Emily A Hayes1, Stephen A Hart2, Charitha Gowda3, Deipanjan Nandi2. 1. The Heart Center, Nationwide Children's Hospital, Columbus OH. Electronic address: emily.hayes@nationwidechildrens.org. 2. The Heart Center, Nationwide Children's Hospital, Columbus OH. 3. Department of Infectious Diseases, Nationwide Children's Hospital, Columbus OH.
Abstract
OBJECTIVE: To determine the risk factors for acquiring a respiratory syncytial virus and vaccine preventable infections (R/VPI) in pediatric heart transplant recipients and the associated morbidity and hospital resource use. STUDY DESIGN: Patients <18 years who underwent heart transplantation from 9/2003-12/2018 at hospitals utilizing the Pediatric Health Information System database were identified. Their transplant hospitalization and subsequent hospitalizations for R/VPI through 12/2018 were analyzed. Risk factors for R/VPI hospitalizations were evaluated using negative regression binomial models adjusted for demographic and clinical confounders. Total hospital costs were adjusted for 2018 US$. RESULTS: Of 3,815 transplant recipients, 681 (17.9%) had an R/VPI hospitalization during 23,746 available person-years of follow-up. There were 984 R/VPIs diagnosed during 951 hospitalizations, and 440 (44.7%) occurred the first year after transplant. The most common causes were respiratory syncytial virus (n=380; 38.6%), influenza (n=265; 26.9%), and pneumococcus (n=105; 10.7%). In adjusted analyses, there was an increased risk of R/VPI hospitalization in patients requiring mechanical circulatory support prior to transplant, patients receiving induction with ≥ 2 immunosuppressive agents, and patients <2 years in the first-year post-transplant. The median length of stay for an R/VPI hospitalization was 4 days (interquartile range [IQR]: 2-8 days) with a median total cost of $11,081 (IQR: $6,215 - $24,322). CONCLUSIONS: Hospitalization for R/VPIs occurred frequently following heart transplantation and were associated with significant cost. Potential strategies to minimize R/VPI include expanding vaccine use through accelerated immunization schedules, further studies of use of palivizumab beyond 2 years of age, and immunogenicity monitoring after vaccination with re-immunization based on guidelines.
OBJECTIVE: To determine the risk factors for acquiring a respiratory syncytial virus and vaccine preventable infections (R/VPI) in pediatric heart transplant recipients and the associated morbidity and hospital resource use. STUDY DESIGN:Patients <18 years who underwent heart transplantation from 9/2003-12/2018 at hospitals utilizing the Pediatric Health Information System database were identified. Their transplant hospitalization and subsequent hospitalizations for R/VPI through 12/2018 were analyzed. Risk factors for R/VPI hospitalizations were evaluated using negative regression binomial models adjusted for demographic and clinical confounders. Total hospital costs were adjusted for 2018 US$. RESULTS: Of 3,815 transplant recipients, 681 (17.9%) had an R/VPI hospitalization during 23,746 available person-years of follow-up. There were 984 R/VPIs diagnosed during 951 hospitalizations, and 440 (44.7%) occurred the first year after transplant. The most common causes were respiratory syncytial virus (n=380; 38.6%), influenza (n=265; 26.9%), and pneumococcus (n=105; 10.7%). In adjusted analyses, there was an increased risk of R/VPI hospitalization in patients requiring mechanical circulatory support prior to transplant, patients receiving induction with ≥ 2 immunosuppressive agents, and patients <2 years in the first-year post-transplant. The median length of stay for an R/VPI hospitalization was 4 days (interquartile range [IQR]: 2-8 days) with a median total cost of $11,081 (IQR: $6,215 - $24,322). CONCLUSIONS: Hospitalization for R/VPIs occurred frequently following heart transplantation and were associated with significant cost. Potential strategies to minimize R/VPI include expanding vaccine use through accelerated immunization schedules, further studies of use of palivizumab beyond 2 years of age, and immunogenicity monitoring after vaccination with re-immunization based on guidelines.
Authors: Diana M Bowser; Katharine R Rowlands; Dhwani Hariharan; Raíssa M Gervasio; Lauren Buckley; Yara Halasa-Rappel; Elizabeth L Glaser; Christopher B Nelson; Donald S Shepard Journal: J Infect Dis Date: 2022-08-15 Impact factor: 7.759