Containment of Local COVID-19 Outbreak Among Hematopoietic Stem Cell Transplant Recipients and Healthcare Workers in a Pediatric Stem Cell Unit

Abstract

The pandemic coronavirus SARS-CoV-2 poses unprecedented stress on the hematopoietic cell transplantation (HSCT) centers. Immunological recovery after HSCT is habitually required for infection control [1]. However, the natural history of the SARS-CoV-2 in pediatric patients receiving HSCT is largely unknown. Furthermore, the transplantation units are facing many other challenges related to HSCT planning and the risk of SARS-CoV-2 spread among healthcare personnel. A traceable outbreak of SARS-CoV-2 among healthcare workers at an adult HSCT unit was recently reported affecting five nurses [2]. Few separated case reports of SARS-COV2 were published in children receiving HSCT [3,4]. We report on an outbreak of COVID-19 among healthcare workers and patients at a pediatric HSCT unit, measurements taken for its containment, and the outcome of pediatric HSCT recipients diagnosed with SARS-CoV-2 infection. This is, to our knowledge, the first report of the SARS-CoV-2 outbreak in a pediatric HSCT unit.

Severity of SARS-CoV-2 infection in children with inborn errors of immunity (primary immunodeficiencies): a systematic review

“…Phagocytic diseases were the sixth most-common IEIs in children who experienced COVID-19 (n = 54, 7.6%) [ 19 , 40 , 43 , 46 , 48 , 52 , 53 , 61 – 63 , 65 , 74 , 77 , 81 , 90 , 92 , 95 , 98 , 101 , 107 , 117 , 124 , 127 ] (see Additional file 2 : Table S3). Among them, 26 have chronic granulomatous disease (48.1% of all phagocytic diseases) [ 40 , 43 , 46 , 48 , 53 , 62 , 65 , 74 , 81 , 90 , 92 , 95 , 98 , 124 ], 8 have Shwachman-Diamond syndromes (14.8%) [ 61 , 95 , 101 ], 6 have HAX1 deficiencies (11.1%) [ 74 , 77 , 124 ], 2 have Glycogen storage diseases type 1b (3.7%) [ 62 ], and 2 have Elastase deficiency (3.7%) [ 81 , 127 ].…”

“…Phagocytic diseases were the sixth most-common IEIs in children who experienced COVID-19 (n = 54, 7.6%) [ 19 , 40 , 43 , 46 , 48 , 52 , 53 , 61 – 63 , 65 , 74 , 77 , 81 , 90 , 92 , 95 , 98 , 101 , 107 , 117 , 124 , 127 ] (see Additional file 2 : Table S3). Among them, 26 have chronic granulomatous disease (48.1% of all phagocytic diseases) [ 40 , 43 , 46 , 48 , 53 , 62 , 65 , 74 , 81 , 90 , 92 , 95 , 98 , 124 ], 8 have Shwachman-Diamond syndromes (14.8%) [ 61 , 95 , 101 ], 6 have HAX1 deficiencies (11.1%) [ 74 , 77 , 124 ], 2 have Glycogen storage diseases type 1b (3.7%) [ 62 ], and 2 have Elastase deficiency (3.7%) [ 81 , 127 ]. The remaining 10 patients have JAGN1 deficiency (n = 1) [ 117 ]; poikiloderma with neutropenia (n = 1) [ 107 ]; cystic fibrosis (n = 1) [ 19 ]; leukocyte adhesion deficiency type 3 (n = 1) [ 65 ]; GATA2 deficiency (n = 1) [ 95 ]; undefined leukopenia (n = 1) [ 46 ]; and unspecified phagocytic diseases (n = 4) [ 52 , 63 , 101 , 124 ].…”

