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2012-2013 RSV season

 Well, cold and flu season is approaching, which also ushers in my least favorite season: prime time to catch RSV. If you are familiar with our story, you know one of my twin boys caught a severe case of RSV (Respiratory Syncytial Virus) last year that had him in the PICU for four days (see "RSV and premature babies"). This year he may be eligible for the Synagis vaccine because of his reactive airways (see "Reactive airways"), as he takes Pulmicort twice a day, has already gone in for breathing treatments, and was on Orapred all of last week. A couple things were brought to my attention this past month that are very important heading into this RSV season:

1. Premature children are at a higher risk for RSV the first two years of their life.

2. Even if your child had RSV last year, he could catch it again this year-- possibly with the same severity or worse than he had it the year before.

The RSV vaccine is exceedingly expensive. Because of that, there are strict guidelines as to who is eligible to receive the RSV vaccine. Last year, at our old pediatrician, the nurse and our doctor emphasized how important it would be to vaccinate our 35-week infant twins. However, when we were sent off to the Synagis representative, she denied us, stating that only infants under 32 gestational weeks are eligible. I'm not sure if something changed, but this year I was handed the "2012-2013 Proposed Synagis Risk Factor Guidelines" for North Carolina (their emphasis) when discussing O's eligibility-- score! :)

The guidelines are broken up into category, birthday, and additional criteria. To quote from the US Bioservices AmerisourceBergen Specialty Group "2012-2013 Proposed Synagis Risk Factor Guidelines" flyer:
North Carolina Medicaid, TRICare, and most private insurance companies servicing NC families have adopted the American Academy of Pediatrics Red Book guidelines to determine coverage eligibility for Synagis. You may use this guide to help determine your patient's eligibility for Synagis.
NC Medicaid and most other insurers authorize coverage of Synagis beginning NOVEMBER 1st, 2012. US Bioservices will begin shipping at the end of October so that you may begin dosing on the November start date.
Chronic lung disease (Birthday: Born on or after November 1st, 2010) Additional criteria: Infants and children under 24 months of age who have had treatment (supplemental oxygen, bronchodilator, diuretic, or chronic corticosteroid therapy) in the 6 months before start of season.
Congenital Heart Disease; hemodynamically significant (Does NOT include VSD, secundum atrial septal defect, pulmonic stenosis, PDAA, uncomplicated aortic stenosis, mild coarctation of the aorta, lesions corrected by surgery unless on continued medication for CHF, or mild cardiomyopathy for which patient not receiving medical therapy) (Birthday: Born on or after November 1st, 2010) Additional Criteria: Infants and children under 24 months of age who are receiving medication to control congestive heart failure, moderate to severe pulmonary hypertension, or cyanotic heart disease.
Prematurity: Gestational age of less than or equal to 28 weeks 6 days (Birthday: Born on or after November 1st, 2011) Additional criteria: Less than or equal to 12 months of age at onset of RSV season.
Prematurity: Gestational age 29 weeks 0 days to 31 weeks 6 days (Birthday: Born on or after May 1st, 2012) Additional criteria: Less than or equal to 6 months of age at onset of RSV season.
Prematurity: Gestational age of less than 34 weeks 6 days (Birthday: Born on or after March 31st, 2012) Additional criteria: Has severe neuromuscular disease or congenital abnormalities of the airways, either of which compromises handling of respiratory secretions. No other risk factors will apply.
Prematurity: Gestational age of 32 weeks 0 days to 34 weeks 6 days (Birthday: Born on or after August 1st, 2012) Additional criteria: At least ONE of these two risk factors: (1) Attends child care-- a home or facility where care is provided for any number of infants or young toddlers (toddlers age 3 and younger) (2) Has a sibling younger than age 5 in the home.
The following conditions DO NOT singularly justify medical necessity for Synagis: an RSV episode during the season, repeated pneumonia, sickle cell disease, being one member of a multiple birth with the other member being approved for Synagis, apnea or respiratory failure of a newborn.
Here are some helpful links on the 2012-2013 Synagis eligibility guidelines:

CDC "RSV: Prophylaxis and High-Risk Groups"

American Academy of Pediatrics Red Book Online "Revised Indications for the Use of Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous for the Prevention of Respiratory Syncytial Virus Infections"

Besides the Synagis vaccine, what can you do to help protect your premature babies this RSV season? A friend of mine was discussing this with me today. Last year our twins were in infant carriers and much easier to protect. We simply hung our Touchy Tags on our infant carriers and strollers and kept well-meaning hands off our infants. This year our twins are toddlers, hers starting the season at 16-months and mine at 18-months. How do we keep toddlers from touching the world around them? For starters, we are implementing the hand-washing routines we did last year. Beyond that, we are keeping sippy cups up-- no sippy cups touching every surface and no sharing sippy cups. We have antibacterial wipes, travel size hand santizers in every bag and stored on the stroller, and lots of prayers... lots and lots of prayers.

Last year I posted a letter on my family website to let visitors know what to expect when they came to see the new babies. This year, I'm going to post the same letter revised. To see last year's letter when they were newborns, check out my blog post "RSV and premature babies." This year's letter, links kept in tact for you to copy and paste, if you choose to also share the letter:

Hello, everyone!

I wanted to make a post because it is cold and flu season, peak time for RSV (Respiratory Syncytial Virus). If you are unfamiliar with RSV, it is the leading cause of bronchitis and pneumonia in babies. To read more about RSV in premature babies, check out: C and O were born at thirty-five weeks, five weeks early. Luckily for us, they had great birth weights, but they were early and they are multiples. As we enter in to peak RSV season, they will still be in the high risk category as they are premature infants under 24 months. ( and O is at a much higher risk than even C with his reactive airways and twice daily nebulizer treatments. To help lower their risk, we are going to keep making hand washing a priority in our home before handling the children. These are the guidelines that we have been following and we wanted to share them with you so know what to expect when visiting:
1. Limiting exposure to germs (school age children, interaction with the public, sick friends/family, etc)
2. Washing and sanitizing hands
3. No cigarette smoke: in person, on clothing, or second hand

4. Avoid crowded childcare
5. Toy sanitation
We would appreciate your support when you visit with our attempts to limit their exposure to RSV. We understand they are sturdy, healthy looking boys and need to catch childhood diseases, but we feel it is important to address their specific health needs and make it a priority.
If you come down with a cold before visiting, please tell us before you arrive.
Most importantly, please get your flu shot!
Links on importance of getting flu shots:
Thank you!


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