Clinical Outcomes in Outpatient Respiratory Syncytial Virus Infection in Immunocompromised Children

Helen Y. Chu; Jennifer Chin; Jessica Pollard; Danielle M. Zerr; Janet A. Englund


Influenza Resp Viruses. 2016;10(3):205-210. 

In This Article

Abstract and Introduction


Background Immunocompromised patients are at high risk for morbidity and mortality due to respiratory syncytial virus (RSV) infection. Increasingly, pediatric patients with malignancy or undergoing transplantation are managed primarily as outpatients. Data regarding the clinical presentation and outcomes of RSV in the outpatient pediatric immunocompromised population are limited.

Methods We performed a retrospective cohort study of children with hematologic malignancy or hematopoietic or solid organ transplant with laboratory-confirmed RSV infection diagnosed as outpatients at an academic medical center between 2008 and 2013.

Results Of 54 patients with RSV detected while outpatients, 15 (28%) were hospitalized, 7 (13%) received ribavirin, and one (2%) received intravenous immunoglobulin. One (2%) patient was critically ill, but there were no deaths due to RSV infection. Fever (P < 0·01) was associated with increased risk of hospitalization.

Conclusions Most immunocompromised children with RSV detected while outpatients did not require hospitalization or receive antiviral treatment. Potential studies of RSV therapies should consider inclusion of patients in an ambulatory setting.


Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in US children under 1 year of age.[1–3] Increased morbidity and mortality have been reported in high-risk patients, such as premature infants, infants with cardiac disease, and severely immunocompromised patients.[4–6] Current therapeutic options for the treatment of RSV are limited to ribavirin and/or intravenous immunoglobulin (IVIG).[7,8] New antivirals directed against RSV are under development with efficacy demonstrated in several human challenge studies in adults.[9,10] Increasingly, pediatric patients with malignancy or those undergoing transplantation are managed in the outpatient cancer care setting. Characteristics and clinical outcomes of RSV infection in pediatric immunocompromised outpatients may be different from acutely ill hospitalized inpatients. The objective of our study was to describe the clinical presentation and outcomes of RSV infection in an immunocompromised outpatient pediatric population.