A multicenter consortium to define the epidemiology and outcomes of inpatient respiratory viral infections in pediatric hematopoietic stem cell transplant recipients

Brian T. Fisher, Lara Danziger-Isakov, Leigh R. Sweet, Flor M. Munoz, Gabriela Maron, Elaine Tuomanen, Alistair Murray, Janet A. Englund, Daniel Dulek, Natasha Halasa, Michael Green, Marian G. Michaels, Rebecca Pellett Madan, Betsy C. Herold, William J. Steinbach

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Background. Respiratory virus infections (RVIs) pose a threat to children undergoing hematopoietic stem cell transplantation (HSCT). In this era of sensitive molecular diagnostics, the incidence and outcome of HSCT recipients who are hospitalized with RVI (H-RVI) are not well described. Methods. A retrospective observational cohort of pediatric HSCT recipients (between January 2010 and June 2013) was assembled from 9 US pediatric transplant centers. Their medical charts were reviewed for H-RVI events within 1 year after their transplant. An H-RVI diagnosis required respiratory signs or symptoms plus viral detection (human rhinovirus/enterovirus, human metapneumovirus, influenza, parainfluenza, coronaviruses, and/or respiratory syncytial virus). The incidence of H-RVI was calculated, and the association of baseline HSCT factors with subsequent pulmonary complications and death was assessed. Results. Among 1560 HSCT recipients, 259 (16.6%) acquired at least 1 H-RVI within 1 year after their transplant. The median age of the patients with an H-RVI was lower than that of patients without an H-RVI (4.8 vs 7.1 years; P < .001). Among the patients with a first H-RVI, 48% required some respiratory support, and 14% suffered significant pulmonary sequelae. The all-cause and attributable case-fatality rates within 3 months of H-RVI onset were 11% and 5.4%, respectively. Multivariate logistic regression revealed that H-RVI onset within 60 days of HSCT, steroid use in the 7 days before H-RVI onset, and the need for respiratory support at H-RVI onset were associated with subsequent morbidity or death. Conclusion. Results of this multicenter cohort study suggest that H-RVIs are relatively common in pediatric HSCT recipients and contribute to significant morbidity and death. These data should help inform interventional studies specific to each viral pathogen.

Original languageEnglish (US)
Pages (from-to)275-282
Number of pages8
JournalJournal of the Pediatric Infectious Diseases Society
Volume7
Issue number4
DOIs
StatePublished - 2018

Keywords

  • Hematopoietic stem cell transplantation
  • Pediatrics
  • Respiratory viral infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases

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    Fisher, B. T., Danziger-Isakov, L., Sweet, L. R., Munoz, F. M., Maron, G., Tuomanen, E., Murray, A., Englund, J. A., Dulek, D., Halasa, N., Green, M., Michaels, M. G., Madan, R. P., Herold, B. C., & Steinbach, W. J. (2018). A multicenter consortium to define the epidemiology and outcomes of inpatient respiratory viral infections in pediatric hematopoietic stem cell transplant recipients. Journal of the Pediatric Infectious Diseases Society, 7(4), 275-282. https://doi.org/10.1093/jpids/pix051