Impact of COVID-19 Related Restrictions on Infections in Children
                with Cancer or after Hematopoietic SCT

Richard Hauch; Malena Hinrichs; Rebecca Ruhwald; Johanna Schrum; Stefan Rutkowski; Wilhelm Woessmann; Beate Winkler

doi:10.1055/a-2000-5388

Klin Padiatr 2023; 235(03): 159-166
DOI: 10.1055/a-2000-5388

Original Article

Impact of COVID-19 Related Restrictions on Infections in Children with Cancer or after Hematopoietic SCT

A Monocentric, Retrospective StudyEinfluss von COVID-19-bezogenen Restriktionen auf Infektionen von Kindern mit Krebs oder nach SZTEine monozentrische, retrospektive Studie

Richard Hauch ^*

¹Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany

²Research Institute Children’s Cancer Center, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Malena Hinrichs^*

¹Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany

,

Rebecca Ruhwald

³Medical controlling, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

,

Johanna Schrum

⁴Department of Pediatric Hematology and Oncology, Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany

,

Stefan Rutkowski

¹Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany

,

Wilhelm Woessmann

¹Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany

,

Beate Winkler

¹Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany

› Author Affiliations

Abstract

Background Infections are a major concern for immunocompromised children. We investigated whether non-pharmaceutical interventions (NPIs) implemented in the general population during the coronavirus disease 2019 (COVID-19) pandemic in Germany had an impact on frequency, type and severity of infections in these patients.

Patients and methods We analyzed all admissions to the clinic of pediatric hematology, oncology and stem cell transplantation (SCT) with (suspected) infection or fever of unknown origin (FUO) from 2018 to 2021.

Results We compared a 27-month period before NPIs (Pre-COVID: 01/2018–03/2020; 1041 cases) with a 12-month period with underlying NPIs (COVID: 04/2020–03/2021; 420 cases). During the COVID period the number of in-patient stays with FUO or infections decreased (38,6 cases/month vs. 35,0 cases/month), the median duration of hospital stays was longer (8 d (CI95: 7–8 d) vs. 9 d (CI95: 8–10 d) P=0,02)), the mean number of antibiotics per case increased (2,1 (CI95: 2,0–2,2) vs. 2,5 (CI95: 2,3–2,7); P=0,003)) and a substantial reduction of viral respiratory and gastrointestinal infections per case was seen (0,24 vs. 0,13; P<0,001). Notably, there was no detection of respiratory syncytial virus, influenza and norovirus, between May 2020 and March 2021. Based on need of intensive care measures and further parameters we conclude that severe (bacterial) infections were not significantly reduced by NPIs.

Conclusions Introduction of NPIs in the general population during the COVID-pandemic substantially reduced viral respiratory and gastrointestinal infections in immunocompromised patients, while severe (bacterial) infections were not prevented.

Zusammenfassung

Hintergründe Immunsupprimierte Kinder sind in besonderem Maße durch Infektionen gefährdet. In dieser Studie wurde untersucht, ob die im Rahmen der COVID-19 Pandemie in Deutschland etablierten NPIs Auswirkungen auf die Häufigkeit, Art und Schwere von Infektionen dieser Patienten hatten.

Patienten und Methoden Es wurden alle Aufenthalte aufgrund von (vermuteter) Infektion in der Klinik für pädiatrische Hämatologie, Onkologie und Stammzelltransplantation zwischen 2018 und 2021 analysiert.

Ergebnisse Wir verglichen eine 27-monatige Periode vor NPIs (Pre-COVID: 01/2018–03/2020; 1041 Fälle) mit einer 12-monatigen Periode unter geltenden NPIs (COVID: 04/2020–03/2021; 420 Fälle). Während der COVID Periode sank die Zahl von Aufenthalten aufgrund von FUO oder Infektionen (38,6 Fälle/Monat vs. 35,0 Fälle/Monat), die mediane Falldauer war länger (8 d (CI95: 7–8 d) vs. 9 d (CI95: 8–10 d) P=0,02)), es wurden pro Fall mehr Antibiotika verabreicht (2,1 (CI95: 2,0–2,2) vs. 2,5 (CI95: 2,3–2,7); P=0,003)) und es zeigte sich eine deutliche Reduktion von viralen respiratorischen und gastrointestinalen Infektionen pro Fall (0,24 vs. 0,13; P<0,001). Interessanterweise konnte keine einzige Infektion mit RSV, Influenzaviren oder Noroviren von Mai 2020 bis März 2021 nachgewiesen werden. Basierend auf der Rate notwendiger intensivmedizinischer Maßnahmen und weiteren Parametern konnte keine signifikante Reduktion schwerer (bakterieller) Infektionen unter NPIs gezeigt werden.

Fazit Durch NPIs in der Bevölkerung wurden virale respiratorische und gastrointestinale Infektionen in der Kohorte immunsupprimierter Kinder deutlich reduziert. Schwere (bakterielle) Infektionen wurden jedoch nicht verhindert.

Key words

COVID-19 - pediatric oncology and hematology - pediatric stem-cell transplantation - immunosuppression - infections

Schlüsselwörter

COVID-19 - Pädiatrische Hämatologie und Onkologie - Pädiatrische Stammzelltransplantation - Immunsuppression - Infektionen

Full Text

References

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