Risk factors and containment of respiratory syncytial virus outbreak in a hematology and transplant unit

Abstract

Respiratory syncytial virus (RSV) usually causes self-limiting upper respiratory tract infections, but can be associated with severe lower respiratory tract infection disease (LRTID) in infants and in patients with hematologic malignancies. We have analyzed the risk factors and the measures for containment within an outbreak of nosocomial RSV infections in a hematology and SCT unit. A total of 56 patients were affected (53 RSV-A and 3 RSV-B) including 32 transplant patients (16 allogeneic and 16 autologous). Forty (71%) of the 56 patients suffered from LRTID and 14 (35%) of the patients with LRTID subsequently died. However, because of concomitant infections with fungal and bacterial pathogens, the impact of RSV on the fatal outcome was difficult to assess. Multivariate analysis showed that low levels of IgG were significantly associated with fatal outcome (P ¼ 0.007), treatment with oral ribavirin represented a protective factor (P ¼ 0.02). An extremely protracted viral shedding was observed in this cohort of patients (median ¼ 30.5 days, range: 1-162 days), especially pronounced in patients after allogeneic transplantation (P ¼ 0.002). Implementation of rigorous isolation and barrier measures, although challenged by long-term viral carriers, was effective in containment of the outbreak.

The European Hematology Association Roadmap for European Hematology Research: a consensus document

“…Community respiratory viruses (CRV): a series of outbreaks have brought CRVs to the attention of clinicians and scientists. 331 CRVs are regarded as an uncommon cause of fever during neutropenia, because they tend to occur seasonally and are difficult to diagnose, but they have not yet been studied systematically. However, the increasing number of reports of fatal CRV infections has illustrated the need for a better understanding of CRV epidemiology.…”

Respiratory Syncytial Virus in Hematopoietic Stem Cell Transplantation and Solid-Organ Transplantation

“…Similarly, in a study of 96 adults with PCR-proven RSV infection, 34 were moderately to severely immunocompromised and received oral ribavirin treatment (600-800 mg twice daily) with or without IVIG (500 mg/kg IV q48 h), the drug was well tolerated, and no RSV-related deaths were seen in the 34 patients described [44]. Likewise, oral ribavirin appeared to have a protective effect against LRD mortality during an outbreak in a hematology and transplant unit (23 vs. 69 %, treated vs. non-treated, respectively; n=56) [46]. In contrast, in a very carefully executed propensity-matched case-control study in 145 hematologic patients with paramyxovirus infections, there was no significant difference in 30-day mortality between those with and without oral ribavirin treatment, suggesting that there may be little value to giving it for RSV or parainfluenza virus infections in those patients [47].…”

Outbreak of respiratory syncytial virus (RSV) infection in immunocompromised adults on a hematology ward

“…The patients in this outbreak had not undergone allogeneic HSCT, which is the setting where outbreaks and high risk of severe disease have mostly been described [Khanna et al, ; Lehners et al, ]. Despite this, the rate of progression to LRTI in the cohort was 38% and two patients (15%) died.…”