Help get the only medication to prevent RSV available in Australia on the PBS

Respiratory Syncytial Virus (RSV) is the most common cause of lower-respiratory-tract infection in infants and young children. Babies born prematurely, babies with lung disease and children with certain types of congenital heart disease are at high risk of getting a very serious respiratory illness if they contract RSV. RSV occurs in seasonal outbreaks, usually through autumn to winter, but the RSV season may vary from one region to another.

Global Prevalence and Risk

•According to the World Health Organization, RSV kills 160,000 people a year.
•RSV is highly contagious. Approximately two-thirds of all infants are infected with RSV during the first year of life and almost 100 percent by the age of two.
•Most of these RSV infections cause minor upper- respiratory illness and cold-like symptoms.
•However, in certain high-risk paediatric patients, RSV infection may cause serious lower-respiratory-tract disease.
•Children hospitalised with RSV infection require more visits to specialized intensive care units and are more likely to be hospitalised in the follow-up period.
•In infants and children, up to 90 percent of bronchiolitis hospitalisations and up to 50 percent of winter pneumonia hospitalisations are caused by RSV.

Additional High-Risk Factors

•Low birth weight
•Day-care attendance
•Exposure to tobacco smoke
•School-age siblings
•Multiple birth
•Family history of asthma
•Distance to, and availability of, hospital care for severe respiratory illness

What does RSV look like?

It is widely accepted that by the age of 3 all infants will have had an RSV infection. RSV infections peak annually in the winter months. During this time hospital admissions for RSV are at their greatest, placing considerable strain on Paediatric Emergency Departments. Some infants will have infections so severe they will require admission to the Paediatric Intensive Care Unit (PICU). In fact Bronchiolitis and Pneumonia, very often caused by RSV, are consistently in the Top 10 reasons for PICU admission within Australian PICU's.
Infants, being unable to breath, will not feed and as a result dangerous dehydration is the principle reason for admission to the PICU. As the virus progresses through the lung, the lung tissue inflames and sloughs off and blocks airways, leading to wheezing and respiratory distress. In some very severe cases this means the infants need to be put on ventilation machines, sometimes for days at a time. In these babies the wheezing episodes can continue up to the age of 10 and often be confused with asthma. While all children will have an RSV infection not all will become so sick they need specialised care. Of those that do need specialised care, such as ventilation, many have a history of Premature Birth or Congenital Heart Disease.

RSV in Australia?

There is currently no vaccination available for RSV. One medicine has been registered in Australia to prevent serious lower respiratory tract disease caused in children at high risk of severe RSV infection. Currently the Federal Government does not fund the supply of this medicine. The medication that has been registered to prevent RSV in Australia is Synagis (Palivizumab) and is costly to either the Public Health System or parents wanting their children to recieve the monthly injections. Synagis (Palivizumab) is not registered on the Pharmaceutical Benefits Schedule in Australia thus making the medicine unreachable for most families of preterm or seriously ill children with Chronic Lung Disease or Heart condtitions. The costs range up to $1000 per injection (depending on the size of the baby or child) and the injections should be given over at least a 6 month period. Thus the cost per year for the first three years of a high risk childs life are in the region of $18,000 and are not covered under the PBS so this is a direct cost to each family.

Sources:
Surveillance of viral pathogens in Australia: respiratory syncytial virus. Paul Roche, Stephen Lambert, Janeane Spencer. Communicable Diseases Intelligence: Vol 27, No 1. 2003

Australia's Children: their health and well-being 2002. Fadwa Al-Yamin, Meredith Bryant, Hilary Sargeant. Australian Institute of Health and Welfare Canberra. AIHW Cat. No. PHE 36. Canberra: AIHW.

Report of the Australian Paediatric Care Registry (ANZPIC): 2003, 2004, 2005.