A Systematic Review of Respiratory Viral Infections Outcomes in Immunocompromised Pediatric Patients

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ID: 327341
2026
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Abstract
Abstract Background Respiratory Viral Infections (RVI) pose a significant challenge in high-risk pediatric patients with cancer and Hematopoietic Cell Transplant (HCT). Although reports have documented its burden, few studies have systematically analyzed data on outcomes of RVI in immunocompromised patients. Methods A systematic review was undertaken to describe respiratory viral infections outcome in immunocompromised pediatrics patients with febrile neutropenia (FN), HCT recipients, and solid organ transplant recipients (SOT) from published data between January 1, 2019 and October 1, 2025. Twenty-eight studies were included based on the presence of quantified effect estimates specifically Odds Ratio (OR), Hazards Ratio (HR), clinical burden statistics (median fever duration), and viral co-infection patterns. The results were analyzed using a narrative approach, organizing findings by outcome category to ensure comprehensive reporting of descriptive statistics and quantified risk estimates. Results Of the twenty-eight studies analyzed, RVIs were highly prevalent in 76.5% of febrile neutropenia cases versus 48.6% in controls. While Rhinovirus (HRV/HRE) was the most frequently identified pathogen across multiple studies (36.8%, 33.1%, 61%, 47%), Respiratory Syncytial Virus (RSV) was strongly linked with severe outcomes, including Lower Respiratory Tract Infection (LRTI) progression and bacteremia. A high proportion of RVIs were nosocomial (79% in one study of HCT patients), and viral co-infections were common, occurring in up to 55% of cases and often involving RSV. Furthermore, antibiotic exposure prior to RVI onset was identified as a risk factor for LRTI progression in HCT recipients, and Pre-HSCT RVI was significantly associated with ICU transfer(OR = 3.45) and increased Treatment-Related Mortality (OR = 5.57). Human Parainfluenza Virus type 3 (PIV-3) URTIs were significantly associated with Air Flow Obstruction (HR 1.87), while RSV URTIs exhibited a stronger association with Bronchiolitis Obliterans Syndrome (HR 2.65). RVIs significantly impacted clinical management, resulting in chemotherapy delays for 22%-33% of patients, alongside considerable resource utilization including 16% hospitalization, 50% parenteral antibiotic use, and 18.6% PICU admission. Finally, a significant gap in care was noted as only 22% of pediatric cancer patients with influenza received oseltamivir. Conclusion Respiratory Viral Infections impose a substantial burden on immunocompromised children, leading to significant morbidity, mortality, resource use, and long-term complications. RSV, PIV-3, and influenza significantly increase mortality, highlighting the need for stricter infection control and prevention.
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Authors Amel Omer, K. Agoramurthi, Abubaker Koko, Nagla Suliman
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag070/piag070.057
URL
https://academic.oup.com/jpids/article-pdf/15/Supplement_2/S24/70833269/piag070.057.pdf
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