“…Among them, 26 have chronic granulomatous disease (48.1% of all phagocytic diseases) [ 40 , 43 , 46 , 48 , 53 , 62 , 65 , 74 , 81 , 90 , 92 , 95 , 98 , 124 ], 8 have Shwachman-Diamond syndromes (14.8%) [ 61 , 95 , 101 ], 6 have HAX1 deficiencies (11.1%) [ 74 , 77 , 124 ], 2 have Glycogen storage diseases type 1b (3.7%) [ 62 ], and 2 have Elastase deficiency (3.7%) [ 81 , 127 ]. The remaining 10 patients have JAGN1 deficiency (n = 1) [ 117 ]; poikiloderma with neutropenia (n = 1) [ 107 ]; cystic fibrosis (n = 1) [ 19 ]; leukocyte adhesion deficiency type 3 (n = 1) [ 65 ]; GATA2 deficiency (n = 1) [ 95 ]; undefined leukopenia (n = 1) [ 46 ]; and unspecified phagocytic diseases (n = 4) [ 52 , 63 , 101 , 124 ]. The most frequent main genetic causes of phagocytic diseases in children infected with SARS-CoV-2 were CYBB (n = 9) [ 40 , 43 , 46 , 90 , 92 , 95 ], HAX1 deficiency (n = 6) [ 74 , 77 , 124 ], SDBS deficiency (n = 5) [ 61 , 101 ], NCF1 (n = 3) [ 62 , 92 ], ELANE (n = 2) [ 81 , 127 ], and SLC37A4 (n = 2) [ 62 ].…”

“…The remaining 10 patients have JAGN1 deficiency (n = 1) [ 117 ]; poikiloderma with neutropenia (n = 1) [ 107 ]; cystic fibrosis (n = 1) [ 19 ]; leukocyte adhesion deficiency type 3 (n = 1) [ 65 ]; GATA2 deficiency (n = 1) [ 95 ]; undefined leukopenia (n = 1) [ 46 ]; and unspecified phagocytic diseases (n = 4) [ 52 , 63 , 101 , 124 ]. The most frequent main genetic causes of phagocytic diseases in children infected with SARS-CoV-2 were CYBB (n = 9) [ 40 , 43 , 46 , 90 , 92 , 95 ], HAX1 deficiency (n = 6) [ 74 , 77 , 124 ], SDBS deficiency (n = 5) [ 61 , 101 ], NCF1 (n = 3) [ 62 , 92 ], ELANE (n = 2) [ 81 , 127 ], and SLC37A4 (n = 2) [ 62 ]. For patients with phagocytic diseases who acquired SARS-CoV-2, the median interquartile range (IQR) age was 96 months [22.5 to 180], with a male predominance [n = 26, 48.1%] [ 19 , 40 , 43 , 46 , 48 , 52 , 53 , 62 , 65 , 74 , 90 , 92 , 95 , 98 , 101 , 107 , 127 ], and majority of the patients belonged to White (Caucasian) (n = 28, 51.8%) [ 43 , 46 , 52 , 61 – 63 , 81 , 95 , 107 , 124 ], Persian (n = 11, 20.4%) [ 19 , 48 , 53 , 74 , 77 ,…”

“…The most frequent main genetic causes of phagocytic diseases in children infected with SARS-CoV-2 were CYBB (n = 9) [ 40 , 43 , 46 , 90 , 92 , 95 ], HAX1 deficiency (n = 6) [ 74 , 77 , 124 ], SDBS deficiency (n = 5) [ 61 , 101 ], NCF1 (n = 3) [ 62 , 92 ], ELANE (n = 2) [ 81 , 127 ], and SLC37A4 (n = 2) [ 62 ]. For patients with phagocytic diseases who acquired SARS-CoV-2, the median interquartile range (IQR) age was 96 months [22.5 to 180], with a male predominance [n = 26, 48.1%] [ 19 , 40 , 43 , 46 , 48 , 52 , 53 , 62 , 65 , 74 , 90 , 92 , 95 , 98 , 101 , 107 , 127 ], and majority of the patients belonged to White (Caucasian) (n = 28, 51.8%) [ 43 , 46 , 52 , 61 – 63 , 81 , 95 , 107 , 124 ], Persian (n = 11, 20.4%) [ 19 , 48 , 53 , 74 , 77 , 98 , 117 ] and Hispanic (n = 9, 16.7%) [ 40 , 65 , 95 ] ethnicity. In those phagocytic diseases patients, few studies reported on specific allele changes (n = 5, 9.2%) [ 62 , 77 , 107 , 124 , 127 ].…”