Respiratory Syncytial Viral Infection in Children with Compromised Immune Function

TLDR

The study emphasizes the need to protect immunocompromised children from RSV when hospitalization cannot be avoided. The authors prospectively studied 608 RSV‑infected children ≤5 years, including 47 immunocompromised by chemotherapy, steroids, or primary immunodeficiency, to assess how immune status affects disease severity. Immunocompromised children receiving chemotherapy or with immunodeficiency experienced more severe RSV, higher mortality, and prolonged viral shedding, whereas steroid therapy did not increase severity; these findings suggest that such children are at risk for complicated or fatal RSV and should be considered for antiviral treatment.

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.