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Influenza-associated morbidity in children with cancer

Authors

  • Sarah K. Tasian MD,

    Corresponding author
    1. Department of Pediatrics, University of Washington and Children's Hospital & Regional Medical Center, Seattle, Washington 98105
    • Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of California, San Francisco, 505 Parnassus Avenue, M649, San Francisco, CA 94143.
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  • Julie R. Park MD,

    1. Department of Pediatrics, University of Washington and Children's Hospital & Regional Medical Center, Seattle, Washington 98105
    2. Division of Pediatric Hematology-Oncology, University of Washington and Children's Hospital & Regional Medical Center, Seattle, Washington
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  • Emily T. Martin MPH,

    1. Division of Pediatric Infectious Diseases, Immunology, and Rheumatology, University of Washington and Children's Hospital & Regional Medical Center, Seattle, Washington
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  • Janet A. Englund MD

    1. Department of Pediatrics, University of Washington and Children's Hospital & Regional Medical Center, Seattle, Washington 98105
    2. Division of Pediatric Infectious Diseases, Immunology, and Rheumatology, University of Washington and Children's Hospital & Regional Medical Center, Seattle, Washington
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  • Disclosure: The authors have no relevant conflicts of interest to disclose.

Abstract

Background

The clinical impact of influenza in children undergoing therapy for cancer is not well-described in the literature.

Procedure

Laboratory-documented influenza infection in pediatric oncology patients cared for in a single regional pediatric medical center between July 2000 and June 2005 was identified by review of medical and laboratory records.

Results

Twenty-seven clinical encounters were identified in 24 pediatric oncology patients with influenza infection. Eighty-three percent of patients were receiving chemotherapy for hematologic or solid malignancies. Two-thirds of patients were hospitalized for a median duration of 7.4 days; 40% of patients experienced a delay in scheduled chemotherapy as result of influenza infection. Most children (67%) were not neutropenic, although 63% were lymphopenic. Importantly, 15% of children with influenza had simultaneously diagnosed bacteremia. Concomitant pathogens included Pseudomonas aeruginosa, Enterobacter cloacae, Enterococcus faecalis, and coagulase-negative Staphylococcus. Primary influenza pneumonia and/or respiratory failure occurred in three children, and ventilatory support was required in four clinical encounters. Antiviral medications were administered to 63% of patients within 2 days of influenza diagnosis.

Conclusion

Pediatric oncology patients experienced significant influenza-associated morbidities. Influenza infection should be considered in febrile children with respiratory symptoms during the respiratory viral season, as well as concurrent bacterial or fungal infections. Pediatr Blood Cancer 2008;50:983–987. © 2008 Wiley-Liss, Inc.

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