Influenza A (H1N1): outbreak management in a dialysis unit and clinical outcomes of infection in chronic hemodialysis patients

Abstract

Introduction: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. Methods: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. Results: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p<0.002). The most common symptoms were fever (92%), cough (92%), and rhinorrhea (83%). Early empirical antiviral treatment with oseltamivir was started in symptomatic patients and infection control measures, including the intensification of contact-reduction measures by the staff members, antiviral chemoprophylaxis to asymptomatic patients undergoing HD in the same shift of infected patients, and dismiss of staff members suspected of being infected, were implemented to control the spread of infection in the dialysis unit. Conclusion: The clinical course of infection with H1N1 in our patients was favorable. None of the patients developed severe disease and the strategies adopted to control the outbreak were successful.

Avaliação da prevalência de H1N1 no Brasil entre 2016 e 2020 e a importância da vacinação como estratégia na redução dos casos

“…A apresentação clínica da infecção pela H1N1 pode variar de sintomas respiratórios leves a insuficiência respiratória aguda. Em idosos, a elevação do risco de mortalidade está relacionada à pneumonia e complicações cardíacas decorrentes da infecção por H1N1, já em crianças, de acordo com Machado et al (2020), a carga de infecção respiratória aguda inferior (IRAI) associada à gripe é substancial (Ventura et al, 2020).…”

“…A disfunção imune tem causas complexas e multifatoriais, incluindo defeitos na ativação do complemento, função de neutrófilos, função de células B e células T. Outro fator de risco é a realização de hemodiálise (HD) em sessões concomitantes, o que implica em exposição a outros pacientes e profissionais de saúde, facilitando a contaminação cruzada dentro da unidade de diálise. Além disso, a disseminação viral prolongada em indivíduos imunossuprimidos pode aumentar o risco de transmissão viral (Ventura et al, 2020).…”

“…Entre março e abril de 2016, Ventura et al (2020), avaliaram 16 indivíduos infectados pelo vírus H1N1, sendo 12 (19,4%) pacientes adultos com DRT em terapia regular de HD e 4 (12,5%) funcionários, durante um surto de H1N1 na unidade de diálise do Hospital Sírio-Libanês, hospital privado da cidade de São Paulo. A taxa de internação hospitalar foi de 25%, superior aos 1-7% estimados para a população geral de indivíduos infectados pelo H1N1.…”

The recommendations and the way forward to fight human infections caused by influenza A (H1N1) in Brazil

“…The influenza A virus is the most common infectious agent in humans, it infects about twenty per cent of the world's population while causing millions of hospitalizations each year and cases of death have also been recorded [ 2 ]. Influenza A (H1N1) is a pulmonary pathology of viral origin with very high human-to-human transmission, this virus belongs to the family of type A Influenza viruses, they evolve regularly while modifying the protein membrane which constitutes their envelope [ 3 ]. co-morbidities and immunosuppression represent only a part of most cases and the complications they causes.…”

Time to Expand Access and Utilization of Home Dialysis: Lessons From the COVID-19 Pandemic

“…2 An H1N1 outbreak in Brazil in 2016 led to infection in 20% of all patients in one dialysis clinic. 3 Dialysis patients are also uniquely susceptible to significant morbidity and mortality from infectious diseases by virtue of reduced host defenses from end stage kidney disease.…”