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Definition of Terms
Respiratory Syncytial Virus (RSV) is one of the most common causes of lower respiratory tract infections in children at high risk of respiratory disease. It is associated with increased morbidity amongst preterm infants and babies born with chronic health conditions such as respiratory and/or cardiac complications.
Palivizumab, provides passive immunity against RSV infection and has been shown to decrease hospitalisation for RSV related illness. There is currently no vaccine to protect against RSV. For patients who have been admitted to hospital for RSV infection, the incidence of an ICU admission related to RSV infection is decreased in patients receiving 4 weekly Palivizumab.
The Royal Children’s Hospital (RCH) funds Palivizumab for selected cardiology patients and other at-risk groups and administration is coordinated by the RCH Immunisation Service. Palivizumab is given as a course of up to 5 intramuscular injections at 1-month intervals throughout the RSV season. The RSV program at RCH generally begins in May each year and concludes at the end of September.
This guideline is restricted to use by Medical and Pharmacy staff and nurse immunisers working in the Immunisation Drop-in Centre (DIC) at RCH. The guideline applies to neonate/infant’s inpatient or outpatients attending RCH and can be administered by approved nurse immunisers in the DIC with a Drug Usage Committee (DUC) approved order on EMR.
Palivizumab can be given from birth. (Usually given in first year of life)
The aims of this guideline are:
Eligibility for Palivizumab is considered by the Drug Usage Committee (DUC) on a case-by-case basis. Criteria for use is established following consultation with relevant clinicians, and examples of approved patients include:
Palivizumab can be given at the same time as routine vaccinations on the National Immunisation Program (NIP). Different sites must be used.
Note: Dose 2 is given 3 weeks after dose 1 and then 4 weekly for the remainder of RSV season.
Prescribers can order Palivizumab as a once off (Stat order) if Palivizumab is not required for the entire duration of the RSV season. The RSV therapy plan can also be ceased at the discretion of the prescriber in certain circumstances i.e cessation of heart failure medications and post corrective cardiac surgery. The Immunisation Drop-in centre must be informed in these circumstances.
Palivizumab is listed in Table 1 of the RCH Hazardous Drugs list, and as
a result a respiratory mask and protective eyewear must be worn for tasks that
pose an increased risk of internalization or splash. See Hazardous Medicines – Safe
handling of (RCH access only).
Palivizumab for injection is available as:
following steps are taken:
Note: RSV does not contain a preservative and should be administered immediately after drawing up the doseSee also RCH Procedure document Single use of injectable medicines and fluids available at Policies and Procedures : Single use of injectable medicines and fluids (RCH access only).
Intramuscular injection technique
Photo courtesy Lloyd Ellis, The Royal Children’s Hospital, Victoria (pg. 80 of Australian Immunisation Handbook, 10th ed. 2013)
Position for infants < 12 months
Photo courtesy Dr Joanne Molloy, Victoria (pg 75 of Australian Immunisation handbook, 10th ed. 2013)
Injections can result in distress and anxiety for infants, children and their parents. It is important that effective pain management strategies are used during injection procedures. Some strategies that are recommended during administration of the Injection include:
See also RCH nursing clinical guidelines: Procedural Management, Breastfeeding Support, and Sucrose for infants.
Palivizumab Adverse reactions:
The evidence table for this guideline can be found here.
Please remember to read the disclaimer.
development of this nursing guideline was coordinated by Sonja Elia, Nurse Practitioner and Manager, Immunisation,
and approved by the Nursing Clinical Effectiveness Committee. Updated August 2021.