Validation of RSV infections in pediatric transplant recipients reported to a national surveillance program: A PICNIC study

Abstract

Background: Respiratory syncytial virus (RSV) infections are a common cause of morbidity and mortality in pediatric transplant recipients. From 2010 to 2013, the Canadian Paediatric Surveillance Program (CPSP) performed national active surveillance of RSV infections occurring in the 2 years following hematopoietic stem cell transplant (HSCT) or solid organ transplant (SOT). This study aimed to validate accuracy of reporting of inpatient cases of post-transplant RSV infections to the CPSP. Methods: Transplant recipients <18 years with potential RSV infection were retrospectively identified from 9 tertiary-care pediatric centres, using ICD-10 codes for RSV and transplant from hospital and local laboratory information systems. Cases included after chart review were cross-referenced with the CPSP database. Sensitivity and positive predictive value (PPV) of the CPSP were calculated, and characteristics of reported and non-reported cases compared. Results: Of 27 cases found using this retrospective search of administrative databases, 8 (30%) had been reported to the CPSP; 10 additional cases reported to the CPSP were not detected by the study. Sensitivity of the CPSP was 30% (95% CI 14% to 50%), and PPV was 44% (95% CI 22% to 69%). The proportion of HSCTs was lower among cases reported to CPSP than among those not reported (13% versus 59%; p=0.03). More community-acquired RSV infections were noted in the reported group than in the non-reported group (100% versus 59%; p=0.04). Conclusion: The CPSP showed poor sensitivity and PPV for detecting RSV infections in pediatric transplant recipients. Additional strategies are needed to develop a surveillance program sufficiently sensitive to capture the burden of RSV in this population to inform preventive approaches.