P2B036: The Effect of Respiratory Viral Infections on Febrile Children with Sickle Cell Disease

Background:

Background:
Children with sickle cell disease (SCD) lose splenic function very early in life and are at risk of developing bacteremia with encapsulated organisms. Therefore, fever is considered an emergency, and families are instructed to bring their children to the ED for evaluation and management of fever. Standard evaluation includes a blood culture, and the child is treated with empiric broad-coverage antibiotics. In our single, large tertiary care pediatric hospital, children, by protocol, are evaluated with nasal respiratory viral panels (RVPs) to identify if they have a viral infection. There have been few reports describing the clinical implications of viruses such as influenza and human metapneumovirus (hMPV) in children with SCD. We undertook this study to see how respiratory viruses affect children with SCD.

Methods:

Methods:
This was a retrospective chart review of all children aged < 21 years with SCD (HbSS, HbSC, HbSβ+thalassemia, or HbSβ°thalassemia) who presented to the ED at Cohen Children’s Medical Center with fever and had a positive respiratory viral panel test from 2014 to 2022. In addition to the type of virus isolated, we also collected information on their clinical outcomes, whether the ED visit led to an inpatient admission, intensive care unit (ICU) stay, acute vaso-occlusive crisis (VOC), acute chest syndrome (ACS), or packed red blood cell (pRBC) transfusion.

Results:

Results:
We identified 1301 RVP positive tests performed on 439 patients over multiple encounters (Mean 2.96 +/- 2.9) within our study period resulting in 1519 total viruses detected. Patients with RVPs positive for Adenovirus had the highest rate of viral co-infection at 52.7%. Patients with RVPs positive for Entero/Rhinovirus (ERV) had the highest admission rate at 43.0% and those with Influenza had the lowest admission rate at 32.1%. Patients with RVPs positive for ERV had the highest need for ICU stay at 5.6%. Those with ERV had the highest rate of need for packed red blood cells at 17.8%. Patients with hMPV had the highest rate of supplemental oxygen at 8.9%, with the second highest rate at 7.9% with ERV. Those with RSV had the highest rate of needing respiratory support greater than supplemental oxygen (including high-flow nasal cannula, and all modalities of positive-pressure ventilation) at 3.6%, with the second highest rate at 2.5% with ERV. Those with ERV also had the highest rate of VOC and ACS at 27.3% and 16.8% respectively.

Conclusion:

Conclusions:
Viral infections are common causes of fever in children with SCD. In our hospital, ERV was associated with considerable morbidity, including higher rates of hospitalization, the need for ICU, need for pRBCs, VOC, and ACS compared to other viruses. Further research and prospective studies must be done to evaluate the relationship of viruses on the clinical outcomes of patients with SCD.