RSV in transplant and immunocompromised patients

Article Figures & Data

TABLE 1

Risk stratification of HSCT recipients for progression from upper to lower RTI: MD Anderson Cancer Center Immunodeficiency Scoring Index

Risk factor at RSV diagnosis	Hazard ratio for progression	Score^a
Absolute neutrophil count < 500/µL	4.1 (1.4–11.6)	3
Absolute lymphocyte count < 200/µL	2.6 (1.0–6.4)	3
Age > 40 years	2.5 (1.1–5.6)	2
Myeloablative conditioning	1.2 (0.6–2.3)	1
Graft-versus-host disease	1.0 (0.5–2.2)	1
Corticosteroids within 30 days (> 20 mg prednisone)	0.89 (0.4–1.8)	1
Allogeneic HSCT within 30 days (or pre-engraftment)	0.68 (0.2–2.3)	1

↵^aMaximum score = 12: Low risk: 0–2, moderate risk 3–6, high risk 7–12
HSCT = hematopoietic stem cell transplant; RSV = respiratory syncytial virus; RTI = respiratory tract infection
Reprinted from Blood, 123(21), Shah DP, Ghantoji SS, Ariza-Heredia EJ, et al, Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections, 3263–3268, 2014, with permission from Elsevier.

TABLE 2

Prevention tools for RSV in at-risk immunocompromised patients

	Indication	Method	Efficacy	Cost
Contact	All adult and pediatric immunocompromised patients at risk for RSV	Wash hands Avoid touching face with unclean hands Avoid close contact with others (eg, sharing cups or utensils, handshaking, kissing) Clean frequently touched surfaces	Unknown; during SARS-CoV-2 pandemic, masking and social distancing reduced RSV to 0% until March 2021²⁵	Unknown

Isolation	Hospitalized adult and pediatric patients with RSV	Standard and contact and droplet precautions²⁹ Eyewear for close contact or procedures	Variable: 30% to 50% reduction in transmission in studies²⁶	More than $150 per patient per day²⁷

Vaccination	Adult patients over age 60, including those with immunocompromising condition	Intramuscular in deltoid region with 1–1.5-inch needle	Not studied, immunocompromised adults not included in trials	$336–$354 per dose

Passive antibody
Nirsevimab	Children under 8 months during first RSV season; children 8–19 months at risk for second RSV season, including immunocompromised children	Intramuscular	Not studied; preliminary data of 90% efficacy included only 1 RSV infection in immunocompromised patient	Approximately $495 per dose
Palivizumab	Consider in immunocompromised children younger than 24 months	Intramuscular once a month during RSV season up to 5 doses	Limited evidence for support	Up to $15,000 per RSV season