Viral infections in paediatric patients receiving conventional cancer chemotherapy

Global Immunization Crisis Amid the COVID-19 Pandemic: Implications for Pediatric Oncology

Declining herd immunity and severe manifestation of vaccine preventable infections underscores the need for vaccinations campaigns to urgently vaccinate children who missed their routine immunizations.

A prospective study on the epidemiology and clinical significance of viral respiratory infections among pediatric oncology patients

Respiratory infections in oncology are both common and potentially severe. However, there is still a gap in the literature, regarding the epidemiology of viral respiratory infections in children with cancer. We prospectively enrolled 224 patients, from September 2012 to August 2015. The cohort included children with hematologic or solid malignancies receiving chemotherapy, or undergoing hemopoietic stem cell transplantation, outpatients/inpatients exhibiting signs/symptoms of febrile/afebrile upper/lower respiratory infection. Viral infection was diagnosed by detection of ≥1 viruses from a sample at time of enrollment, using the CLART^® PneumoVir kit (GENOMICA, Spain). Α detailed questionnaire including demographics and medical history was also completed. Samples were processed in batches, results were communicated as soon as they became available. Children recruited in whom no virus was detected composed the no virus detected group. Viral prevalence was 38.4% in children presenting with respiratory illness. A single virus was found in 30.4%, with RSV being the most frequent. Viral coinfections were detected in 8%. Children with viral infection were more likely to be febrile upon enrollment and to present with lower respiratory signs/symptoms. They had longer duration of illness and they were more likely to receive antibiotics/antifungals. Only 22% of children with influenza received oseltamivir. Mortality was low (2.7%), however, pediatric intensive care unit (PICU) admission and death were correlated with virus detection. In our study mortality was low and PICU admission was related to virus identification. Further research is needed to clarify whether antibiotics in virus-proven infection are of value and underline the importance of oseltamivir's timely administration in influenza.

Viral surveillance using PCR during treatment of AML and ALL

BACKGROUND

While viral surveillance of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and adenovirus using PCR is routine in patients undergoing hematopoetic stem cell transplant and solid organ transplant, the utility in the nontransplant pediatric leukemia population is unknown. Our institution screens patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) for viral DNAemia by PCR as part of clinical care.

PROCEDURE

This retrospective chart review included patients treated for newly diagnosed or relapsed AML or ALL between April 2010 and September 2014. We retrieved data for viral PCR screening, detection and quantification, duration of positivity, and prophylaxis or treatment.

RESULTS

One hundred eleven patients were included in analyses. Forty (36.0%) had at least one blood PCR positive for EBV, CMV, or adenovirus. Patients with ALL had significantly higher rates of persistent viral detection and treatment than those with AML (P < 0.02, P < 0.01, respectively). International patients had significantly higher rates of viral detection (P < 0.01), persistence (P < 0.01), any treatment (P < 0.03), and antiviral treatment (P < 0.01); 16.9% of patients who received intravenous immunoglobulin (IVIG) prophylactically had viral detection compared to 63% of patients who did not receive prophylactic IVIG (P = 0.0008).

CONCLUSIONS

Patients with ALL were more susceptible than those with AML to viral reactivation that was persistent or resulted in treatment. Patients with relapsed ALL, refractory ALL, or infantile ALL are most likely to benefit from asymptomatic screening for CMV and adenovirus. International patients are at higher risk for reactivation and may merit screening. EBV reactivation was not significant and does not warrant screening.

Neutropenia Precautions for Children Receiving Chemotherapy or Stem Cell Transplantation for Cancer

Infections in children and adolescents with cancer are a significant cause of morbidity and mortality, especially in those receiving chemotherapy who are neutropenic and/or immunocompromised. The aim of this article is to review existing evidence in order to provide a practice recommendation to prevent or minimize infections in neutropenic and/or immunocompromised patients receiving chemotherapy and/or stem cell transplant. Systematic reviews were undertaken and research was graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A variety of interventions are implemented to reduce infections in the neutropenic and/or immunocompromised population; however, few are supported by research evidence. Existing literature should continue to be reviewed to further identify interventions that can influence positive patient outcomes and provide opportunities for individuals in the medical field to work together to improve clinical care.

