Respiratory syncytial virus in hematopoietic cell transplant recipients and patients with hematologic malignancies

Khawaja, Fareed; Chemaly, Roy F.

The prevention of RSV in HM patients and HCT recipients is limited to infection control measures and interventions. There are many reports of outbreaks in these popu-lations of patients, [13] [14] [15] [16] [17] [18] 101, 102 and the emphasis has been on multifaceted interventions, including compliance with hand hygiene, contact precautions with gowns and the use of gloves, screening visitors and healthcare workers for respiratory symptoms and restricting visitors and healthcare workers if they are symptomatic, grouping RSV-infected patients together, and sometimes screening asymptomatic patients in the same treatment areas. These interventions have been shown to be effective in mixed adult and pediatric patients. 19, 103, 104 At our institution, we place all patients diagnosed with respiratory viral infections on contact and droplet precautions. 105 Interestingly, the use of chemoprophylaxis with palivizumab was described during an outbreak 15 in patients who were at high risk of acquiring RSV infections in a bone marrow transplant ward. Sixteen asymptomatic patients were given one prophylactic dose of palivizumab during the outbreak, and none developed an RSV infection. These results warrant further investigation into the use of palivizumab in an outbreak; however, no definite recommendation can be made at this time. Finally, an RSV vaccine for children or adults is not available at present. Multiple trials in children and healthy adults are in progress (www: ClinicalTrials.gov). Whether immunization for RSV would be beneficial in immunocompromised patients is uncertain.