Expert consensus on palivizumab use for respiratory syncytial virus in developed countries

Paediatr Respir Rev. 2020 Feb;33:35-44. doi: 10.1016/j.prrv.2018.12.001. Epub 2018 Dec 18.


Respiratory syncytial virus (RSV) infection is a leading cause of hospitalisation in early childhood and palivizumab is the only licensed intervention for prevention. Palivizumab guidelines should reflect the latest evidence, in addition to cost-effectiveness and healthcare budgetary considerations. RSV experts from Europe, Canada and Israel undertook a systematic review of the evidence over the last 5 years and developed recommendations regarding prophylaxis in industrialised countries. Almost 400 publications were reviewed. This group recommended palivizumab for: preterm infants (<29 and ≤31 weeks gestational age [wGA] and ≤9 and ≤6 months of age, respectively; high-risk 32-35wGA), former preterm children ≤24 months with chronic lung disease/bronchopulmonary dysplasia, children ≤24 months with significant congenital heart disease; and other high-risk populations, such as children ≤24 months with Down syndrome, pulmonary/neuromuscular disorders, immunocompromised, and cystic fibrosis. Up to 5 monthly doses should be administered over the RSV season. It is our impression that the adoption of these guidelines would help reduce the burden of RSV.

Keywords: Evidence-based medicine; Lower respiratory tract infection; Neonatal lung disease; Palivizumab; Respiratory syncytial virus.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Bronchopulmonary Dysplasia / complications
  • Canada
  • Child, Preschool
  • Cystic Fibrosis / complications
  • Developed Countries*
  • Down Syndrome / complications
  • Europe
  • Evidence-Based Medicine
  • Gestational Age
  • Heart Defects, Congenital / complications
  • Humans
  • Immunocompromised Host / immunology
  • Infant
  • Infant, Extremely Premature
  • Infant, Newborn
  • Infant, Premature
  • Israel
  • Neuromuscular Diseases / complications
  • Palivizumab / therapeutic use*
  • Patient Selection*
  • Practice Guidelines as Topic
  • Respiratory Syncytial Virus Infections / complications
  • Respiratory Syncytial Virus Infections / immunology
  • Respiratory Syncytial Virus Infections / prevention & control*


  • Antiviral Agents
  • Palivizumab