Exposure to Ribavirin Aerosol

Publisher Website
Google Scholar
Abstract
The antiviral drug ribavirin is administered as an aerosolized mist via nasal and oral inhalation for the treatment of respiratory syncytial virus (RSV) to highly compromised infants and young children. The excess aerosol is exhausted directly into the patient treatment room, potentially exposing anyone who enters. Since the drug has demonstrated teratogenic effects in animal toxicity studies, exposure of women of child-bearing age to ribavirin is contraindicated. The population at risk includes female physicians, nurses, respiratory therapists, other hospital staff, and patient visitors (e.g., family members). In Phase One of this study, ribavirin aerosol was characterized with cascade impaction, revealing a mass median aerodynamic diameter (MMAD) of 1.0 mm. Ribavirin aerosol is produced by a Small Particle Aerosol Generator (Model SPAG-2). Changes in the SPAG-2 output concentration as a function of time and the corresponding changes in hospital treatment room air concentrations were evaluated. Fluctuations in particle size were recorded for different drying and nebulizer flow rates from the SPAG-2. In Phase Two of the study, occupational exposure to ribavirin was evaluated, and a survey of acute health effects among exposed nurses was conducted. The exposure of pediatric nurses to ribavirin was evaluated with personal and area air monitoring techniques and from blood sample analysis. Due to the teratogenic potential of ribavirin, control methods to reduce airborne concentrations of ribavirin were recommended. A health survey of exposed nurses and controls was conducted to evaluate reports of acute health effects associated with occupational exposure to ribavirin. The health survey consisted of pre- and postexposure questionnaire data, physical examinations, and pulmonary function testing. No significant, overt, adverse reaction to ribavirin exposure was found among exposed nurses at the low air concentrations observed.