Synagis® Injection for Infants

Synagis® muscular injections can help high-risk infants avoid serious complications from respiratory syncytial virus (RSV). Dr. Schochet and Dr. Lie discuss the symptoms, transmission, and prevention of RSV.

Synagis® (Palivizumab) Muscular Injection

Synagis® (palivizumab) for infants is an FDA-approved prescription, made up of virus-fighting antibodies, which helps prevent serious respiratory tract infections caused by respiratory syncytial virus (RSV). While Synagis® is not a vaccine, it can help high-risk infants by protecting them from severe RSV disease.

Synagis® is given as a series of injections, typically in the thigh muscle, which should begin prior to RSV season, before the virus is active, and continuing every 28-30 days for the duration of the RSV season. RSV season typically begins in the fall and continues through winter and spring in most areas of the U.S.

How Synagis® Benefits High Risk Infants

Babies who are born at 35 weeks or less are considered to be premature and have a greater risk of contracting RSV due to:

• Insufficient antibodies received from their mothers
• Underdeveloped lungs
• Narrow airways

Synagis® can give protection to the vulnerable lungs of premature or low birth-weight babies by providing the infection-fighting antibodies needed.

High-risk infants who benefit from Synagis® intramuscular injections include:

• Premature or low birth-weight babies
• Children under 2 with hemodynamically significant congenital heart disease
• Children under 2 who have bronchopulmonary dysplasia/chronic lung disease of prematurity
• Children with certain types of chronic lung or heart diseases
• Children with compromised or weakened immune systems

For optimal protection, high-risk infants should receive the Synagis® injections on time every month during the RSV season, as each dose gives approximately 1 month of protection. While Synagis® does not completely eliminate the risk of RSV, even a child who gets an RSV infection after the first dose should continue monthly injections to help prevent new RSV infections.

Possible side effects from Synagis® include:

• Fever
• Rash
• Bruising
• Redness, discomfort, warmth, or swelling around injection site

On rare occasions, more serious side effects have been reported, including severe allergic reactions, which can be life threatening. Severe allergic reaction symptoms may include:

• Itchy rash
• Muscle weakness
• Facial swelling
• Difficulty swallowing or breathing
• Bluish skin tone
• Drop in blood pressure
• Unresponsiveness

If your child exhibits severe allergic reaction symptoms after receiving Synagis®, you should contact your doctor or seek medical help immediately. Any child who has had a severe allergic reaction to Synagis® should not receive further injections.

Synagis® is not a treatment for RSV, but rather a preventative measure as protection against serious complications from RSV. The American Academy of Pediatrics (AAP) recommends palivizumab be administered to high-risk infants who are likely to benefit from the injection treatments.

The CDC (Centers for Disease Control and Prevention) posts information for healthcare professionals regarding palivizumab prophylaxis among infants and young children at increased risk of hospitalization for RSV infection. They state that on July 28, 2014, AAP released updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for RSV infection. For specific and latest palivizumab guidance, please consult the AAP policy statement. An accompanying AAP technical report provides additional context and rationale for the guidance.

If you child or infant is at high-risk for RSV, contact Dr. Schochet or Dr. Lie about monthly Synagis® muscular injections.

Respiratory Syncytial (sin-SISH-uhl) Virus (RSV)

Respiratory syncytial virus (RSV) is a highly contagious and common respiratory virus that infects the breathing passages and lungs. Most children have had RSV by the age of 2, with nothing more than cold-like symptoms. For high-risk infants and children, however, RSV can cause serious health problems that can result in hospitalization.

RSV is the leading cause of pneumonia and bronchiolitis (inflamed air passages in the lungs) in children under the age of 1 in the U.S. Those at high risk for severe RSV infection include:

• Premature babies
• Children under 2 with lung or heart disease
• Infants under 10 weeks old
• Children under 2 who have bronchopulmonary dysplasia/chronic lung disease of prematurity
• Children under 2 with hemodynamically significant congenital heart disease
• Young children and infants with suppressed immune systems

Symptoms of Respiratory Syncytial Virus (RSV)

Symptoms of RSV can range from mild to life-threatening, depending on the general health of the child. Symptoms typically appear within 4-6 days of exposure to RSV, and usually present as a cold-like illness at the onset, but can quickly cause various respiratory problems.

For otherwise healthy children, symptoms usually subside within a week or 2. High-risk patients generally take longer to recover and may be contagious for several weeks afterward. Symptoms of RSV can include:

• Runny nose
• Decreased appetite
• Cough
• Sneezing
• Fever
• Wheezing

Contact your doctor if your child exhibits more serious symptoms, such as:

• High fever
• Thick nasal discharge
• Difficulty breathing
• Green, yellow, or gray mucus from cough
• Refusal to nurse or bottle-feed
• Unusual inactivity or irritability
• Dehydration signs (cool, dry skin, no tears when crying, little or no urine in diaper for 6 hours or more)

Diagnosing and Treating RSV

RSV infections often result in a doctor visit. For most children, there is usually no need to distinguish RSV from the common cold. Home treatment for mild cases of RSV include:

• Fever reducing medications
• Plenty of fluids
• Cool mist vaporizer
• Removal of nasal fluids with bulb syringe

For high-risk infants and children, an antigen detection test, which identifies RSV in nasal secretions, may be performed to determine if RSV is the cause of the symptoms. Serious respiratory infections may require hospitalization and/or treatment with:

• Oxygen
• Intubation
• Mechanical ventilation
• IV fluids
• Medications to open airways

Approximately 57,000 children under age 5 are hospitalized each year in the U.S. due to RSV. Hospitalization for RSV usually lasts for a few days with a full recovery within 2 weeks after release.

Transmitting and Preventing RSV in Infants

RSV is highly contagious, being transmitted through direct or indirect contact with someone who is infected, or through virus-containing droplets that enter the air after the infected person sneezes or coughs. RSV is frequently contracted at a school or daycare environment, where children come in contact with surfaces, such as doorknobs and tabletops, which have been touched by an infected person. RSV nasal and oral secretions can be transferred and remain on hard surfaces for many hours, and soft surfaces, such as hands and tissues, for shorter time periods.

People with RSV are generally contagious for 3-8 days, unless they are in a high-risk group (who can remain contagious for weeks). Anyone who is experiencing the cold-like symptoms of RSV should:

• Wash hands frequently with soap and water
• Cover coughs and sneezes
• Clean surfaces after touching
• Avoid sharing utensils or cups
• Avoid close contact with others

If your child is at high-risk for RSV, you should:

• Keep hard surfaces disinfected
• Wash your child’s hands frequently, especially if in contact with someone who is symptomatic
• Avoid close facial contact with your child if you have cold symptoms
• Ask others to wash hands before touching your baby
• Avoid taking your baby into crowded areas
• Keep your child away from cigarette smoke
• Limit daycare, especially during RSV season

For infants and children at high-risk for RSV, monthly intramuscular injections of Synagis® (palivizumab) are available during the RSV season to help prevent respiratory infections brought on by severe RSV.

For more information about preventing Respiratory Syncytial Virus Infection (RSV), see:

• Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee
• Download the CDC’s mobile app “Disease of the Week” and find RSV.

If your child is exhibiting signs of RSV, or is at high-risk for contracting RSV, please call our office for an appointment. For more information about pediatric respiratory disease please submit an online appointment request or contact the office of Dr. Peter Schochet and Dr. Hauw Lie.