{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T01:09:17Z","timestamp":1771981757881,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Viral respiratory infections pose a significant risk for pediatric cancer patients and may lead to a delay in chemotherapy, prolonged hospitalization, and mortality. Limited data exist regarding the contributors to adverse clinical outcomes. The present study aims to describe the associations between clinical, epidemiological, and laboratory factors and severe outcomes of respiratory viral infections among children with cancer. This was a retrospective cohort study among pediatric cancer patients treated in the Pediatric Hematology\u2013Oncology Department at Rambam Health Care Campus from 2016 to 2022. Patients with a positive rt-qPCR test for one of the following viruses were included: Adenovirus, Respiratory Syncytial Virus (RSV), Human Metapneumovirus (HMPV), SARS-CoV-2, Parainfluenza, or Influenza. Demographic, clinical, and laboratory data were collected for each case. GEE analyses were conducted to assess the associations between independent variables and severe outcomes (admission to the Pediatric Intensive Care Unit (PICU), hospitalizations exceeding seven days, co-bacterial infections, and mortality within 30 days). A total of 366 viral infections episodes were identified among 238 patients. There were 187 (51%) children with hematological malignancies, 113 (31%) with solid tumors, and 66 patients (18%) who had undergone bone marrow transplantation. Influenza was the most frequently detected virus, accounting for 89 events (24%), followed closely by Adenovirus, with 82 events (23%). Among the 38 severe events, prolonged hospitalization was the most prevalent outcome, occurring in 33 cases. Adenovirus infection was significantly associated with severe outcomes (OR = 2.97, p = 0.010), and antibiotic therapy was associated with 3.62 times higher odds of severe outcomes (p = 0.010). Patients presenting with O2 saturation levels below 92% had 5.71 times higher odds of experiencing severe outcomes. Among the subgroup of hematological malignancies, RSV was positively associated with severe outcomes (OR = 4.08, p = 0.048). Adenovirus was associated with severe outcomes in pediatric cancer patients, highlighting its prevalence and potential for treatment. Similarly, RSV was associated with adverse outcomes specifically among hematological cancer patients, emphasizing the importance of vaccination. A very low mortality from viral infection was also notable.<\/jats:p>","DOI":"10.3390\/microorganisms13112628","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T15:03:15Z","timestamp":1763564595000},"page":"2628","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Factors for Severe Outcomes Among Pediatric Cancer Patients with Respiratory Viral Infection"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3870-952X","authenticated-orcid":false,"given":"Alon","family":"Kristal","sequence":"first","affiliation":[{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-1806","authenticated-orcid":false,"given":"Avi","family":"Magid","sequence":"additional","affiliation":[{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel"},{"name":"Department of International Health, Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nira","family":"Arad-Cohen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hemato-Oncology, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moran","family":"Szwarcwort-Cohen","sequence":"additional","affiliation":[{"name":"Virology Laboratory, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8353-0108","authenticated-orcid":false,"given":"Yael","family":"Shachor-Meyouhas","sequence":"additional","affiliation":[{"name":"The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"},{"name":"Management, Rambam Health Care Campus, Haifa 3109601, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Alchikh, M., Conrad, T.O., Obermeier, P.E., Ma, X., Schweiger, B., Opota, O., and Rath, B.A. (2024). Disease Burden and Inpatient Management of Children with Acute Respiratory Viral Infections during the Pre-COVID Era in Germany: A Cost-of-Illness Study. Viruses, 16.","DOI":"10.3390\/v16040507"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/petr.12022","article-title":"The impact of RSV, adenovirus, influenza, and parainfluenza infection in pediatric patients receiving stem cell transplant, solid organ transplant, or cancer chemotherapy","volume":"17","author":"Lo","year":"2013","journal-title":"Pediatr. Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1002\/jmv.25432","article-title":"Prevalence and characteristics of acute respiratory virus infections in pediatric cancer patients","volume":"91","author":"Soudani","year":"2019","journal-title":"J. Med. Virol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.phoj.2021.01.004","article-title":"Viral respiratory infection among children treated in hemato-oncology department\u2013Clinical and epidemiological characteristics","volume":"6","author":"Meron","year":"2021","journal-title":"Pediatr. Hematol. Oncol. