One-year observational study of palivizumab prophylaxis on infants at risk for respiratory syncytial virus infection in Latin America.

OBJECTIVE: This study aims to describe real world palivizumab use and effectiveness in high-risk Latin American infants and young children. METHOD: Prospective, multicenter observational study with infants at risk for severe RSV infection who received palivizumab according to routine clinical practice. Subjects were followed for one year with monthly visits after the first dose of palivizumab. An infant was considered adherent if receiving all the expected injections or five or fewer injections within appropriate inter-dose intervals. Annual incidence rates and risk factors of lower respiratory tract infection (LRTI) hospitalization were determined through Poisson regression models (α=0.05). RESULTS: The study enrolled 458 children from seven countries in Latin America, from February 2011 to September 2012. The majority (98%) were born <36 weeks gestation. Overall, patients received 83.7% of their expected injections and 86.7% completed one year of follow-up. Of the 61 LRTI hospitalizations, 12 episodes were due to RSV infection. The RSV-associated hospitalization rate was 2.9 per 100 patient-years. Bronchopulmonary dysplasia was identified as an independent risk factor for LRTI hospitalization. A total of 1165 adverse events were recorded during one year of follow-up. One hundred and two patients (22.3%) had a total of 135 serious adverse events, but no events were considered to be related to palivizumab. CONCLUSIONS: The rate of RSV hospitalization in high-risk infants in Latin America was low and aligned with those observed in randomized control trials and observational studies. Palivizumab prophylaxis appeared effective and had a good safety profile in this population.

Prevention of respiratory tract infections: Situation in 12 private day care centers in the city of Buenos Aires.

INTRODUCTION: Day care center attendance is a risk factor for acquiring respiratory tract infections. There are preventive measures which should be applied. OBJECTIVES: To describe the availability of adequate supplies or building facilities, staff habits, behaviors and training, and the existence and enforcement of official guidelines or institutional standards regarding the prevention of respiratory tract infections in day care centers for infants in the city of Buenos Aires. METHODS: Exploratory and cross sectional study carried out at systematically selected private day care centers for infants. The person responsible of the day care center was interviewed and a 3-hour observation session was held in a room of each of the day care centers. Information was collected on hand washing practices, clearance of nasal secretions, school exclusion guidance, immunization control, breastfeeding promotion and the existence of guidelines, standards and training on the prevention of respiratory tract infections. RESULTS: Twelve day care centers were included. Though 8 of the 12 centers had the necessary infrastructure and items, hand washing was uncommon and the technique used was incorrect. Clearance of nasal secretions was not followed by hand washing. At 11 of the 12 day care centers, children's immunization is monitored; at 9 of 12, school exclusion guidelines are not followed; none of the centers have breastfeeding promotion material. In 1 of 12, teachers were trained in the subject the year before and, 1 out of 12 had its own guidelines for infection prevention. CONCLUSION: Despite the availability of resources, preventive measures were not regularly and systematically implemented in the day care centers visited.

Prevention of respiratory infections at day care centers: recommendations and systematic review of the evidence.

INTRODUCTION: Attending a day care center is a risk factor for respiratory infections. The objective of this study is to review which nonspecific prevention measures are recommended for day care centers and the evidence of their usefulness in this setting. METHODS: Recommendations regarding nonspecific prevention at national level were searched using Google and the web sites of the Argentine Society of Pediatrics, the ministries of education and the ministries of health from different countries, both in English and Spanish. Recommendations regarding hand hygiene, clearance of secretions, cleaning the environment and elements, breastfeeding, and exclusion of symptomatic subjects were reviewed. A systematic search of the literature was conducted to find intervention studies at day care centers that evaluated the effectiveness of recommendations, published in Spanish and English. Results and the methodological quality of studies were analyzed. RESULTS: Seven guidelines were found. Hand hygiene and environment cleaning were the only recommendations described in all guidelines. The exclusion of symptomatic subjects is mentioned in all, but criteria are heterogeneous. Clearance of nasal secretions and promotion of breastfeeding are outlined only in a few of the guidelines. Eight intervention studies on hand hygiene, cleaning of the environment, and clearance of secretions were found, whose results were heterogeneous and had major methodological limitations. CONCLUSION: A timely and adequate hand hygiene and an appropriate cleaning of the environment have been uniformly recommended by different guidelines as non-specific prevention measures against respiratory infections. The evidence on the usefulness of these measures in this setting is limited.

