1195. Epidemiology of Respiratory Viral Infections in Pediatric Solid Organ Transplant or Hematopoietic Stem Cell Transplant Recipients
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Background: Since the advent of molecular diagnostics, there are limited epidemiologic data for respiratory viral infections (RVI) in pediatric solid organ (SOT) or hematopoietic stem cell transplant (HSCT) recipients.  This study aimed to describe the epidemiology of RVI and all-cause mortality 3 months following the onset of RVI in this high-risk pediatric population.

Methods: Multi-center retrospective cohort study of patients 0 to <18 years undergoing a SOT or HSCT between January 1st, 2010 - June 30th, 2013. Inpatient records were reviewed for up to 365 days post-transplant, until death or re-transplant to identify RVI. RVI was defined as a positive PCR for a viral respiratory pathogen with physician documentation of respiratory symptoms.  Patients with an RVI were followed for 3-months to determine outcome. 

Results: A cohort of 2,367 pediatric SOT and HSCT recipients (median age 6.4 yrs; range 6 days to 18 years) was identified. 382 inpatient RVI episodes were diagnosed in 341 (14.4%) patients (Table) with similar RVI rates in SOT and HSCT patients (15.6% vs. 17.5%, p-value=0.2).  RVI onset occurred a median of 74 days (IQR: 12 to 180) after transplant. Among the 382 RVI episodes, 425 respiratory viruses were detected by PCR. Rhinovirus/picornavirus was most commonly detected (51%), followed by RSV (17%), parainfluenza 1/2/3/4 (17%), Influenza A/B (10%), human metapneumovirus (8%), and coronavirus (2%). The all-cause mortality within 3-months of RVI onset was 7.3%. 

Table. Distribution of RVI by Type of Transplantation

Transplant Type                     (N)

Patients with at least one RVI

3-Month All-cause Mortality

n, (%)

n (%)

All transplants

382

(16%)

28

(7%)

(2,367)

 

 

 

 

SOT (1098):

 

 

 

 

 

Lung (68)

11

(3%)

0

(0%)

 

Heart (249)

46

(12%)

0

(0%)

 

Liver(454)

71

(19%)

0

(0%)

 

Kidney (285)

16

(4%)

0

(0%)

 

Intestine (20)

6

(2%)

3

(50%)

 

Liver/intestine (5)

4

(1%)

1

(25%)

 

Heart/lung (2)

1

(0%)

1

(100%)

 

Other multi-visceral (15)

5

(1%)

1

(20%)

HSCT (1260):

 

 

 

 

 

Auto (351)

49

(13%)

5

(10%)

 

Allo  (909)

172

(19%)

17

(10%)

Conclusion: This is the largest study of RVI in pediatric SOT and HSCT patients.  Inpatient RVI is a common occurrence in the first year following HSCT or SOT, with 7% of patients dying within 3-months of RVI onset. Future investigation is warranted to define mortality attributable to RVI, to better establish the morbidity of RVI, and to identify interventions to reduce RVI.

Brian T. Fisher, DO, MSCE1, Lara Danziger-Isakov, MD, MPH2, Janet Englund, MD, FIDSA3, Alistair Murray, BA3, Gabriela Maron, MD4, Elaine Tuomanen, MD5, Flor Munoz, MD6, Leigh Sweet, MD7, Michael Green, MD, MPH, FIDSA8, Marian Michaels, MD, MPH9, Natasha Halasa, MD, MPH, FPIDS10, Daniel Dulek, MD11, Betsy C. Herold, MD, FIDSA, FPIDS12, Rebecca Pellett Madan, MD, MS13, Jerica Gee, BFA14, Ava Brozovich, MPH15 and William Steinbach, MD, FAAP, FIDSA, FPIDS16, (1)Division of Infectious Diseases, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Center for Clinical Epidemiology and Biostatistics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (2)Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (3)Seattle Children's Hospital, Seattle, WA, (4)Hosp. Natl. de Ninos Benjamin Bloom, Memphis, TN, (5)St. Jude Children's Research Hospital, Memphis, TN, (6)Baylor College of Medicine, Texas Children's Hospital, Houston, TX, (7)Baylor College of Medicine, Houston, TX, (8)Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, (9)Children's Hospital of Pittsburgh, Pittsburgh, PA, (10)School of Medicine, Vanderbilt University, Nashville, TN, (11)Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical School, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, (12)Department of Pediatrics; Division of Infectious Diseases, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, (13)Albert Einstein College of Medicine, Bronx, NY, (14)The Children's Hospital of Philadelphia, Philadelphia, PA, (15)Duke Children's Hospital, Durham, NC, (16)Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC

Disclosures:

B. T. Fisher, Pfizer: Grant Investigator , Research grant
Merck: Grant Investigator , Research grant

L. Danziger-Isakov, None

J. Englund, None

A. Murray, None

G. Maron, None

E. Tuomanen, None

F. Munoz, None

L. Sweet, None

M. Green, Bristol Myers Squibb: Consultant , Consulting fee
Chiimerix: Consultant , Consulting fee

M. Michaels, None

N. Halasa, AstraZeneca: Grant Investigator , Grant recipient
Sanofi Pasteur: Grant Investigator , Grant recipient
Pfizer: Grant Investigator , Grant recipient
Gilead: Grant Investigator , Grant recipient

D. Dulek, None

B. C. Herold, None

R. Pellett Madan, None

J. Gee, None

A. Brozovich, None

W. Steinbach, Astellas: Grant Investigator and Scientific Advisor , Consulting fee and Research grant
Merck: Scientific Advisor , Consulting fee

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