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Klin Padiatr 2023; 235(03): 159-166
DOI: 10.1055/a-2000-5388
Original Article

Impact of COVID-19 Related Restrictions on Infections in Children with Cancer or after Hematopoietic SCT

A Monocentric, Retrospective StudyEinfluss von COVID-19-bezogenen Restriktionen auf Infektionen von Kindern mit Krebs oder nach SZTEine monozentrische, retrospektive Studie
Richard Hauch    *
1   Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
2   Research Institute Children’s Cancer Center, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Malena Hinrichs   *
1   Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
,
Rebecca Ruhwald
3   Medical controlling, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Johanna Schrum
4   Department of Pediatric Hematology and Oncology, Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
,
Stefan Rutkowski
1   Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
,
Wilhelm Woessmann
1   Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
,
Beate Winkler
1   Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
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Correction: Impact of COVID-19 Related Restrictions on Infections in Children with Cancer or after Hematopoietic SCTKlin Padiatr 2023; 235(03): e1-e2
DOI: 10.1055/a-2059-1033

Abstract

Background Infections are a major concern for immunocompromised children. We investigated whether non-pharmaceutical interventions (NPIs) implemented in the general population during the coronavirus disease 2019 (COVID-19) pandemic in Germany had an impact on frequency, type and severity of infections in these patients.

Patients and methods We analyzed all admissions to the clinic of pediatric hematology, oncology and stem cell transplantation (SCT) with (suspected) infection or fever of unknown origin (FUO) from 2018 to 2021.

Results We compared a 27-month period before NPIs (Pre-COVID: 01/2018–03/2020; 1041 cases) with a 12-month period with underlying NPIs (COVID: 04/2020–03/2021; 420 cases). During the COVID period the number of in-patient stays with FUO or infections decreased (38,6 cases/month vs. 35,0 cases/month), the median duration of hospital stays was longer (8 d (CI95: 7–8 d) vs. 9 d (CI95: 8–10 d) P=0,02)), the mean number of antibiotics per case increased (2,1 (CI95: 2,0–2,2) vs. 2,5 (CI95: 2,3–2,7); P=0,003)) and a substantial reduction of viral respiratory and gastrointestinal infections per case was seen (0,24 vs. 0,13; P<0,001). Notably, there was no detection of respiratory syncytial virus, influenza and norovirus, between May 2020 and March 2021. Based on need of intensive care measures and further parameters we conclude that severe (bacterial) infections were not significantly reduced by NPIs.

Conclusions Introduction of NPIs in the general population during the COVID-pandemic substantially reduced viral respiratory and gastrointestinal infections in immunocompromised patients, while severe (bacterial) infections were not prevented.

Zusammenfassung

Hintergründe Immunsupprimierte Kinder sind in besonderem Maße durch Infektionen gefährdet. In dieser Studie wurde untersucht, ob die im Rahmen der COVID-19 Pandemie in Deutschland etablierten NPIs Auswirkungen auf die Häufigkeit, Art und Schwere von Infektionen dieser Patienten hatten.

Patienten und Methoden Es wurden alle Aufenthalte aufgrund von (vermuteter) Infektion in der Klinik für pädiatrische Hämatologie, Onkologie und Stammzelltransplantation zwischen 2018 und 2021 analysiert.

Ergebnisse Wir verglichen eine 27-monatige Periode vor NPIs (Pre-COVID: 01/2018–03/2020; 1041 Fälle) mit einer 12-monatigen Periode unter geltenden NPIs (COVID: 04/2020–03/2021; 420 Fälle). Während der COVID Periode sank die Zahl von Aufenthalten aufgrund von FUO oder Infektionen (38,6 Fälle/Monat vs. 35,0 Fälle/Monat), die mediane Falldauer war länger (8 d (CI95: 7–8 d) vs. 9 d (CI95: 8–10 d) P=0,02)), es wurden pro Fall mehr Antibiotika verabreicht (2,1 (CI95: 2,0–2,2) vs. 2,5 (CI95: 2,3–2,7); P=0,003)) und es zeigte sich eine deutliche Reduktion von viralen respiratorischen und gastrointestinalen Infektionen pro Fall (0,24 vs. 0,13; P<0,001). Interessanterweise konnte keine einzige Infektion mit RSV, Influenzaviren oder Noroviren von Mai 2020 bis März 2021 nachgewiesen werden. Basierend auf der Rate notwendiger intensivmedizinischer Maßnahmen und weiteren Parametern konnte keine signifikante Reduktion schwerer (bakterieller) Infektionen unter NPIs gezeigt werden.

