Respiratory Syncytial Virus Infections in Children With Cancer

Abstract

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections (LRTIs) in children, especially those with cancer. Data on RSV infections in this vulnerable population is limited. We conducted a retrospective study of all RSV infections in children with cancer from 1998 to 2009 to determine characteristics and outcomes of these infections, identify risk factors for LRTI and mortality, and the effect of antiviral therapy on these outcomes. We identified 59 patients with a median age of 5 years; 53% had hematologic malignancy, 32% were hematopoietic stem cell transplant recipients, 39% had received corticosteroids, and 76% cytotoxic chemotherapy within 1 month before RSV infection. LRTI developed in 22 (37%) patients with a trend of higher rate in males (odds ratio=2.57 [0.86-7.62], P=0.09) and children with lymphocytopenia (odds ratio=2.95 [0.86-10.12], P=0.085). No significant differences were observed in the rates of progression to LRTI (3/10 [30%] vs. 19/49 [39%], P=0.729) and RSV-associated mortality (0/10 [0%] vs. 3/49 [6%], P=0.422) for patients receiving antiviral therapy at upper respiratory tract infection stage compared with those who did not. However, patients with LRTI had significantly better outcomes when treated with aerosolized ribavirin plus immunomodulators (mainly palivizumab) when compared with aerosolized ribavirin alone (mortality rates: 0/6 [0%] vs. 3/4 [75%], P=0.03). Ribavirin did not show any benefit in reducing LRTI or mortality; however, addition of palivizumab to the treatment regimen may be potentially beneficial, especially for children with LRTI.

Defining the Incidence and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Children with Chronic Diseases

“…For example, a Spanish study by Mendoza Sánchez et al [ 17 ] retrospectively reviewed respiratory viral infections in children aged ≤14 years and found rates of RSV infection were twice as high in patients with HIV than those receiving chemotherapy for cancer (101 vs. 46 per 1000, respectively). For patients undergoing HSCT or SOT, RSV infections typically occur within the first 2 years following transplant [ 35 , 37 ]. Increased disease severity has been associated with prolonged shedding of RSV and with higher viral loads maintained for longer periods [ 56 ].…”

“…Outbreaks of RSV have been reported to occur in cancer care outpatient departments where many pediatric patients with malignancy or those undergoing transplantation are managed [ 33 , 50 , 57 ]. In a retrospective study of all RSV infections in children with cancer from 1998 to 2009 at the MD Anderson Cancer Centre in Texas, Chemaly et al [ 37 ] found that, whilst the majority of cases (43/59; 73%) were community-acquired, over one-quarter (27%) were nosocomial. Since many HSCT and SOT recipients and children with malignancies are frequently seen in clinics, this could explain in part the high rates of RSV infection reported among this patient group.…”

“…Progression from a generally self-limiting upper respiratory tract infection (URTI) to a more severe LRTI has been shown to occur in 18–28% of RSV-infected, immune-compromised patients [ 20 , 37 , 59 ]. Kim et al [ 59 ] in the US (Seattle, WA) retrospectively evaluated 181 HSCT recipients (median age 40 years; 6 children aged <2 years of age, 20 children aged 2–14 years) who presented with a RSV URTI.…”

Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection

“…54 Among 57 patients, 37% experienced progression to lower respiratory tract disease. Three patients died of respiratory failure within 60 days of RSV diagnosis (1 had concomitant bacteremia and fungemia and 1 had concomitant herpes simplex pneumonia).…”

Molecular characteristics and successful management of a respiratory syncytial virus outbreak among pediatric patients with hemato-oncological disease

“…Patients with hemato-oncological disease are at risk for severe RSV-caused infection -especially in the context of hematopoietic stem cell transplantation (HSCT) [6,7]. In the literature varying RSV-related case fatality rates are reported in children with cancer to range from 5% to 33% [8][9][10].…”