sIn the present national surveillance survey, we compared PICU admissions and the need for mechanical ventilation for the treatment of RSV bronchiolitis between the following two consecutive seasons: before and after the introduction of palivizumab in Israel. Seventeen percent of the patients admitted to a PICU in both periods were candidates for RSV prophylaxis according to the AAP guidelines. For period 1, 13.3%; and for period 2, 9.7% (p < 0.01) were candidates for RSV prophylaxis according to the IMH recommendations. The difference in the rates associated with the AAP and the IMH guidelines is probably attributable to the broader criteria of the AAP guidelines.
The present study takes an alternative look at the epidemiology of severe RSV disease. It did not ask which patients were at greater risk of severe disease, but rather, among those with severe disease what risk factors were present. We sought to investigate the potential impact of palivizumab therapy on the burden of PICU admissions due to RSV infections. We evaluated the PICU admissions for RSV bronchiolitis with respect to the recognized risk factors associated with an increased severity of RSV disease, namely, prematurity and CLD. The study showed that the majority of children who were admitted to the PICU lacked these risk factors, probably because the majority of infants in the general population are not premature and do not have CLD.