Fazit Durch NPIs in der Bevölkerung wurden virale respiratorische und gastrointestinale Infektionen in der Kohorte immunsupprimierter Kinder deutlich reduziert. Schwere (bakterielle) Infektionen wurden jedoch nicht verhindert.

Key words

COVID-19 - pediatric oncology and hematology - pediatric stem-cell transplantation - immunosuppression - infections

Schlüsselwörter

COVID-19 - Pädiatrische Hämatologie und Onkologie - Pädiatrische Stammzelltransplantation - Immunsuppression - Infektionen

* contributed equally to this work as shared first authors


Supplemental Material



Publication History

Article published online:
27 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
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  • References

  • 1 Bailey LC, Reilly AF, Rheingold SR. Infections in pediatric patients with hematologic malignancies. Semin Hematol 2009; 46: 313-324
    CrossrefPubMedSearch in Google Scholar
  • 2 Buda S DrR, Biere B, Buchholz U, Tolksdorf K, Schilling J, Goerlitz L, Streib V, Preuß U, Prahm K, Haas W und die AGI-Studiengruppe. ARE-Wochenbericht KW 40/2021. Arbeitsgemeinschaft Influenza – Robert Koch-Institut 2021. 10.25646/9127
    PubMed
  • 3 Dorantes-Acosta E, Ávila-Montiel D, Klünder-Klünder M. et al. Survival and Complications in Pediatric Patients With Cancer and COVID-19: A Meta-Analysis. Front Oncol 2020; 10: 608282
    CrossrefPubMedSearch in Google Scholar
  • 4 Dror T, Akerman M, Noor A. et al. Seasonal variation of respiratory viral infections: a comparative study between children with cancer undergoing chemotherapy and children without cancer. Pediatr Hematol Oncol 2021; 38: 444-455
    CrossrefPubMedSearch in Google Scholar
  • 5 Dutta A, Flores R. Infection Prevention in Pediatric Oncology and Hematopoietic Stem Cell Transplant Recipients. Healthcare-Associated Infections in Children 2018; 281-299
    CrossrefPubMedSearch in Google Scholar
  • 6 Hakim H, Flynn PM, Knapp KM. et al. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2009; 31: 623-629
    CrossrefPubMedSearch in Google Scholar
  • 7 Ippolito G, La Vecchia A, Umbrello G. et al. Disappearance of Seasonal Respiratory Viruses in Children Under Two Years Old During COVID-19 Pandemic: A Monocentric Retrospective Study in Milan, Italy. Front Pediatr 2021; 9: 721005
    CrossrefPubMedSearch in Google Scholar
  • 8 Klastersky J. Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis 2004; 39: 32-37
    CrossrefPubMedSearch in Google Scholar
  • 9 Koch-Institut R. Zur aktuellen Situation von RSV in der Saison 2020/21. Epidemiologisches Bulletin 2021; 38: 41 ISSN 2569-5266
    PubMedSearch in Google Scholar
  • 10 Lion T. Adenovirus persistence, reactivation, and clinical management. FEBS Lett 2019; 593: 3571-3582
    CrossrefPubMedSearch in Google Scholar
  • 11 Liu P, Xu M, Cao L. et al. Impact of COVID-19 pandemic on the prevalence of respiratory viruses in children with lower respiratory tract infections in China. Virol J 2021; 18: 159
    CrossrefPubMedSearch in Google Scholar
  • 12 Markham JL, Richardson T, DePorre A. et al. Inpatient Use and Outcomes at Children’s Hospitals During the Early COVID-19 Pandemic. Pediatrics 2021; 147: e2020044735
    CrossrefPubMedSearch in Google Scholar
  • 13 McNeil JC, Flores AR, Kaplan SL. et al. The Indirect Impact of the SARS-CoV-2 Pandemic on Invasive Group a Streptococcus, Streptococcus Pneumoniae and Staphylococcus Aureus Infections in Houston Area Children. Pediatr Infect Dis J 2021; 40: e313-e316
    CrossrefPubMedSearch in Google Scholar
  • 14 Meherali S, Punjani N, Louie-Poon S. et al. Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. Int J Environ Res Public Health 2021; 18: 3432
    CrossrefPubMedSearch in Google Scholar
  • 15 Network CV (2022). Activity of respiratory viruses https://clinical-virology.net/en/charts/chart/ctype/count/network/resp/section/viruses?from=2018-01-01&to=2021-03-31
    PubMed
  • 16 Oh DY, Buda S, Biere B. et al. Trends in respiratory virus circulation following COVID-19-targeted nonpharmaceutical interventions in Germany, January – September 2020: Analysis of national surveillance data. Lancet Reg Health Eur 2021; 6: 100112
    CrossrefPubMedSearch in Google Scholar
  • 17 Ramphal R.. Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. Clin Infect Dis 2004; 39: 25-31
    CrossrefPubMedSearch in Google Scholar
  • 18 Raymond E, Thieblemont C, Alran S. et al. Impact of the COVID-19 Outbreak on the Management of Patients with Cancer. Target Oncol 2020; 15: 249-259
    CrossrefPubMedSearch in Google Scholar
  • 19 Redlberger-Fritz M, Kundi M, Aberle SW. et al. Significant impact of nationwide SARS-CoV-2 lockdown measures on the circulation of other respiratory virus infections in Austria. J Clin Virol 2021; 137: 104795
    CrossrefPubMedSearch in Google Scholar
  • 20 Saab R, Obeid A, Gachi F. et al. Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia region: A report from the Pediatric Oncology East and Mediterranean (POEM) group. Cancer 2020; 126: 4235-4245
    CrossrefPubMedSearch in Google Scholar
  • 21 Steele AC, Mullins LL, Mullins AJ. et al. Psychosocial Interventions and Therapeutic Support as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62: 585-618
    CrossrefPubMedSearch in Google Scholar
  • 22 Terliesner N, Unterwalder N, Edelmann A. et al. Viral infections in hospitalized children in Germany during the COVID-19 pandemic: Association with non-pharmaceutical interventions. Frontiers in Pediatrics 2022; 10: 935483
    CrossrefPubMedSearch in Google Scholar
  • 23 Thom KA, Kleinberg M, Roghmann MC.. Infection prevention in the cancer center. Clin Infect Dis 2013; 57: 579-585
    CrossrefPubMedSearch in Google Scholar
  • 24 Ulrich A, Schranz M, Rexroth U. et al. Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1–2016 – week 32–2020. The Lancet Regional Health - Europe 2021; 6: 100103
    CrossrefPubMedSearch in Google Scholar
  • 25 Vliora C, Papadakis V, Doganis D. et al. A prospective study on the epidemiology and clinical significance of viral respiratory infections among pediatric oncology patients. Pediatr Hematol Oncol 2019; 36: 173-186
    CrossrefPubMedSearch in Google Scholar
  • 26 Wilder JL, Parsons CR, Growdon AS. et al. Pediatric Hospitalizations During the COVID-19 Pandemic. Pediatrics 2020; 146: e2020005983
    CrossrefPubMedSearch in Google Scholar
  • 27 Yan H, Li X, Lu X. et al. Changes in pediatric healthcare utilization in Hunan Province, China, during the COVID-19 pandemic: a multi-center cross-sectional study. Transl Pediatr 2021; 10: 870-881
    CrossrefPubMedSearch in Google Scholar
  • 28 Zhang A, Hu Q, Liu A. et al. Prevention of COVID-19 infection in a pediatric oncology ward in Wuhan. Pediatr Blood Cancer 2020; 67: e28424
    CrossrefPubMedSearch in Google Scholar