updated November 2018
Palivizumab or Synagis® is a humanized monoclonal antibody produced by recombinant technology that is used to prevent respiratory syncytial virus (RSV) infection. It is administered intramuscularly as five monthly doses of 15 mg/kg during the RSV season.
In October of 2003, the Nova Scotia Provincial Blood Coordinating Program (NSPBCP) began monitoring requests for palivizumab in Nova Scotia. A letter from the NSPBCP was distributed to all Nova Scotia pediatricians in February 2004, detailing RSV infection prophylaxis recommendations for the remainder of the 2003/04 season. These recommendations were based on guidelines for palivizumab use from the Canadian Pediatric Society and the National Advisory Committee on Immunization (NACI). When NACI guidelines were extended to include the use of palivizumab for infants < 24 months with “hemodynamically significant” congenital heart disease, a review process was established by the NSPBCP in collaboration with the IWK Children’s Heart Centre to ensure appropriate use for infants with cardiac indications (CHD).
The NSPBCP convened a working group of medical specialists in April 2004 to review RSV prophylaxis cost and utilization data for Nova Scotia, to develop a Provincial RSV Infection Prophylaxis consensus guidelines for the upcoming RSV season. This was to assist the NSPBCP in designing a utilization management program for RSV immunoprophylaxis products. The IWK Health Centre will now continue the utilization management program initiated by the NSPBCP.
For the 2016-2017 season the Nova Scotia Palivizumab guidelines were changed by the IWK Utilization Management Program (IWKUMP) to align with recommendations from the Canadian Pediatric Society, in which palivizumab was considered for infants < 30 weeks gestation, rather than for premature infants 30 to 32 weeks gestational age. Of note, the American Academy of Pediatrics recommends the use of palivizumab for premature infants less than 29 weeks gestation.
There are no changes to the 2018-2019 guidelines for palivizumab eligibility.
Documents for the 2018-19 season are to be distributed to stakeholders in November of 2018 and contain the indications for use of palivizumab (SYNAGIS®) in Nova Scotia for the recommended season. The initial dose should be given between December 1 and January 6, and every four weeks, to a maximum of five doses. This defined season is based on when infants are deemed to be most at risk for contracting the disease in Nova Scotia (January to May) as a result of RSV surveillance in the province. Nova Scotia epidemiology experts will continue to monitor this defined season.