One-year observational study of palivizumab prophylaxis on infants at risk for respiratory syncytial virus infection in Latin America / Estudo observacional de um ano da profilaxia com palivizumabe em neonatos com risco para infecção por vírus sincicial respiratório na América Latina

Abstract Objective: This study aims to describe real world palivizumab use and effectiveness in high-risk Latin American infants and young children. Method: Prospective, multicenter observational study with infants at risk for severe RSV infection who received palivizumab according to routine clinical practice. Subjects were followed for one year with monthly visits after the first dose of palivizumab. An infant was considered adherent if receiving all the expected injections or five or fewer injections within appropriate inter-dose intervals. Annual incidence rates and risk factors of lower respiratory tract infection (LRTI) hospitalization were determined through Poisson regression models (α = 0.05). Results: The study enrolled 458 children from seven countries in Latin America, from February 2011 to September 2012. The majority (98%) were born <36 weeks gestation. Overall, patients received 83.7% of their expected injections and 86.7% completed one year of follow-up. Of the 61 LRTI hospitalizations, 12 episodes were due to RSV infection. The RSV-associated hospitalization rate was 2.9 per 100 patient-years. Bronchopulmonary dysplasia was identified as an independent risk factor for LRTI hospitalization. A total of 1165 adverse events were recorded during one year of follow-up. One hundred and two patients (22.3%) had a total of 135 serious adverse events, but no events were considered to be related to palivizumab. Conclusions: The rate of RSV hospitalization in high-risk infants in Latin America was low and aligned with those observed in randomized control trials and observational studies. Palivizumab prophylaxis appeared effective and had a good safety profile in this population.

Resumo Objetivo: Descrever o uso e a eficácia do palivizumabe no mundo real em neonatos e jovens crianças de alto risco latino-americanas. Método: Estudo observacional prospectivo multicêntrico com neonatos em risco devido a infecção grave por VSR que receberam palivizumabe de acordo com a prática clínica de rotina. Os indivíduos foram acompanhados por um ano, com visitas mensais após a primeira dose de palivizumabe. Um neonato foi considerado adepto se recebeu todas as injeções esperadas ou ≤ 5 injeções nos intervalos entre doses adequados. As taxas de incidência anuais e os fatores de risco de internação por infecção do trato respiratório inferior (ITRI) foram determinados por meio dos modelos de regressão de Poisson (α = 0,05). Resultados: O estudo inscreveu 458 crianças de sete países da América Latina, de fevereiro de 2011 a setembro de 2012. A maioria (98%) nasceu com < 36 semanas. Em geral, os pacientes receberam 83,7% de suas injeções esperadas e 86,7% completaram um ano de acompanhamento. Das 61 internações por ITRI, 12 episódios foram devidos a infecção por VSR. A taxa de internação associada ao VSR foi de 2,9 em cada 100 pacientes-ano. A displasia broncopulmonar foi identificada como um fator de risco independente da internação por ITRI. Foram registrados 1.165 eventos adversos durante um ano de acompanhamento; 122 (22,3%) apresentaram 135 eventos adversos graves, porém nenhum deles foi considerado relacionado ao palivizumabe. Conclusões: A taxa de internação por VSR em neonatos de alto risco na América Latina foi baixa e em linha com as observadas em ensaios clínicos controlados randomizados e estudos observacionais. A profilaxia com palivizumabe pareceu eficaz e com bom perfil de segurança nessa população.

[Newborn ventilation: comparison between a T-piece resuscitator and self-infating bags in a neonatal preterm simulator]. / Ventilación del recién nacido: comparación entre un reanimador con pieza en T y bolsas autoinflables en un simulador de neonato prematuro.

