Who Shall Not Receive Palivizumab

To the Editor. A respiratory syncytial virus (RSV)-specific monoclonal antibody, palivizumab, is now available. The clinical effect of the drug has so far been evaluated in only 1 randomized, blinded clinical study against a placebo—the IMpact-RSV study.1 In this study, palivizumab was given as an intramuscular injection every 30 days throughout the RSV season to premature children and children with bronchopulmonary dysplasia. The study demonstrated an overall 55% reduction in the hospitalization rate for RSV, while the overall length of stay in intensive care unit were significantly longer for the children treated with palivizumab compared with placebo: 12.7 and 13.3 days, respectively (P = .023). The IMpact-RSV study also demonstrated that palivizumab did not prevent RSV infection, but rather modulated its clinical course. Seven of the children with a RSV infection in the treatment group (n = 1002) were in need of assisted ventilation in contrast to 1 in the placebo group (n = 500). Two of the children in the treatment group died of an RSV infection; none died in …