Active or latent infection requiring resolution / prophylaxis before initiating VAC cytot...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-IFS-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-IFS`
Sources	`SRC-NCCN-PEDIATRIC-SARCOMA` `SRC-ONCOKB`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating VAC cytotoxic chemotherapy or larotrectinib / entrectinib for infantile fibrosarcoma: HBsAg-positive (vertical transmission risk in newborns; reactivation on cytotoxic chemo), anti-HBc-positive (occult HBV), HIV-positive (vertical transmission, ART coordination), active TB, or active CMV / herpes (immunocompromise on cytotoxic protocols).
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "finding": "active_cmv",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Pediatric infection screening is broader than adult — include CMV / herpes given immunosuppression on VAC and likelihood of reactivation in neonates / infants. HBsAg+ infants: confirm vertical transmission, consult pediatric hepatology, entecavir / tenofovir prophylaxis adapted to weight. HIV+ pediatric: ART coordination critical — TRK inhibitors (larotrectinib, entrectinib) are CYP3A4 substrates, avoid CYP3A4 inhibitors. Pneumocystis prophylaxis (TMP-SMX) is standard on cytotoxic arm. Surfaces hold via parallel pre-treatment workup.

Used By

No reverse references found in the YAML corpus.