Principles of prevention and treatment recommendations for HCT recipients
| Virus . | Prophylaxis . | Asymptomatic shedding . | URTI . | LRTI . |
|---|---|---|---|---|
| RSV | • Infection control procedures • Palivizumab for children ≤2 y (during season) | Isolation | • Isolation • Ribavirin for high-risk situations*,† | • Isolation • Low-risk situations: oral ribavirin† • High-risk situations: aerosolized ribavirin initially followed by oral† • Supportive care |
| Influenza virus | • Infection control procedures • Vaccination of contacts • Vaccination 2-3 weeks before transplant in recipients of nonmyeloablative conditioning‡ • Vaccination of HCT recipients as early as possible, depending on timing of flu season | • Isolation • Oseltamivir or zanamivir | • Isolation • Oseltamivir or zanamivir | • Isolation • Oseltamivir or zanamivir • Consider combination therapy with rimantadine (only Influenza A) and/or ribavirin • Consider IV peramivir if mechanically ventilated • Supportive care |
| Parainfluenza virus | Infection control procedures | Isolation | • Isolation • Consider reduction of steroid dose | • Isolation • Supportive care • Consider ribavirin if mechanically ventilated† |
| Metapneumovirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care • Consider ribavirin if mechanically ventilated† |
| Rhinovirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care |
| Coronavirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care |
| Bocavirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care |
| Virus . | Prophylaxis . | Asymptomatic shedding . | URTI . | LRTI . |
|---|---|---|---|---|
| RSV | • Infection control procedures • Palivizumab for children ≤2 y (during season) | Isolation | • Isolation • Ribavirin for high-risk situations*,† | • Isolation • Low-risk situations: oral ribavirin† • High-risk situations: aerosolized ribavirin initially followed by oral† • Supportive care |
| Influenza virus | • Infection control procedures • Vaccination of contacts • Vaccination 2-3 weeks before transplant in recipients of nonmyeloablative conditioning‡ • Vaccination of HCT recipients as early as possible, depending on timing of flu season | • Isolation • Oseltamivir or zanamivir | • Isolation • Oseltamivir or zanamivir | • Isolation • Oseltamivir or zanamivir • Consider combination therapy with rimantadine (only Influenza A) and/or ribavirin • Consider IV peramivir if mechanically ventilated • Supportive care |
| Parainfluenza virus | Infection control procedures | Isolation | • Isolation • Consider reduction of steroid dose | • Isolation • Supportive care • Consider ribavirin if mechanically ventilated† |
| Metapneumovirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care • Consider ribavirin if mechanically ventilated† |
| Rhinovirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care |
| Coronavirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care |
| Bocavirus | Infection control procedures | Isolation | Isolation | • Isolation • Supportive care |
Recommendations from the Fred Hutchinson Cancer Research Center, University of Washington, and Seattle Children’s Hospital (the Seattle Cancer Care Alliance).
Due to recent price increases, restrictions have been put in place for the use of aerosolized ribavirin.
Benefit and dosing of oral ribavirin in pediatric patients is not clearly understood.
Exceptions may be made in certain immunodeficiencies.