The risks of exposure to, and severe disease from RSV, should be carefully assessed when administering Palivizumab. Down’s syndrome itself has been shown to be a risk factor for severe RSV infection, even in the absence of congenital

heart disease. For infants and children with Down’s syndrome ≤24 months of age at the beginning of the RSV season, Doxorubicin ic50 the prevention of severe RSV disease using Palivizumab may be considered when the patient suffered any of following past or present complications, or has abnormal laboratory test results: • Anatomical, physiological or functional abnormalities of the respiratory system: Airway obstruction and/or associated apnea due to marked megaloglossia, Bioactive Compound Library glossoptosis, respiratory tract malacia, or other airway abnormalities, pulmonary hypertension,

pulmonary hypoplasia/dysplasia, or emphysematous lung. * Although the normal values vary depending on the months of age, one suggestion would be 2000/mm3 or lower and 1000/mm3 or lower for lymphocyte counts and T-lymphocytes, respectively. (1) If patients have a tendency to bleed due to thrombocytopenia (such as because of Wiskott–Aldrich syndrome and myeloablation) or other coagulopathy, or they are receiving anticoagulants and/or antiplatelet drugs, bleeding resulting from an intramuscular injection of Palivizumab may be serious. It is recommended that Palivizumab be carefully given to such patients, for example, with application of pressure to

the injection site for an appropriate length of time to ensure hemostasis. It is important to employ strict infection control measures even when using Palivizumab. It is particularly important to educate guardians, since their cooperation is essential in managing high-risk children. It is also important to provide instructions not only for RSV infection, but also for other pathogens causing respiratory tract infections. In addition, guardians should understand that adhering to the administration schedule is critical to maximize the effectiveness. Recent medical advances have improved the lives of immunocompromised patients, but as a result, the chance of exposure to and infection by RSV among these high risk patients has increased. Severe RSV infections in immunodeficiency disorders such as SCID have long been recognized, at least since GNAT2 the 1980s 2, 4 and 5. Hall et al. examined the immunological status of 608 infants under the age of five who were hospitalized with an RSV infection over a ten year period [2]. They identified 47 patients with immunologic abnormalities, including those receiving chemotherapy (20 cases) or steroids (22 cases) and those with primary immunodeficiency syndrome (5 cases). The frequency of nosocomial infections, as well as the rates of infection in the lower respiratory tract, admissions to the ICU and mortality was compared with immunologically normal children.