INTRODUCTION: Although the provision of effective assisted ventilation is the most effective intervention in delivery room resuscitation of depressed newborn infants, there is still limited evidence about which is the optimal device to deliver positive pressure ventilation (PPV). OBJECTIVE: To compare the accuracy of pressures and ventilation rate (VR) delivered to a neonatal simulator with three devices: 240 ml and 450 ml self-infating bags (SIB) and a T-piece resuscitator, and to evaluate the variability in terms of providers' experience. MATERIAL AND METHODS: 76 health care providers divided in two groups according to experience were asked to provide positive pressure ventilation to a neonatal simulator through a facial mask or an endotracheal tube with three ventilating devices: a T-piece resuscitator, a 240 ml and a 450 ml self-infating bags. Participants used each combination of device and interface randomly on 2 consecutive occasions. Mean and maximum PIP and respiratory rate were recorded. Statistical analyses were performed using two-factor analysis of variance for repeated measures. RESULT: SIB 240 and 450 were similar in the mean target peak inspiratory pressure (PIP) but both were significantly different (p < 0.001) from T-piece, although all values were close to the target. Mean VR was over the target for all the devices (p < 0.001). The highest difference found was 7 ± 1.7 breaths/minute with the 240 ml bag when compared with the T-piece using a mask. Experienced operators were closer than novice operators to target VR, regardless of the device or interface. CONCLUSION: The accuracy for the devices was comparable in the variables measured regardless operator´s experience. Overall, the T-piece provided lower PIP while both SIB, higher than the target. The VR was over the target for all the devices. Both SIB and novice participants were associated with higher VR. The intraoperator consistency was comparable in the variables measured with all devices.

Prevención de infecciones respiratorias: Situación en 12 jardines maternales privados de la Ciudad Autónoma de Buenos Aires / Prevention of respiratory tract infections: Situation in 12 private day care centers in the city of Buenos Aires

Introducción. La asistencia al jardín maternal es un factor de riesgo para contraer infecciones respiratorias. Existen medidas de prevención que deberían aplicarse. Objetivos. Describir la disponibilidad de insumos o infraestructura edilicia apropiados; hábitos, conductas y capacitación del personal; y la existencia y aplicación de recomendaciones oficiales o normas institucionales para la prevención de infecciones respiratorias en jardines maternales de la Ciudad de Buenos Aires. Métodos. Estudio exploratorio observacional transversal realizado en jardines maternales privados seleccionados en forma sistemática. Se realizó una entrevista al responsable institucional y una sesión de observación de tres horas de duración en una sala de cada jardín. Se recabó información sobre lavado de manos, higiene de secreciones nasales, pautas de exclusión escolar, control de inmunizaciones, promoción de lactancia materna y existencia de guías, normas y capacitación sobre prevención de infecciones respiratorias. Resultados. Se incluyeron 12 jardines. Si bien en 8/12 salas se contaba con infraestructura y elementos necesarios, el lavado de manos fue infrecuente y con técnica inadecuada. La higiene de secreciones nasales se realizó sin higiene de manos posterior. En 11/12 jardines, se realiza control de las inmunizaciones de los niños; en 9/12, no se cumplen las pautas de exclusión escolar; en ninguno hay material de promoción de la lactancia materna. En 1/12, los docentes habían recibido capacitación sobre el tema en el último año y, en 1/12, había una guía propia para prevención de infecciones. Conclusión. Pese a la disponibilidad de recursos, la implementación de medidas de prevención no se realizó en forma regular y sistemática en los jardines visitados.

Introduction. Day care center attendance is a risk factor for acquiring respiratory tract infections. There are preventive measures which should be applied. Objectives. To describe the availability of adequate supplies or building facilities, staff habits, behaviors and training, and the existence and enforcement of official guidelines or institutional standards regarding the prevention of respiratory tract infections in day care centers for infants in the city of Buenos Aires. Methods. Exploratory and cross sectional study carried out at systematically selected private day care centers for infants. The person responsible of the day care center was interviewed and a 3-hour observation session was held in a room of each of the day care centers. Information was collected on hand washing practices, clearance of nasal secretions, school exclusion guidance, immunization control, breastfeeding promotion and the existence of guidelines, standards and training on the prevention of respiratory tract infections. Results. Twelve day care centers were included. Though 8 of the 12 centers had the necessary infrastructure and items, hand washing was uncommon and the technique used was incorrect. Clearance of nasal secretions was not followed by hand washing. At 11 of the 12 day care centers, children's immunization is monitored; at 9 of 12, school exclusion guidelines are not followed; none of the centers have breastfeeding promotion material. In 1 of 12, teachers were trained in the subject the year before and, 1 out of 12 had its own guidelines for infection prevention. Conclusion. Despite the availability of resources, preventive measures were not regularly and systematically implemented in the day care centers visited.

