The Burden of Community-acquired Respiratory Viral Infections in High-risk Immunocompromised Patients After the COVID-19 Pandemic
Recommended Citation
Moss CT, Hsu JL, Ramesh M, Gauvreau GM, Turner J, Duong ML, Sheshadri A, McCulloch D, Bender Ignacio R, Boeckh M, Nettles R, Chien J, Negrou E, Boateng F, Talantov D, Cheng G. The Burden of Community-acquired Respiratory Viral Infections in High-risk Immunocompromised Patients After the COVID-19 Pandemic. Am J Respir Crit Care Med 2025; 211:2.
Document Type
Conference Proceeding
Publication Date
5-1-2025
Publication Title
Am J Respir Crit Care Med
Abstract
Rationale The COVID-19 pandemic and subsequent public health measures significantly altered the landscape of community-acquired respiratory viral infections (CARVs). Those experiencing immunosuppression from treatment of hematologic malignancies, including hematopoietic cell transplantation (HCT), are particularly susceptible to poor outcomes. Our study sought to better understand the incidence and clinical impact of CARVs in these immunocompromised individuals in the year immediately following the COVID-19 pandemic. Methods This prospective, multicenter, observational study was conducted at four large academic centers from January 2023 to March 2024. Eligibility criteria included adults (>18 years of age) with active hematological malignancies and after HCT. Participants were followed every 2 weeks for respiratory symptoms using a cloud-based symptom tracker for up to 12 months. Following a positive acute respiratory infection (ARI) symptom screen, in person evaluations were conducted which included physical examination, laboratory tests, and a nasal swab for polymerase chain reaction (PCR) testing for 18 viral and 4 bacterial pathogens with a commercially available assay (BioFire). Results A total of 140 participants were enrolled and 80% completed the study. The most common reasons for study discontinuation was death (20%, 12/28), and subject withdrawl (6.4%, 9/28). The median age of participants was 60 years and 75 (53.6%) were female. Participants were non-Hispanic, caucasian (72.1%), Asian (14%) and black (10.3%). The majority had received an HCT (83.6%, n=117); median time between transplantation and enrollment was 1 year. At least once before or during the study, 99 (71%) participants received a COVID-19 vaccine, and 32 (22.9%) participants received an Influenza vaccine. The symptom tracker triggered 100 ARI visits in 64 participants, of which 60 (43%, 60/140) had clinically confirmed infection with 87% of confirmed cases having a positive respiratory viral PCR panel. The incidence rate of clinically confirmed ARIs was 5.01 per 100 participant months (95% CI: 3.86-6.41). The most common CARV was rhinovirus/enterovirus (n=14, 23.3%) followed by COVID-19 (n=13, 21.7%) and seasonal coronavirus (n=5, 8.3%) (Figure 1). There were no confirmed bacterial infections. Hospitalization occurred in 8 participants (13.3%), with 4 requiring intensive care unit admission. In total, 12 deaths occurred; 3 followed a clinically confirmed ARI including one attributed to respiratory failure. Conclusions This study underscores the significant burden of CARVs in immunocompromised individuals, particularly those post-HCT. The findings highlight the need for robust public health strategies, improved vaccination efforts, and research into effective diagnostic and therapeutic interventions to mitigate the risks faced by this vulnerable population.
Volume
211
First Page
2