Nasopharyngeal detection of respiratory viruses in febrile neutropenic children

BACKGROUND

Although fever is common in neutropenic children, a microbiological etiology is determined in only 15% to 30% of cases. The authors investigated the frequency of respiratory virus detection in the upper airways of febrile neutropenic children with negative bacterial cultures.

METHODS

This is a 3-year prospective study of children younger than 19 years, hospitalized with febrile neutropenia and negative bacterial cultures. Respiratory samples were obtained for amplification of viral nucleic acids via Luminex xTAG technology.

RESULTS

There were 50 febrile neutropenic episodes among 42 patients. Respiratory viruses were detected in 26 (52%) febrile episodes. A single virus was detected in 22 febrile episodes; multiple viruses were detected in the remaining 4. Rhinovirus/Enterovirus was most frequently detected.

CONCLUSION

Respiratory viruses were detected frequently in nasopharyngeal samples from febrile neutropenic patients with negative bacterial cultures, thus providing an impetus to determine the relationship between virus detection, infection, and pathology in this unique patient population.

Epidemiology and potential preventative measures for viral infections in children with malignancy and those undergoing hematopoietic cell transplantation

In pediatric patients with malignancy and those receiving hematopoietic stem cell transplants, bacterial and fungal infections have been the focus of fever and neutropenia episodes for decades. However, improved diagnostic capabilities have revealed viral pathogens as a significant cause of morbidity and mortality. Because of limited effective antiviral therapies, prevention of viral infections is paramount. Pre-exposure and post-exposure prophylaxis and antiviral suppressive therapeutic approaches are reviewed. Additionally, infection control practices specific to this patient population are discussed. A comprehensive approach utilizing each of these can be effective at reducing the negative impact of viral infections.

Sapovirus as a gastrointestinal pathogen in febrile pediatric patients with cancer

Human caliciviruses are the second most common cause of viral gastroenteritis after rotavirus in children. Unlike norovirus, sapovirus infection is less well characterized and defined in the clinical setting of gastrointestinal disease, and there are no reports of sapovirus infections in pediatric oncology patients receiving chemotherapy treatment. Stool samples from all pediatric oncology patients presenting with fever and diarrhea at one pediatric oncology unit were tested prospectively for sapovirus by real-time reverse transcription-PCR sapovirus genogrouping was performed by nested PCR. Sapovirus was detected in 2 of 100 stool specimens prospectively sampled from 58 symptomatic pediatric oncology inpatients between December 2008 and September 2009. Both patients received low-dose chemotherapy for their underlying conditions at the time of infection with sapovirus. Genogrouping of the viruses showed the presence of a GI.1 strain and GII.3 strain, unlike the most common GI.2 strain responsible for outbreaks in different European countries. The contribution of sapovirus infection to the morbidity of pediatric cancer patients and its potential for nosocomial spread is discussed. Sapovirus, an often unrecognized pathogen, should be considered along with other viruses in pediatric cancer patients suffering from gastrointestinal disease.

Impact of influenza-like illness and effectiveness of influenza vaccination in oncohematological children who have completed cancer therapy

In order to evaluate the impact of influenza-like illness and the effectiveness of influenza vaccination in children with oncohematological disease who have completed cancer therapy, 182 children with a diagnosis of oncohematological disease were divided into two subgroups on the basis of the length of time off therapy (<6 months or 6-24 months) and randomised 1:1 to receive influenza vaccination or not. The controls were 91 otherwise healthy children unvaccinated against influenza. The results show that the clinical and socioeconomic impact of influenza-like illnesses and the effectiveness of influenza vaccination in oncohematological children who have completed cancer therapy are related to the length of the off therapy period, and seem to be significantly greater in those who have been off therapy for less than 6 months in comparison with healthy controls. This suggests that the administration of influenza vaccination should be strongly recommended only among oncohematological children who have been off therapy for less than 6 months.