Prevención de infecciones respiratorias: Situación en 12 jardines maternales privados de la Ciudad Autónoma de Buenos Aires / Prevention of respiratory tract infections: Situation in 12 private day care centers in the city of Buenos Aires

Introducción. La asistencia al jardín maternal es un factor de riesgo para contraer infecciones respiratorias. Existen medidas de prevención que deberían aplicarse. Objetivos. Describir la disponibilidad de insumos o infraestructura edilicia apropiados; hábitos, conductas y capacitación del personal; y la existencia y aplicación de recomendaciones oficiales o normas institucionales para la prevención de infecciones respiratorias en jardines maternales de la Ciudad de Buenos Aires. Métodos. Estudio exploratorio observacional transversal realizado en jardines maternales privados seleccionados en forma sistemática. Se realizó una entrevista al responsable institucional y una sesión de observación de tres horas de duración en una sala de cada jardín. Se recabó información sobre lavado de manos, higiene de secreciones nasales, pautas de exclusión escolar, control de inmunizaciones, promoción de lactancia materna y existencia de guías, normas y capacitación sobre prevención de infecciones respiratorias. Resultados. Se incluyeron 12 jardines. Si bien en 8/12 salas se contaba con infraestructura y elementos necesarios, el lavado de manos fue infrecuente y con técnica inadecuada. La higiene de secreciones nasales se realizó sin higiene de manos posterior. En 11/12 jardines, se realiza control de las inmunizaciones de los niños; en 9/12, no se cumplen las pautas de exclusión escolar; en ninguno hay material de promoción de la lactancia materna. En 1/12, los docentes habían recibido capacitación sobre el tema en el último año y, en 1/12, había una guía propia para prevención de infecciones. Conclusión. Pese a la disponibilidad de recursos, la implementación de medidas de prevención no se realizó en forma regular y sistemática en los jardines visitados.(AU)

Introduction. Day care center attendance is a risk factor for acquiring respiratory tract infections. There are preventive measures which should be applied. Objectives. To describe the availability of adequate supplies or building facilities, staff habits, behaviors and training, and the existence and enforcement of official guidelines or institutional standards regarding the prevention of respiratory tract infections in day care centers for infants in the city of Buenos Aires. Methods. Exploratory and cross sectional study carried out at systematically selected private day care centers for infants. The person responsible of the day care center was interviewed and a 3-hour observation session was held in a room of each of the day care centers. Information was collected on hand washing practices, clearance of nasal secretions, school exclusion guidance, immunization control, breastfeeding promotion and the existence of guidelines, standards and training on the prevention of respiratory tract infections. Results. Twelve day care centers were included. Though 8 of the 12 centers had the necessary infrastructure and items, hand washing was uncommon and the technique used was incorrect. Clearance of nasal secretions was not followed by hand washing. At 11 of the 12 day care centers, childrens immunization is monitored; at 9 of 12, school exclusion guidelines are not followed; none of the centers have breastfeeding promotion material. In 1 of 12, teachers were trained in the subject the year before and, 1 out of 12 had its own guidelines for infection prevention. Conclusion. Despite the availability of resources, preventive measures were not regularly and systematically implemented in the day care centers visited.(AU)

Prevención de infecciones respiratorias en jardines maternales: recomendaciones y revisión sistemática de la evidencia / Prevention of respiratory infections at day care centers: recommendations and systematic review of the evidence

Introducción. La concurrencia al jardín maternal es un factor de riesgo para contraer infecciones respiratorias. El propósito de este trabajo es revisar cuáles son las medidas de prevención inespecífica que se recomienda tomar en los jardines maternales y cuál es la evidencia de su utilidad en este ámbito. Métodos. Se realizó una búsqueda de recomendaciones de prevención inespecífica de alcance nacional, a través de Google, las páginas web de la Sociedad de Pediatría, los Ministerios de Educación y de Salud de distintos países, en inglés y castellano. Se revisaron recomendaciones sobre higiene de manos, limpieza de secreciones, limpieza del ambiente y de elementos, lactancia materna y exclusión de sujetos sintomáticos. Se realizó una búsqueda bibliográfica sistemática de estudios de intervención en jardines maternales que evaluaran la eficacia de las recomendaciones, publicados en castellano e inglés. Se analizaron los resultados y la calidad metodológica de los estudios. Resultados. Se encontraron siete guías. La higiene de manos y la limpieza del ambiente fueron las únicas recomendaciones que figuran en todas las guías. La exclusión de sujetos sintomáticos se menciona en todas, con heterogeneidad de criterio. El modo de limpieza de secreciones nasales y el fomento de la lactancia materna figuran solo en algunas de las guías. Se encontraron 8 estudios de intervención sobre higiene de manos, del ambiente y limpieza de secreciones, que presentaron resultados heterogéneos e importantes limitaciones metodológicas. Conclusión. La higiene de manos oportuna y adecuada y una apropiada limpieza ambiental son uniformemente recomendadas por distintas guías para la prevención inespecífica de infecciones respiratorias. La evidencia sobre la utilidad de las medidas en este ámbito es limitada.

