Respiratory syncytial virus infection outbreak among pediatric patients with oncologic diseases and/or BMT

Anak, Sema; Atay, Didem; Ünüvar, Ayşegül; Garipardıç, Mesut; Ağaoğlu, Leyla; Öztürk, Gülyüz; Karakaş, Zeynep; Devecioğlu, Ömer

doi:10.1002/ppul.21184

Cited by 32 publications

(44 citation statements)

References 21 publications

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“…RSV outbreaks among vulnerable hospitalised patients are of particular concern as affected patients are more likely to experience longer hospital stays, with increased risk of morbidity and mortality 4, 7, 8. Numerous hospital outbreaks have been reported in multiple age groups and settings including neonatal intensive care, haematology, transplant and oncology units 9, 10, 11, 12…”

Section: Introductionmentioning

confidence: 99%

Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

French¹,

McKenzie

Coope³

et al. 2016

Influenza Resp Viruses

104

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Respiratory syncytial virus (RSV) causes a significant public health burden, and outbreaks among vulnerable patients in hospital settings are of particular concern. We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control measures. We searched the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, together with key websites, journals and grey literature, to end of 2012. Risk of bias was assessed using the Cochrane risk of bias tool or Newcastle–Ottawa scale. A narrative synthesis was conducted. Forty studies were included (19 addressing research question one, 21 addressing question two). RSV transmission risk varied by hospital setting; 6–56% (median: 28·5%) in neonatal/paediatric settings (n = 14), 6–12% (median: 7%) in adult haematology and transplant units (n = 3), and 30–32% in other adult settings (n = 2). For question two, most studies (n = 13) employed multi‐component interventions (e.g. cohort nursing, personal protective equipment (PPE), isolation), and these were largely reported to be effective in reducing nosocomial transmission. Four studies examined staff PPE; eye protection appeared more effective than gowns and masks. One study reported on RSV prophylaxis for patients (RSV‐Ig/palivizumab); there was no statistical evidence of effectiveness although the sample size was small. Overall, risk of bias for included studies tended to be high. We conclude that RSV transmission risk varies widely during hospital outbreaks. Although multi‐component control strategies appear broadly successful, further research is required to disaggregate the effectiveness of individual components including the potential role of palivizumab prophylaxis.

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Section: Introductionmentioning

confidence: 99%

Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

French¹,

McKenzie

Coope³

et al. 2016

Influenza Resp Viruses

104

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“…Additional therapies, including intravenous immunoglobulin (IVIG), RSV hyperimmunoglobulin, and palivizumab (a monoclonal RSV IgG), have been utilized for RSV infection with mixed efficacy in immunocompromised patients [31,[49][50][51]. Early studies suggested that ribavirin plus RSV-IVIG (RespiGam/MedImmune), a hyperimmune globulin preparation with high concentrations of RSV-neutralizing antibody, conferred a mortality advantage over ribavirin alone in RSV-infected pediatric HSCT patients with LRD; however, RSV-IVIG has since been removed from the market because alternatives now exist to this human plasma-derived product (RespiGam) [52].…”

Section: Prevention and Treatmentmentioning

confidence: 99%

“…However, this recommendation is not strongly supported by the American Academy of Pediatrics [53]. Palivizumab was used as prophylaxis in an adult HSCT unit following an RSV outbreak in which 16 RSV-negative patients received the drug in combination with strict infection control measures, and none acquired the virus [50]. In contrast, a case series of 40 allogeneic HSCT patients infected with RSV received treatment with palivizumab, but this did not seem to have any impact on the progression to LRD or mortality [54].…”

Section: Prevention and Treatmentmentioning

confidence: 99%

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

Neemann

Freifeld

2015

Curr Infect Dis Rep

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Respiratory syncytial virus (RSV), one of the most common causes of respiratory infections in immunocompetent individuals, can cause significant pulmonary morbidity and mortality in hematopoietic stem cell (HSCT) and less often in solid-organ transplant recipients. Early diagnosis and medical intervention prior to the progression from upper to lower respiratory tract viral involvement is essential to positively affect the clinical course. The greatest risk of disease progression from upper to lower respiratory tract disease is during the early posttransplant period for HSCT recipients, with lymphopenia being an important risk factor. Polymerase chain reaction has become the preferred method for rapidly diagnosing infection in this population because of higher sensitivity compared to traditional viral culture and direct viral antigen methods. Despite the lack of prospective randomized trials, retrospective pooled analyses have suggested that systemically delivered ribavirin (either aerosolized, oral, or IV; with or without immunomodulator therapy) can decrease the risk of progression of disease. Additionally, there are a number of clinical trials currently in process to evaluate several new agents that target RSV in the high-risk HSCT patient population.

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“…Consequently, no international consensus has been reached and pediatric patients still remain understudied. In this regard, some studies suggest improved outcomes with the addition of high-dose Ig, 18,19 RSV-IVIG 20 or MoAb (palivizumab) 21 in children undergoing HSCT, but clear evidence of efficacy is lacking. Prophylaxis with palivizumab has been approved by the FDA in prematurity or in bronchopulmonary dysplasia, 22 but is still limited by its high cost.…”

Section: Intravenous Ribavirin In Pediatric Hematopoietic Transplantamentioning

confidence: 99%

“…No RSV-specific gamma globulin or humanized MoAb (palivizumab) was administered. All four LRTI patients showed a favorable clinical response, with 100% survival after a mean follow-up of 17 months (range [13][14][15][16][17][18][19][20][21][22][23][24]. With regard to IVIG, our guideline was not adhered to in two patients with severe LRTI-RSV who did not receive combined therapy with IVIG (episodes 1 and 6).…”

Section: Patient Characteristicsmentioning

confidence: 99%

Intravenous ribavirin for respiratory syncytial viral infections in pediatric hematopoietic SCT recipients

Molinos-Quintana

Soto

Gómez-Rosa

et al. 2012

Bone Marrow Transplant

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A Molinos-Quintana, C Pé rez-de Soto, M Gó mez-Rosa, JA Pé rez-Simó n and JM Pé rez-HurtadoRespiratory syncytial virus (RSV) is a potential cause of serious morbidity and even mortality among children undergoing hematopoietic SCT (HSCT). Contrary to the available information regarding the aerosolized formulation of ribavirin, there is a paucity of published studies using i.v. ribavirin in adults, and very few single reports on pediatric patients. Aerosolized drug administration has been limited by potential toxicity and special air-flow requirements. In this regard, i.v. ribavirin could prevent these disadvantages, but its efficacy and safety remain controversial in the pediatric HSCT setting. The present study describes the outcome of six pediatric patients undergoing HSCT with nine episodes of proven RSV. Four episodes corresponded to lower respiratory tract infection (LRTI) and five presented with upper respiratory tract infection (URTI). All LRTI patients showed favorable clinical responses, with 100% survival and no progression to LRTI in the remaining five URTI. No side effects were documented during ribavirin administration. We conclude that ribavirin was well tolerated intravenously, without associated side effects, and was effective in the treatment of RSV in this limited number of pediatric HSCT patients. The role and efficacy of i.v. ribavirin needs to be further clarified by prospective controlled trials in pediatric populations.

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Respiratory syncytial virus infection outbreak among pediatric patients with oncologic diseases and/or BMT

Cited by 32 publications

References 21 publications

Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

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

Intravenous ribavirin for respiratory syncytial viral infections in pediatric hematopoietic SCT recipients

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