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Respiratory syncytial viral infection in children with compromised immune function
Insights
Children with cancer or immunodeficiency face severe respiratory syncytial virus (RSV) infections. Hospitalized immunocompromised children, especially those on chemotherapy, require protection against severe RSV disease.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Respiratory syncytial virus (RSV) is a common cause of respiratory illness in infants and young children.
- The impact of compromised immune status on RSV infection severity and outcomes in young children is not fully understood.
Purpose of the Study:
- To evaluate the relationship between immune status and the severity of respiratory syncytial virus (RSV) infection in hospitalized children.
- To identify risk factors for severe RSV disease among immunocompromised children.
Main Methods:
- Prospective study of 608 children aged five years or younger hospitalized with RSV over 10 winters.
- Comparison of clinical outcomes, including pneumonia and mortality, between immunocompromised and immunocompetent children.
- Assessment of viral shedding duration in relation to immune status and treatments.
Main Results:
- Immunocompromised children, particularly those receiving chemotherapy for cancer or with primary immunodeficiency, experienced more severe RSV disease, including pneumonia and higher mortality.
- Children on long-term steroid therapy showed prolonged viral shedding but not necessarily more severe clinical manifestations.
- Over half of immunocompromised children acquired RSV nosocomially (in the hospital).
Conclusions:
- Children receiving chemotherapy for cancer and those with immunodeficiency disease are at high risk for complicated or fatal RSV infections.
- Antiviral therapies and preventative measures are crucial for protecting immunocompromised children against RSV, especially in hospital settings.
Abstract:
For 10 winters, 608 children five years old or younger who were hospitalized with respiratory syncytial virus (RSV) infection were prospectively studied to evaluate the relation between their immune status and the severity of their infection. Forty-seven had been immunocompromised by chemotherapy, steroid therapy, or a primary immunodeficiency disorder. Among the immunocompromised children, those receiving chemotherapy for cancer and those with immunodeficiency disease had more severe RSV disease, with pneumonia occurring at all ages, and a higher mortality rate. Children receiving long-term steroid therapy did not appear to have more severe clinical manifestations than normal children. Viral shedding, however, was significantly greater and more prolonged in the children receiving steroid therapy, and particularly in those receiving chemotherapy or with an immunodeficiency disease. Giant-cell pneumonia was documented in one child with leukemia. Over half the immunocompromised children acquired the RSV infection nosocomially. These findings indicate that children receiving chemotherapy for cancer and those with immunodeficiency disease are at risk for complicated or fatal infections from RSV and should be considered for antiviral and other therapies as they become available. Efforts should also be made to protect compromised children if hospitalization cannot be avoided.