Respiratory Syncytial Viral Infection in Children with Compromised Immune Function

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. (N Engl J Med 1986; 315:77–81.), As the potential for treatment of and prophylaxis against respiratory syncytial virus (RSV) infection increases, it becomes increasingly important to identify the children who should be considered at risk for severe or fatal RSV infection.^{1 2 3} Infants hospitalized with congenital heart disease belong in such a group, and certain premature infants also appear to be at increased risk for complicated RSV infection.^{4 5 6} Whether immunocompromised patients are similarly at risk is not clear. Such patients, especially those with severe combined immunodeficiency diseases, have been noted to have frequent and multiple viral infections, and several case reports have noted severe RSV disease in.