Bronchiolitis primary prevention: Difference between revisions
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There are steps that are important to be taken in order to prevent the spread of the infection. These steps include: | There are steps that are important to be taken in order to prevent the spread of the infection. These steps include: | ||
*Covering the [[coughs]] and [[sneezes]] with a tissue or upper shirt sleeve, not your hands. | *Covering the [[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, and eating utensils. | *Avoid close contact such as: kissing, shaking hands, sharing cups, and 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 the RSV season. | *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 the RSV season. | ||
===Palivizumab prophylaxis=== | ===Palivizumab prophylaxis=== | ||
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*[[Prophylaxis]] is recommended in selected patients with high risk of severe bronchiolitis: | *[[Prophylaxis]] is recommended in selected patients with 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 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. | ||
| Line 30: | Line 30: | ||
::*Moderate to severe [[pulmonary hypertension]]. | ::*Moderate to severe [[pulmonary hypertension]]. | ||
:*History of [[prematurity]]. | :*History of [[prematurity]]. | ||
::*[[Prophylaxis]] is recommended | ::*[[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 disregarding the age of the patient. If the [[prophylaxis]] is started, it should continue through all the [[RSV]] season. | ::*For patients born with 28 weeks of [[gestation]] or less, [[prophylaxis]] is recommended for their first [[RSV]] season disregarding the age of the patient. If the [[prophylaxis]] is started, it should continue through all the [[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 the [[prophylaxis]] is started, it should continue through all the [[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 the [[prophylaxis]] is started, it should continue through all the [[RSV]] season. | ||
::*For patients born with 32 to 35 weeks of [[gestation]], [[prophylaxis]] | ::*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: | ||
:::*Infants with school-aged siblings. | :::*Infants with school-aged siblings. | ||
:::*Infants who attend to child care centers. | :::*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. | *Infants who have either [[congenital abnormalities]] of the [[airway]] or [[neuromuscular disease]] that compromises handling of [[respiratory]] [[secretions]]. | ||
====Dosage==== | ====Dosage==== | ||
*15 mg/kg monthly doses to a maximum of 5 doses | *15 mg/kg monthly doses to a maximum of 5 doses are 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 are the recommended regimen for patients born between 32 and 35 weeks of [[gestation]] who meet the criteria for [[prophylaxis]]. | ||
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*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 infections in infants by the ingestion of immune factors such as [[immunoglobulins]] A and G. | *[[Breastfeeding]] lowers the risk of lower tract [[infections]] in infants by the 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. | ||
==References== | ==References== | ||
Revision as of 14:47, 31 July 2017
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Bronchiolitis primary prevention On the Web |
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Risk calculators and risk factors for Bronchiolitis primary prevention |
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 hand washes, contact avoidance with patients with symptomatic respiratory infections, and prevention of tobacco smoke exposure. These preventive measures are to prevent the viral dissemination during the RSV season. In patients with high risk of developing severe infections, passive immunization with palivizumab is recommended.
Primary Prevention
General measures
There are steps that are important to be taken in order to prevent the spread of the infection. These steps include:
- Covering the 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, sharing cups, and 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 the 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 selected patients with 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.
- Cyanotic heart disease.
- 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 disregarding the age of the patient. If the prophylaxis is started, it should continue through all the 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 the prophylaxis is started, it should continue through all the 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:
- 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 are 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 are 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 tract infections in infants by the 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.