INTRODUCTION: Attending a day care center is a risk factor for respiratory infections. The objective of this study is to review which nonspecific prevention measures are recommended for day care centers and the evidence of their usefulness in this setting. METHODS: Recommendations regarding nonspecific prevention at national level were searched using Google and the web sites of the Argentine Society of Pediatrics, the ministries of education and the ministries of health from different countries, both in English and Spanish. Recommendations regarding hand hygiene, clearance of secretions, cleaning the environment and elements, breastfeeding, and exclusion of symptomatic subjects were reviewed. A systematic search of the literature was conducted to find intervention studies at day care centers that evaluated the effectiveness of recommendations, published in Spanish and English. Results and the methodological quality of studies were analyzed. RESULTS: Seven guidelines were found. Hand hygiene and environment cleaning were the only recommendations described in all guidelines. The exclusion of symptomatic subjects is mentioned in all, but criteria are heterogeneous. Clearance of nasal secretions and promotion of breastfeeding are outlined only in a few of the guidelines. Eight intervention studies on hand hygiene, cleaning of the environment, and clearance of secretions were found, whose results were heterogeneous and had major methodological limitations. CONCLUSION: A timely and adequate hand hygiene and an appropriate cleaning of the environment have been uniformly recommended by different guidelines as non-specific prevention measures against respiratory infections. The evidence on the usefulness of these measures in this setting is limited.

Ventilación del recién nacido: comparación entre un reanimador con pieza en t y bolsas autoinflables en un simulador de neonato prematuro / Newborn ventilation: comparison between a T-piece resuscitator and self-inflating bags in a neonatal preterm simulator

Administrar ventilación asistida adecuada es la intervención más eficaz durante la reanimación de los recién nacidos en sala de partos. La evidencia sobre cuál es el dispositivo óptimo para suministrar ventilación con presión positiva (VPP) luego del nacimiento es aún limitada. Objetivo. Comparar la precisión en la administración de presión positiva y frecuencia respiratoria en un modelo de reanimación neonatal, con bolsas autoinflables (BAI) de 240 ml y 450 mly un reanimador con pieza en T y evaluar la variabilidad según la experiencia del operador.Población y métodos. 76 profesionales divididos en dos grupos, de acuerdo a su experiencia, realizaron VPP a un simulador neonatal empleando los tres dispositivos de ventilación, con máscara facial y tubo endotraqueal. Utilizaron aleatoriamente cada combinación de dispositivo y la interfaz en dos oportunidades consecutivas. Se realizó análisis de varianza a dos factores paramediciones repetidas.Resultados. Las BAI 240 y 450 fueron similares en la media de la presión inspiratoria máxima (PIM), pero ambas fueron significativamente diferentes(p menor 0,001) con respecto al reanimador con pieza en T, aunque los valores se acercaron a lo solicitado. La frecuencia respiratoria media sobrepasó la indicada con todos los dispositivos (p menor 0,001). Los operadores experimentados, independientemente del dispositivo y de la interfaz utilizados, estuvieron más cerca que los principiantes de la frecuencia respiratoria solicitada. Conclusión. Tanto la pieza en T como las BAI administraron PIM cercanas a las indicadas, independientemente de la experiencia del operador,y con las bolsas se observaron valores superiores.Las BAI y los operadores principiantes se asociaron con una mayor FR. La consistencia intraoperador fue equiparable en las variablesmedidas con todos los dispositivos.(AU)

Ventilación del recién nacido: comparación entre un reanimador con pieza en t y bolsas autoinflables en un simulador de neonato prematuro / Newborn ventilation: comparison between a T-piece resuscitator and self-inflating bags in a neonatal preterm simulator

