Influenza-associated morbidity in children with cancer

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.