 35 weeks gestational age are classified at the greatest risk of severe disease if infected with RSV.

An independent economic evaluation led by Dr Dechao Wang a statistician at the University of Birmingham's department of public health and epidemiology, concluded: ‘When additional risk factors were modelled, prophylaxis against RSV with palivizumab was within the willingness-to-pay threshold of £30,000 per QALY in a number of important subgroups of children with chronic lung disease.'

The Government's Joint Committee on Vaccination and Immunisation has seen the new evidence and established a subgroup to consider the benefits of immunisation in high-risk groups.

Dr Doug Fleming, a member of the JCVI and director of the RCGP's Birmingham research unit, said his own research, based on a decade's worth of data, demonstrated the need for RSV immunisation after finding the infection caused at least as much illness as flu.

Dr Fleming said: ‘'I imagine that the HTA could stimulate a lot of interest and it would be a worthwhile thing to do - the effects of RSV in children are quite severe. If you average the effects of by year, the number of cases attributable to RSV would probably be more than flu.'

Effectiveness of palivizumab

• RSV admissions in preterm infants or children with chronic lung disease - 4.8% (48/1,002) in the palivizumab group, 10.6% (53/500) in the no prophylaxis group
• RSV hospitalisation rates in children with CHD - 5.3% (34/639) in the palivizumab group, 9.7% (63/648) in the no prophylaxis group
• Prophylaxis against RSV infection with palivizumab was the NICE cost effective threshold of £30,000 per QALY in children less than three months born before 30 weeks, and children between 3-6 months born before 26 weeks

Source: Health Technology Assessment 2008; Vol. 12: No. 36

Immunising children against RSV (pictured) would be cost-effective, research has found Immunising children against RSV (pictured) would be cost-effective, research has found

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