Influenza B virus infection in pediatric solid organ transplant recipients.
OBJECTIVE
Influenza B virus causes epidemic infection in normal children, but only one case of infection in an immunocompromised solid organ transplant (SOT) recipient has been reported. Characterization of the clinical course of influenza B virus infection in pediatric SOT recipients may increase the utilization of preventive and therapeutic interventions by pediatricians caring for these immunocompromised children.


METHODS
Retrospective chart review of patients whose respiratory viral cultures yielded influenza B from January 1989 through March 1992.


METHODS
Twelve pediatric SOT recipients with influenza B virus infection were identified. These included five renal, four hepatic, and three cardiac allograft recipients, ranging from 19 months to 17 years 9 months of age (median 6 years 2 months). The posttransplant interval ranged from 6 weeks to 4 years 6 months (average 26.7 months). No patient had been immunized against influenza. Exposure histories were documented for eight children; five of these occurred in the hospital.


RESULTS
Clinical symptoms included fever (12/12), respiratory (11/12), or gastrointestinal complaints (8/12). Five patients had neurologic involvement; one died of uncal herniation. Ten children were hospitalized (median duration, 3 days; range, 2 to 79 days). Two patients (post-transplant interval, 3 to 8 months) required mechanical ventilation, and one of these received aerosolized ribavirin. Three children had concurrent allograft rejection.


CONCLUSIONS
Influenza B infection is potentially life-threatening in pediatric SOT recipients. We recommend annual immunization of pediatric SOT recipients, their household contacts, and health care workers. Prospective studies are needed to evaluate the efficacy of influenza vaccination in pediatric SOT recipients.
Department of Pediatrics, University of Minnesota Medical School, Minneapolis 55455.
T J
TJ
Mauch
S
S
Bratton
T
T
Myers
E
E
Krane
S R
SR
Gentry
C E
CE
Kashtan
D000293:Adolescent; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D009981:Influenza B virus / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology* / Q000382:microbiology; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies