Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: focus on community respiratory virus infections.

Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant (HSCT) recipients, cosponsored by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, and the American Society for Blood and Marrow Transplantation, were issued in October 2000. The guidelines recommend that to minimize transmission of community respiratory virus (CRV) infection, health care workers and visitors with symptoms of upper respiratory tract infection be restricted from having contact with HSCT recipients and candidates undergoing conditioning therapy. To screen HSCT recipients for CRVs, active clinical surveillance for CRV disease should be conducted on all hospitalized HSCT recipients and candidates undergoing conditioning therapy, including daily monitoring for signs and symptoms of CRV infections. Respiratory syncytial virus (RSV) is the most important CRV because it is the most prevalent and because RSV pneumonia has a high case-fatality rate. For this reason, it is recommended that respiratory secretions of any hospitalized HSCT candidate or recipient with signs and symptoms of CRV infection be tested promptly for RSV. If test results are positive, the patient should be treated early and aggressively. Early preemptive therapy with such treatments as aerosolized ribavirin has been proposed, but limited data preclude a recommendation as to the optimal strategy. Lifelong seasonal influenza vaccination is recommended for all HSCT recipients.