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e242","DOI":"10.1097\/MPH.0000000000001418","article-title":"A 3-year retrospective study of the epidemiology of acute respiratory viral infections in pediatric patients with cancer undergoing chemotherapy","volume":"41","author":"Tahta","year":"2019","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1080\/08880018.2019.1631920","article-title":"Prevalence and clinical outcome of respiratory viral infections among children with cancer and febrile neutropenia","volume":"36","author":"Meena","year":"2019","journal-title":"Pediatr. Hematol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/MPH.0b013e3181b1edc6","article-title":"Etiology and clinical course of febrile neutropenia in children with cancer","volume":"31","author":"Hakim","year":"2009","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1007\/s00431-021-04338-y","article-title":"SARS-CoV-2 in pediatric cancer: A systematic review","volume":"181","author":"Schlage","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13045-021-01181-4","article-title":"COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: A Polish national study","volume":"14","author":"Zakrzewska","year":"2021","journal-title":"J. Hematol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ch\u00e1vez-Pacheco, J.L., Castillejos-L\u00f3pez, M., Hern\u00e1ndez-Regino, L.M., Velasco-Hidalgo, L., Zapata-Tarres, M., Correa-Carranza, V., Rosario-M\u00e9ndez, G., Barrientos-R\u00edos, R., Aquino-G\u00e1lvez, A., and Torres-Esp\u00edndola, L.M. (2024). Challenges in Treating Pediatric Cancer Patients during the COVID-19 Pandemic: Balancing Risks and Care. Viruses, 16.","DOI":"10.3390\/v16050690"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"102800","DOI":"10.1016\/j.jiph.2025.102800","article-title":"A systematic review and meta-analysis of the global prevalence of human enteric adenovirus infections","volume":"18","author":"Wikswo","year":"2025","journal-title":"J. Infect. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1055\/s-0031-1283287","article-title":"Adenovirus","volume":"Volume 32","author":"Lynch","year":"2011","journal-title":"Seminars in Respiratory and Critical Care Medicine"},{"key":"ref_13","first-page":"595","article-title":"Adenovirus respiratory infection among immunocompetent patients in a pediatric intensive care unit during 10-year period: Co-morbidity is common","volume":"21","author":"Hadash","year":"2019","journal-title":"Isr. Med. Assoc. J. IMAJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/jpids\/piy049","article-title":"Outcomes of human adenovirus infection and disease in a retrospective cohort of pediatric hematopoietic cell transplant recipients","volume":"8","author":"Fisher","year":"2019","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1007\/s00431-024-05914-8","article-title":"Burden of viral respiratory infections in the pediatric intensive care unit: Age, virus distribution, and the impact of the COVID-19 pandemic","volume":"184","author":"Cohen","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3187","DOI":"10.1002\/jmv.25756","article-title":"Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study","volume":"92","author":"Pieczonka","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e467","DOI":"10.1097\/MPH.0000000000001480","article-title":"Brincidofovir as a salvage therapy in controlling adenoviremia in pediatric recipients of hematopoietic stem cell transplant","volume":"41","author":"Meena","year":"2019","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"105034","DOI":"10.1016\/j.antiviral.2021.105034","article-title":"Emerging antiviral therapeutics for human adenovirus infection: Recent developments and novel strategies","volume":"188","author":"Dodge","year":"2021","journal-title":"Antivir. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2079322","DOI":"10.1080\/21645515.2022.2079322","article-title":"RSV disease in infants and young children: Can we see a brighter future?","volume":"18","author":"Baraldi","year":"2022","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1002\/ppul.27310","article-title":"New advances in RSV: Is prevention attainable?","volume":"60","author":"Zar","year":"2025","journal-title":"Pediatr. Pulmonol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1056\/NEJMoa2216480","article-title":"Bivalent prefusion F vaccine in pregnancy to prevent RSV illness in infants","volume":"388","author":"Kampmann","year":"2023","journal-title":"New Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1056\/NEJMoa2309189","article-title":"Nirsevimab for prevention of hospitalizations due to RSV in infants","volume":"389","author":"Drysdale","year":"2023","journal-title":"New Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1177\/000992280404300303","article-title":"Adenovirus infection in hospitalized immunocompetent children","volume":"43","author":"Peled","year":"2004","journal-title":"Clin. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kobia\u0142ka, M., Jackowska, T., and Wrotek, A. (2023). Risk factors for severe respiratory syncytial virus infection in hospitalized children. Viruses, 15.","DOI":"10.3390\/v15081713"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Dorantes-Acosta, E., Avila-Montiel, D., Kl\u00fcnder-Kl\u00fcnder, M., Juarez-Villegas, L., and Marquez-Gonzalez, H. (2021). Survival and complications in pediatric patients with cancer and COVID-19: A meta-analysis. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.608282"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/s10147-021-01971-3","article-title":"Delayed diagnosis and treatment of children with cancer during the COVID-19 pandemic","volume":"26","author":"Dvori","year":"2021","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Boeriu, E., Borda, A., Vulcanescu, D.D., Sarbu, V., Arghirescu, S.T., Ciorica, O., Bratosin, F., Marincu, I., and Horhat, F.G. (2022). Diagnosis and management of febrile neutropenia in pediatric oncology patients\u2014A systematic review. Diagnostics, 12.","DOI":"10.3390\/diagnostics12081800"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/11\/2628\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T09:16:43Z","timestamp":1764062203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/11\/2628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,19]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["microorganisms13112628"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13112628","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,19]]}}}