key: cord-0876182-69f41hvt
authors: Zhang, Ai; Hu, Qun; Liu, Aiguo; Wang, Songmi; Jin, Shourui; Wang, Yao; Wang, Li; Hao, Yan
title: Prevention of COVID‐19 infection in a pediatric oncology ward in Wuhan
date: 2020-08-11
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28424
sha: b9dce5bf5e0f105aa976725e479090151f7920bf
doc_id: 876182
cord_uid: 69f41hvt

OBJECTIVE: To assess the screening and isolation measures for preventing coronavirus disease 2019 (COVID‐19) infection from newly admitted patients into a pediatric oncology ward. METHODS: We retrospectively analyzed 44 patients with established hematologic malignancies admitted for chemotherapy from January 23 to March 27, 2020 in the Department of Pediatric Hematology of Tongji Hospital, Wuhan. Every patient and their caregivers were well educated on personal protection and put it into effect at home and in hospital. Screening for COVID‐19 of all the patients and caregivers before admission was performed. Both clinical features and screening results including chest computerized tomography (CT); nucleic acid testing of nasopharyngeal, oropharyngeal or anal swabs; and quantitative antibodies (IgM and IgG) detecting of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) of these patients were described. RESULTS: The results of nucleic acid and antibodies (IgM and IgG) testing of all the 44 inpatients and their caregivers were negative. Abnormal chest CT images were observed in six symptomatic patients, while chest CT images of their caregivers did not show the changes related to viral pneumonia. These symptomatic patients all recovered after antibacterial combined with antifungal treatment, but without any antiviral agents. CONCLUSIONS: COVID‐19 infection could be prevented in pediatric patients with malignancies if proper protective measures were implemented. For patients presenting suspicious symptoms, comprehensive examinations should be carried out.

The virus is considered to be transmitted by respiratory droplets and contact. 2 In the early days of the COVID-19 infection outbreak, pediatric patients were rather rare, who were thought to be not susceptible to this virus. However, along with the emerging of familial aggregation, the number of children suffering from COVID-19 infection gradually increased. Meanwhile, cancer itself along with its treatment makes cancer patients more susceptible to infections due to weakened immune response to respiratory bacteria and virus. Liang et al 3 were the first to assess the impact of COVID-19 on cancer patients in China. They found that 1% of those infected with COVID-19 had a history of cancer, higher than the incidence of cancer in the Chinese population (0.29%), and the risk of developing severe events in COVID-19 disease is statistically significantly higher in patients with cancer, with a hazard ratio of 3.56.

By now, little has been known about the situation of pediatric cancer patients in the current pandemic. Wuhan is the epicenter of the outbreak of COVID-19 pandemic in China. Herein, we had an investigation on the management of the cancer patients undergoing treatment in the Department of Pediatric Hematology of Tongji Hospital, one of the main treatment centers for childhood cancers in Wuhan and even in Hubei province.

As the epicenter of the outbreak in China, intensive travel restrictions were imposed on Wuhan on January 23, 2020, as well as many other cities across Hubei province, to limit the spread of COVID-19 in China. 

Demographic information and clinical characteristics including exposure history, signs and symptoms, chest CT scan results, treatments, clinical outcomes, and laboratory findings of each patient were obtained from the electronic medical record system of Tongji Hospital.

SARS-CoV-2 RNA in pharyngeal or anal swab samples was identified by a reverse transcription PCR. The level of SARS-CoV-2 antibodies in the serum was detected by chemiluminescence assay.

The clinical features of patients in our investigation are displayed in 

COVID-19 pandemic has rapidly escalated into a global crisis, with a wide spread in more than 100 countries. The pathogen is a novel, highly contagious coronavirus named SARS-CoV-2, transmitted by respiratory droplets and close contact. 2 Most pediatric patients had mild symptoms, without fever or pneumonia. They had good prognosis and recovered within 1-2 weeks after disease onset. Close contact with COVID-19 infected patients is the main transmission route in children. 4 However, a study has now found out that younger children, especially infants (≤5 years) are more likely to develop into severe and critical cases than older children (≥6 years), probably contributed to immaturity of the immune system. 5 It has been acknowledged that viral infections, including other human coronaviruses, are associated with increased morbidity and mortality in immunocompromised children. 6 Thus, children with cancer, who are immunosuppressive due to underlying disease and related treatment, are at a high risk of infection with COVID-19.

In our investigation, no patient was diagnosed as COVID-19

infected. Appropriate management of pediatric cancer patients is particularly important for the prevention of COVID-19 infection when patients receive essential antitumor treatment at the same time. The measures we have taken are as listed below. 

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

A novel coronavirus from patients with pneumonia in China

Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China

Diagnosis and treatment of 2019 novel coronavirus infection in children: a pressing issue

Epidemiological characteristics of 2143 pediatrics patients with 2019 coronavirus disease in China

Characteristics and outcomes of coronavirus infection in children: the role of viral factors and an immunocompromised state

Treatment with oral ribavirin and IVIG of severe human metapneumovirus pneumonia (HMPV) in immune compromised child

Asymptomatic patients with novel coronavirus disease (COVID-19)

Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus

Prevention of COVID-19 infection in a pediatric oncology ward in Wuhan

This work was partially supported by the Huazhong University of Science and Technology emergency technology research project response to COVID-19, 2020kfyXGYJ020.

The authors declare that there is no conflict of interest.

https://orcid.org/0000-0002-5122-4296