Clinical features and outcome of 2009-influenza A (H1N1) after allogeneic hematopoietic SCT

Abstract

The impact of the 2009 H1N1-Influenza A (H1N1) pandemic in allogeneic hematopoietic SCT recipients (allo-HSCT) is not yet well defined. Between May 2009 and May 2010, all allo-HSCTs who presented with respiratory symptoms were screened for the presence of the H1N1 virus. Oseltamivir resistance was assessed and chart reviews were performed for all cases. In all, 51 of 248 (20%) allo-HSCT recipients followed at our outpatient clinic were screened. We identified 10 patients with H1N1 infection. Close contact with children was the most commonly suspected mode of transmission. Upper and lower respiratory tract infections were present in eight and five patients, respectively. Lymphopenia (o1 G/L) was the most frequent biological abnormality. High immunosuppression was responsible for severe infection requiring mechanical ventilation associated with prolonged viral shedding in three patients who had significant comorbidities and GvHD. Two of them developed an oseltamivirresistant strain and both patients died subsequently despite intensive therapy, resulting in a case fatality rate of 20%. In conclusion, although most allo-HSCTs had mild symptoms from H1N1 infection, severe immunosuppression and emergence of oseltamivir resistance were likely responsible for a substantial morbidity, further supporting the need for vaccination and monitoring of close contacts, especially children.

Parainfluenza Virus Lower Respiratory Tract Disease After Hematopoietic Cell Transplant: Viral Detection in the Lung Predicts Outcome

“…Although our study focused on patients infected with PIV, we hypothesize that the outcome differences seen among the "possible" disease category may also exist for other respiratory viruses. Indeed, most studies and guidelines of non-PIV respiratory viruses include "possible" cases in their definitions of LRTD [7,[15][16][17][18][19]. Additional studies are needed to extend these results to other respiratory virus infections.…”

A Randomized Trial of One versus Two Doses of Influenza Vaccine after Allogeneic Transplantation

“…For instance, Nichols et al noted a 10% mortality within 30 days of influenza infection after HSCT (8), likely related to improved supportive care measures (9). While encouraging, the recent development of antiviral resistant strains of influenza, that have been reported in HSCT patients, clearly have the potential to increase overall mortality(10). …”

BCSH/BSBMT/UK clinical virology network guideline: diagnosis and management of common respiratory viral infections in patients undergoing treatment for haematological malignancies or stem cell transplantation

“…;Ison et al, 2003;Martino et al, 2005;Johnstone et al, 2008;Schiffer et al, 2009;Choi et al, 2011;Renaud & Campbell, 2011;Shah & Chemaly, 2011;Chemaly et al, 2012a;Mohty et al, 2012;Widmer et al, 2012;Jacobs et al, 2013a;Renaud et al, 2013;Shah et al, 2013;Kim et al, 2014).…”