Clinical Outcomes of Respiratory Syncytial Virus Infection Among Pediatric Immunocompromised Hosts

Background: Pediatric immunocompromised patients are at an increased risk of severe respiratory syncytial virus (RSV) infection. Here, we aimed to describe the clinical course and outcomes of RSV infection in immunocompromised children.

Methods: This single-center study at St. Jude Children's Research Hospital involved immunocompromised children ≤21 years old with a positive RSV clinical test from 2007 to 2019. Demographic and clinical characteristics, laboratory values, treatment delays for underlying conditions, and outcomes were gathered from electronic medical records. Multivariate models identified risk factors predictive of severe RSV-lower respiratory tract infection (LRTI).

Results: A total of 391 patients, predominantly children over 2 years old (median age: 5), were included in the study. Acute lymphoblastic leukemia (ALL) was the most prevalent underlying disease. Most patients (85.7%) exhibited upper respiratory tract infections, while approximately 6% progressed to LRTIs. Over half of the patients (58.8%) required hospitalization, and one-third experienced modifications or delays in their underlying disease treatment due to RSV infection. Severe RSV infections were observed in 15.9% of patients. All-cause mortality was 2.6%, with 0.7% of deaths attributed to RSV.

Conclusions: One-third of patients experienced a delay in treatment for their underlying disease due to RSV infection, a phenomenon not well understood but potentially significant. Many immunocompromised children with RSV require hospitalization, including those over 2 years old. RSV imposes a significant burden on immunocompromised children of all ages, affecting their cancer treatment plans both directly and indirectly.