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RSV-related infections in immunocompromised children resulted in poor outcomes
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Immunocompromised children with respiratory syncytial virus-related infections have an increased risk of poor outcomes, including mortality, according to recent study findings published in The Pediatric Infectious Disease Journal.
“While mortality rates in healthy infants with RSV pneumonia are less than 0.5%, they can reach up to 60% in untreated immunocompromised children,” researchers wrote.
The retrospective-cohort study included 117 RSV-positive immunocompromised pediatric inpatients. Researchers evaluated community-acquired RSV (CA-RSV) infections and their outcomes compared with nosocomial RSV (N-RSV) infections.
They found that 35.9% of participants presented with N-RSV infection. More than one-third of participants also had a lower respiratory tract infection; of those, 28% were admitted to the ICU, and there was a 5% mortality rate. Participants who died were all diagnosed with CA-RSV lower respiratory tract infection at hospital admission, and RSV was still detectable after death from respiratory samples or post-mortem lung biopsy.
There was advanced evidence of lower tract disease with respiratory distress in participants with CA-RSV (OR=2.5; 95% CI, 1.1-5.6) compared with those with N-RSV. Participants with CA-RSV were also less likely to have prolonged hospital admission (OR=0.7; 95% CI, 0.5-0.8).
“Differences in mortality rates among those with CA-RSV compared with N-RSV warrant further study, with enhanced opportunities for prevention and early detection of infection,” researchers wrote.
Disclosure: The study was funded in part by Abbott Laboratories, Canada, and the division of infectious diseases at the Hospital for Sick Children, Toronto.
Perspective
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H. Cody Meissner, MD
Several important points are raised by this article. First, the report reminds us of the risk of nosocomial RSV disease on the pediatric ward. Respiratory viruses are spread by 3 major routes: small particle aerosols (diameter <10 microns), large particle droplet aerosols (diameter >10 microns) and by fomites followed by self inoculation. Effective infection control practices must address each potential route. Second, RSV infection whether nosocomial or community acquired may result in severe disease in an immunocompromised child. In this series, 5 of 117 (4.3%) immunocompromised children died of complications of RSV lower tract disease. A fatal outcome in a non-compromised child due to RSV infection has become a rare event (<250 deaths/yr in children < 5years of age) in the United States.
The risk of a poor outcome correlates inversely with a falling lymphocyte count, so particularly when RSV is circulating in the community, infection control procedures must be followed meticulously. Third, the report reminds us of the critical need for effective antiviral therapy in the treatment of RSV respiratory infection. Some uncontrolled observations suggest that early treatment of RSV infection in a compromised host with aerosolized ribavirin and either hyperimmune globulin or a specific RSV monoclonal antibody may prevent progression of disease. Although this therapy is sometimes used in this population, no definitive evidence of benefit is available. RSV monoclonal antibody has been demonstrated to have no beneficial effect on treatment of RSV infection in a normal child or adult.
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