key: cord-0837653-how2g753
authors: Cesaro, Simone; Compagno, Francesca; Zama, Daniele; Meneghello, Linda; Giurici, Nagua; Soncini, Elena; Onofrillo, Daniela; Mercolini, Federico; Mura, Rossella; Perruccio, Katia; De Santis, Raffaella; Colombini, Antonella; Barone, Angelica; Sainati, Laura; Baretta, Valentina; Petris, Maria Grazia
title: Screening for SARS‐CoV‐2 infection in pediatric oncology patients during the epidemic peak in Italy
date: 2020-06-15
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28466
sha: e69d43277ba8b3f5d525342d4acc2bfade725c7e
doc_id: 837653
cord_uid: how2g753

nan

The infection by the new coronavirus-2019 (SARS-CoV-2) can be asymptomatic or mildly symptomatic in up to 80% of infected people, whereas the severe or lethal forms have been associated with several risk factors. [1] [2] [3] Children with tumors represent a special risk group because treatment is frequently based on high-dose chemotherapy and, in leukemia and lymphoma, on steroids that result in severe impairment of innate and adaptive immunity. The effect of chemotherapy on an asymptomatic patient with SARS-CoV-2 infection is unknown, although a more severe course could be expected.

During the epidemic peak in Italy, to prevent the hospital admission of asymptomatic infected patients, 14 pediatric hematology-oncology centers adopted a policy to screen the patients for SARS-CoV-2 by nasopharyngeal swab (NFS) before allowing them to start chemotherapy or enter hospital for supportive measures. Geographically, 10 centers were located in northern Italy, one in central Italy, and three in southern Italy/Isles. We report the results of this screening performed from February 20 to April 19, 2020. Follow-up data are as on April 30, 2020.

At the start of screening, all centers were using the preventative measures recommended to contain the epidemic: social and physical distancing, use of hand hygiene, gloves, and surgical masks for patient, health personnel, and caregiver, screening of patients and parents for fever and signs or symptoms of respiratory tract infection, and restricted access by nonhealth personnel. In the Chinese epidemic, only 1% of infected people were younger than 10 years or 11-18 years old. [2] [3] [4] Pediatric cases of COVID-19 overall had a good prognosis, because most of them were asymptomatic or with mild or moderate symptoms and only 2.5% were severely ill. 4, 5 The real incidence of asymptomatic infected people is unknown because it depends on how thoroughly the search is conducted but their identification and tracing are important to prevent the diffusion of infection. In this study, we found that the incidence of positive NFS in pediatric patients coming to hospital for chemotherapy was 3% for all centers, and 3.4% for the northern Italian centers.

The main measure adopted for these patients was the postponing of chemotherapy until two NFS were negative at least 24 h apart.

This precaution is in line with data on adult cancer patients showing that recent chemotherapy or oncology surgery was a risk factor for a more severe COVID-19 infection 6 and with a case report of a severe respiratory form of COVID-19 in a Chinese child with T-cell acute leukemia. 7 The impact of chemotherapy on the risk of progression of an asymptomatic or mildly symptomatic SARS-CoV-2 infection toward a severe or lethal form of COVID-19 is not really known. In a multicenter survey among pediatric oncology centers, only nine out

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