Bronchiolitis primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]

Effective measures for the primary prevention of bronchiolitis include washing hands, avoiding contact with patients with symptomatic respiratory infections, and prevention from tobacco smoke exposure. These preventive measures are aimed at avoiding viral dissemination during the RSV season. In patients with a high risk of developing severe infection, passive immunization with palivizumab is recommended.

The steps that are taken in order to prevent the spread of the infective bronchiolitis include:

• Covering coughs and sneezes with a tissue or upper shirt sleeve, not your hands.
• Washing hands often with soap and water for 20 seconds.
• Avoid close contact such as, kissing, shaking hands, and sharing cups or eating utensils.
• Cleaning contaminated surfaces (such as doorknobs) may help stop the spread of RSV.

Parents of children at high risk for developing severe RSV disease should help their child by taking the following measures:^[1]

• Avoid close contact with sick people.
• Wash the child’s hands often with soap and water.
• Avoid touching the child’s face with unwashed hands.
• Limit the time they spend in child-care centers or other potentially contagious settings, especially during fall, winter, and spring. This may help prevent infection and spread of the virus during RSV season.

Recommendations are based on the 2009 AAP Modified Recommendations for use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections.^[2]

• Prophylaxis is recommended in selected patients with a high risk of severe bronchiolitis:

• Patients younger than 2 years of age who require medical therapy for chronic lung disease 6 months or less before the RSV season.
• Patients younger than 2 years of age with congenital heart disease.

• Infants who are receiving congestive heart failure treatment.
• Infants with cyanotic heart disease.
• Infants with moderate to severe pulmonary hypertension.

• History of prematurity:

• Prophylaxis is recommended for premature infants with less than 32 weeks of gestation with or without chronic lung disease of prematurity.
• For patients born with 28 weeks of gestation or less, prophylaxis is recommended for their first RSV season, regardless of the age of the patient. If prophylaxis is started, it should continue throughout the RSV season.
• For patients born with 29 to 32 weeks of gestation, prophylaxis is recommended for patients are born 6 months or less before the RSV season. If prophylaxis is started, it should continue throughout the RSV season.
• For patients born with 32 to 35 weeks of gestation, prophylaxis is recommended in patients who are born 3 months before the RSV season or during the RSV season and who have 1 of the following risk factors which may require hospitalization due to bronchiolitis:

• Infants with school-aged siblings.
• Infants who attend to child care centers.

• Infants should not be exposed to tobacco as it has been shown that it increases the risk of RSV infection.
• Breastfeeding lowers the risk of lower respiratory tract infections in infants because of ingestion of immune factors such as immunoglobulins A and G.
• The use of alcohol-based rubs or antimicrobial soaps to maintain correct hand hygiene in health care workers is important to prevent nosocomial dissemination of the disease when dealing with hospitalized patients

• Infants who have either congenital abnormalities of the airway or neuromuscular disease that compromises handling of respiratory secretions.

• 15 mg/kg monthly doses to a maximum of 5 doses is the recommended regimen for patients born before 32 weeks of gestation, congenital heart disease with significant hemodynamic consequences, or chronic lung disease.
• 15 mg/kg monthly doses to a maximum of 3 doses is the recommended regimen for patients born between 32 and 35 weeks of gestation who meet the criteria for prophylaxis.

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