Respiratory Tract Infections Due to Human Metapneumovirus in Immunocompromised Children

Chu, Helen Y.; Renaud, Christian; Ficken, Elle; Thomson, Blythe; Kuypers, Jane; Englund, Janet A.

At our institution as well as other transplant centers, all pediatric HSCT recipients are screened by respiratory viral PCR prior to transplant. Pretransplant screening for RSV and delay of transplant in adults is effective in reducing rates of pneumonia [20] . Our policy in pediatric patients is to delay transplant if patients have evidence of infection with RSV, influenza, adenovirus, or hMPV, even if patients are asymptomatic. Transplantation is not generally delayed for asymptomatic shedding of rhinovirus, bocavirus, or coronavirus. This study further enforces the risks associated with transplantation during documented hMPV viral shedding or disease. Because infection may result in such serious disease, potential modalities to treat or at least stabilize patients while white blood cells and/or immune function can return are considered and utilized in these patients. Treatment with IVIG and ribavirin is currently being utilized at our institution for severely immunocompromised individuals [21, 22] . Among the patients who received treatment, we demonstrated a 22% mortality rate as compared to a 2% mortality rate in untreated individuals. This, however, is almost certainly a reflection of clinical decision-making to initiate treatment in individuals with more severe disease.