Under Recognized Respiratory Tract Infections in Non-Neutropenic Fever Children with Cancer: Real-World Insights from Mass Religious Gatherings and Influenza Seasons
Aeshah AlAzmi
*
Department of Pharmaceutical Care Clinical Services, King Abdulaziz Medical City, Jeddah, Saudi Arabia and King Abdullah International Medical Research Center, Jeddah, Saudi Arabia and Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia and Department of Pediatrics, Oncology/Hematology/BMT, Princes Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
Wasil Jastaniah
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia and Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia and Department of Pediatrics, Oncology/Hematology/BMT, Princes Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia and Department of Pediatrics, Faculty of Medicine, Umm AlQura University, Makkah, Saudi Arabia.
Mona AlDabbagh
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia and Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia and Department of Pediatrics, Division of Infectious Diseases, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
Naglla Elimam
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Mohammed AlHindi
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia and Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia and Department of Pediatrics, Division of Intensive Care, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Background: No existing research has addressed respiratory tract infections (RTIs) in children with non-neutropenic fever (NNF) who are present during seasons of religious mass gatherings (Hajj, Ramadan), especially if this coincides with the influenza season. The treatment approach for RTI cases in NNF children during mass religious gatherings may not be applicable in the normal season.
Methods: This study includes a retrospective analysis of RTI in NNF children who were present during mass religious gathering seasons and/or flu season, and who were being treated for malignancy at Princess Noorah Oncology Center from May 1, 2016 through December 2017.
Results: A total of 4599 spikes in fever were identified in 124 non-neutropenic children in whom 455 spikes (9.9%, 455 out of 4599) were documented during mass religious gatherings and/or the flu season. NNF secondary to RTIs was documented in 59.7% of patients during the study seasons with a total of 245 fever spikes recorded. Ceftriaxone-based therapy was the main treatment approach for NNF including the RTI cases that were associated with 50% of subsequent hospitalization for further management. Among all the examined risk factors, a prolonged fever of more than three days was significantly associated with NNF secondary to RTI during mass religious gatherings if coincident with the flu season, OR=0.034 [95% CI, 0.013 - 0.09] P-value <0.001.
Conclusions: The present study showed that the prevalence rate of NNF of RTI in NNF children increased during periods of mass gathering. There is need therefore for a national consensus to address NNF management during mass religious gatherings, particularly if coincident with the flu season.
Keywords: Respiratory tract infections RTI, cancer, non-neutropenic fever (NNF) religious mass gatherings, influenza season