Once a shipment of Synagis® is received what should I do with it?
- Unpack and place immediately into a monitored refrigerator where temperature is maintained between 2° and 8° Celsius.
- Routinely check inventory and use Synagis® with earliest expiration date first.
What if cold chain practices have possibly been broken?
- Do not assume it is unusable. Unpack and place in a monitored refrigerator as soon as possible in a container marked “DO NOT USE” until suitability is determined.
- Document details such as lot number, expiry date, maximum and minimum temperatures and time spent outside 2° and 8°Celsius
- Contact your regional RSV Coordinator and provide the documented details.
- Direction for management of the product will be forwarded once a decision by the regional RSV Prevention Program and product distributor has been reached.
When do I begin to administer Synagis®?
- The regional RSV Prevention Programs will notify points of care of the RSV commencement and completion dates.
What Information should be provided to families, if their child does not qualify for Synagis®?
- Review with families primary prevention measures including:
- Hand washing
- Avoiding crowded locations i.e. shopping malls, large gatherings, no public transportation
- Reduce exposure to people who are ill
- Importance of breastfeeding
- No exposure to smoking
- Do not share personal items such as pacifiers, cups, spoons, washcloths and towels
- Provide “More than a Cold” brochure if available
What Information should be provided to families, if their child qualifies for Synagis®?
- Obtain an informed consent form the parents/legal guardian by reviewing the following:
- Explanation of the disease
- Identification of the drug
- Benefits verses risks
- Assessing families concerns
- Accommodating language and literacy barriers
- Emphasize the importance of keeping their monthly appointments to ensure protection. If not given on a monthly basis the (trough) level of Synagis® may fall below what is required to provide adequate levels of protection. 1
- Review with families primary prevention measures
Where will the child receive their RSV doses?
- The regional RSV Prevention Programs will connect families to points of care such as hospitals, community health centers and First Nations Health Centers close to their place of residence.
What are the side effects?
- Common side effects of Synagis® are upper respiratory tract infection (URTI), minor injection site reaction, rash, rhinitis, otitis media and fever.
Is Synagis® a blood product?
- No! Synagis® is a monoclonal antibody produced by recombinant DNA technology. It has no potential for transmitting blood-borne infectious diseases.
Should children who have tested positive for RSV receive Synagis®?
- Children who have a positive RSV viral panel and /or hospitalization may not be eligible for initiation or continuation of RSV immunoprophylaxis for the current RSV season.
- The ARPP medical directors will review children with a positive RSV viral panel and will determine if RSV immunoprophylaxis should be commenced or continued.
Can Synagis® be given with routine immunizations?
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Synagis® does not interfere with the immune response to vaccines and can be administered at the same time, at a separate and appropriately spaced injection site.
It is preferable to space vaccinations and Synagis® administration by 48 hours to identify the causative agent in the event of an adverse reaction.
Should a child who is ill be given Synagis®?
- Minor illness: It is permissible to administer Synagis® with minor illness such as a cold with a low-grade fever i.e. 38 °.
- Moderate to severe illness: It is recommended to defer RSV immunoprophylaxis and if indicated refer to healthcare services.
- Reschedule the deferred dose as soon as the symptoms improve/subside.
Should a child receive the Influenza vaccine i.e. seasonal or H1N1 while receiving Synagis®?
- Yes, there are no contraindications for receiving an influenza vaccine and Synagis®. Influenza vaccine is recommended once the child is 6 months of age.
Should a child receive Synagis® if ill with influenza like illness?
- Synagis® should be deferred.
- Refer the family to their physician to assess if Tamiflu should be initiated in the child and family.
- Reschedule the deferred dose when the child is symptom free.
- If the child is hospitalized, it is at the discretion of the attending physician to administer Synagis®.
- There are no contraindications for receiving Synagis® while ill with influenza like illness.
What is the recommended course of action if a child presents with a communicable disease such as chicken pox or measles?
- If a communicable disease is suspected, isolate the child and family immediately.
- Implement infectious disease polices as per institution’s current standards.
- Defer Synagis® until child is symptom free
References:
1) Synagis® Handbook for Healthcare Professionals copyright August 2016