Administrar ventilación asistida adecuada es la intervención más eficaz durante la reanimación de los recién nacidos en sala de partos. La evidencia sobre cuál es el dispositivo óptimo para suministrar ventilación con presión positiva (VPP) luego del nacimiento es aún limitada. Objetivo. Comparar la precisión en la administración de presión positiva y frecuencia respiratoria en un modelo de reanimación neonatal, con bolsas autoinflables (BAI) de 240 ml y 450 mly un reanimador con pieza en T y evaluar la variabilidad según la experiencia del operador.Población y métodos. 76 profesionales divididos en dos grupos, de acuerdo a su experiencia, realizaron VPP a un simulador neonatal empleando los tres dispositivos de ventilación, con máscara facial y tubo endotraqueal. Utilizaron aleatoriamente cada combinación de dispositivo y la interfaz en dos oportunidades consecutivas. Se realizó análisis de varianza a dos factores paramediciones repetidas.Resultados. Las BAI 240 y 450 fueron similares en la media de la presión inspiratoria máxima (PIM), pero ambas fueron significativamente diferentes(p menor 0,001) con respecto al reanimador con pieza en T, aunque los valores se acercaron a lo solicitado. La frecuencia respiratoria media sobrepasó la indicada con todos los dispositivos (p menor 0,001). Los operadores experimentados, independientemente del dispositivo y de la interfaz utilizados, estuvieron más cerca que los principiantes de la frecuencia respiratoria solicitada. Conclusión. Tanto la pieza en T como las BAI administraron PIM cercanas a las indicadas, independientemente de la experiencia del operador,y con las bolsas se observaron valores superiores.Las BAI y los operadores principiantes se asociaron con una mayor FR. La consistencia intraoperador fue equiparable en las variablesmedidas con todos los dispositivos.(AU)

Ventilación del recién nacido: comparación entre un reanimador con pieza en t y bolsas autoinflables en un simulador de neonato prematuro / Newborn ventilation: comparison between a T-piece resuscitator and self-inflating bags in a neonatal preterm simulator

Administrar ventilación asistida adecuada es la intervención más eficaz durante la reanimación de los recién nacidos en sala de partos. La evidencia sobre cuál es el dispositivo óptimo para suministrar ventilación con presión positiva (VPP) luego del nacimiento es aún limitada. Objetivo. Comparar la precisión en la administración de presión positiva y frecuencia respiratoria en un modelo de reanimación neonatal, con bolsas autoinflables (BAI) de 240 ml y 450 mly un reanimador con pieza en T y evaluar la variabilidad según la experiencia del operador.Población y métodos. 76 profesionales divididos en dos grupos, de acuerdo a su experiencia, realizaron VPP a un simulador neonatal empleando los tres dispositivos de ventilación, con máscara facial y tubo endotraqueal. Utilizaron aleatoriamente cada combinación de dispositivo y la interfaz en dos oportunidades consecutivas. Se realizó análisis de varianza a dos factores paramediciones repetidas.Resultados. Las BAI 240 y 450 fueron similares en la media de la presión inspiratoria máxima (PIM), pero ambas fueron significativamente diferentes(p menor 0,001) con respecto al reanimador con pieza en T, aunque los valores se acercaron a lo solicitado. La frecuencia respiratoria media sobrepasó la indicada con todos los dispositivos (p menor 0,001). Los operadores experimentados, independientemente del dispositivo y de la interfaz utilizados, estuvieron más cerca que los principiantes de la frecuencia respiratoria solicitada. Conclusión. Tanto la pieza en T como las BAI administraron PIM cercanas a las indicadas, independientemente de la experiencia del operador,y con las bolsas se observaron valores superiores.Las BAI y los operadores principiantes se asociaron con una mayor FR. La consistencia intraoperador fue equiparable en las variablesmedidas con todos los dispositivos.

The cysteine-rich region and secreted form of the attachment G glycoprotein of respiratory syncytial virus enhance the cytotoxic T-lymphocyte response despite lacking major histocompatibility complex class I-restricted epitopes.

The cytotoxic T-lymphocyte (CTL) response is important for the control of viral replication during respiratory syncytial virus (RSV) infection. The attachment glycoprotein (G) of RSV does not encode major histocompatibility complex class I-restricted epitopes in BALB/c mice (H-2(d)). Furthermore, studies to date have described an absence of significant CTL activity directed against this protein in humans. Therefore, G previously was not considered necessary for the generation of RSV-specific CTL responses. In this study, we demonstrate that, despite lacking H-2(d)-restricted epitopes, G enhances the generation of an effective CTL response against RSV. Furthermore, we show that this stimulatory effect is independent of virus titers and RSV-induced inflammation; that it is associated primarily with the secreted form of G; and that the effect depends on the cysteine-rich region of G (GCRR), a segment conserved in wild-type isolates worldwide. These findings reveal a novel function for the GCRR with potential implications for the generation of protective cellular responses and vaccine development.