Children with congenital immune defects – a high-risk group for blood-borne infections (hepatitis B and C)

Objective. Determination of the risk factors for hepatitis B (HB) and C (HC) infection in patients with congenital immune defects (CID), a high-risk group among patients treated in pediatric oncohematology departments and clinics.

Materials and methods. The study included 1,587 patients with CID, aged 0 to 18 years, admitted to the Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology in the period from 2014 to 2022 to undergo diagnostic and therapeutic procedures that are not available in regional clinics. Among them, there were 37 patients with HCV and 40 with HBV. For the assessment of the invasive burden and comparison, 5 clinical groups were identified: patients with CID, benign blood diseases (BBD), hemoblastoses (HB), solid malignant tumors (SMT), benign neoplasms (BN). The invasive load was assessed in 500 patients (100 from each clinical group, patients were selected randomly). The invasive load was assessed by the level of infusion load (the number of parenteral drugs administered), the frequency of diagnostic blood sampling, the number of blood doses and its components, the number of surgeries, bone marrow and lumbar punctures, diagnostic endoscopic studies with counting the number of manipulations per 1 patient per day. The median was calculated to assess the invasive load.

Results. Patients with CID were the group with the highest risk of contracting blood-borne infections among clinical groups of patients: HBV infection incidence among them was 2.5% (12.5 times higher than in patients with SMT, 3.1 times higher than in HB, 2.8 times higher than in BBD, 62,5 times higher than in BN), HCV - 2.3% (1.9, 1.8, 1.8 and 3.8 times higher, respectively). Patients with CID were characterized by the lowest invasive burden: 2.2 interventions per day per 1 patient, which was 5 times less than in patients with HB, 2.8 times less than in patients with SMT, 2.3 times less than in patients with BBD, 1.9 times less than in patients with BN. The medians of invasive interventions for patients with CID were positive only for infusion load and diagnostic blood sampling, but were lower than in patients with HB (the group with the highest invasive load), by 14 and 1.3 times, respectively. The invasive load in patients with CID in a specialized hospital setting was low, but during the long-term diagnostic search for their primary diagnosis, accompanied by frequent hospitalizations due to infectious diseases, children were exposed to a long-term massive invasive load in conditions not intended for immunocompromised patients.

Conclusion. The leading risk factor for infection with HBV and HCV in children with CID is the impact of unsafe invasive factors, such as parenteral drug administration and diagnostic blood sampling. Deficiency of the T-cell link of immunity, characteristic of such patients, is of no small importance.