Influenza prevention and treatment in transplant recipients and immunocompromised hosts

Abstract

The host immune response is critical for the control and clearance of influenza virus after initial infection. Unfortunately, key components of the innate and adaptive responses to influenza are compromised in solid organ and hematopoietic stem cell transplant recipients. As a result, influenza in these key patient populations is associated with prolonged viral shedding, more frequent complications, including bacterial and fungal superinfections and rejection, and increased mortality. While vaccine is the critical prophylaxis strategy in other populations, response rates are diminished, particularly early post‐transplant, among immunocompromised patients. Prospective data suggest that antiviral prophylaxis represents an effective and safe alternative to vaccine in patients who would be predicted to have poor responses to influenza vaccine. While there have not been randomized, controlled studies of antiviral therapy completed in solid organ or hematopoietic stem cell patient populations, observational data suggest that early therapy is associated with reduced rates of progression to lower airway involvement, morbidity, and mortality. Further studies are needed to define the optimal regimen, dose, duration, and endpoint to define successful treatment.

Pharmacological Characterization of the Spectrum of Antiviral Activity and Genetic Barrier to Drug Resistance of M2-S31N Channel Blockers

“…selection pressure is combination therapy. Combination therapy has a proven track record of reducing resistance evolution and side effects, and it is highly recommended for people with compromised immune systems who might need extended antiviral treatment to clear the viruses (Ison, 2013). As an example, the triple-drug combination therapy, commonly known as highly active antiretroviral therapy, was shown to be more effective over single-or double-drug combination therapy in suppressing human immunodeficiency virus drug resistance (Gulick et al, 1997(Gulick et al, , 1998De Clercq, 2007).…”

Preparing for the 2018‐2019 influenza season

“…Treatment dosing is weight based in children and should be given for 5 days or longer if symptoms do not improve. Immunocompromised children may require longer duration of treatment …”

Travellers and influenza: risks and prevention

“…29 Underlying health conditions especially associated with an increased risk for complicated influenza are immunecompromised individuals, either due to the underlying disease, or to immunomodulatory treatment, like organ transplant recipients and those taking medication for autoimmune conditions. 30 Furthermore, chronic pulmonary disease 31 , diabetes mellitus, cardiovascular disease and malignancies are also considered risk factors for developing severe influenza or complications. 32 Impact on Travellers Even a relatively mild, self-limiting seasonal influenza virus infection can have drastic impact on the success of a holiday or business trip.…”