Outcome of influenza infections in outpatients after allogeneic hematopoietic stem cell transplantation

Khanna, Nina; Steffen, Ingrid; Studt, Jan Dirk; Schreiber, Adrian; Lehmann, Thomas; Weisser, Maja; Flückiger, Ursula; Gratwohl, Aloïs; Halter, Joerg; Hirsch, Hans H.

doi:10.1111/j.1399-3062.2008.00362.x

Cited by 114 publications

(133 citation statements)

References 13 publications

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“…Interestingly, LRTI, prolonged viral shedding, hospitalization, longer antiviral treatment, ventilator requirement and H1N1 resistance were documented only in SID patients. Lymphopenia, which has been previously reported as a risk factor for LRTI, both for community-acquired RVI [1][2][3][4]33 and for H1N1 influenza 9,[14][15][16][17][18]26 was observed in six patients at the time of diagnosis. Chronic GvHD and its corollary of long-term immunosuppression has also been associated with the risk of developing RVI and LRTI.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital-acquired infection was defined as symptom onset 47 days after admission. The immunodeficiency status was graded as published elsewhere, 4 either as severe (SID) or MID (moderate). Lymphopenia was defined by lymphocyte counts o1 G/L.…”

Section: Data Collection and Analysismentioning

confidence: 99%

“…4,5 Influenza pneumonia-related mortality can reach 25%, particularly in those patients with chronic GvHD. 1,2 Recently, a new type of influenza A (H1N1) virus, characterized by antigenically distant surface Ags compared with human viruses, 6 has been involved in a worldwide pandemic outbreak that began in Mexico in March 2009.…”

Section: Introductionmentioning

confidence: 99%

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

Mohty

Thomas

Vukicevic

et al. 2011

Bone Marrow Transplant

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collection and Analysismentioning

confidence: 99%

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

Mohty

Thomas

Vukicevic

et al. 2011

Bone Marrow Transplant

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“…The prophylactic and therapeutic efficacy of antiviral agents in SOT and HSCT recipients with influenza has been shown in case series [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…While some studies have shown the effectiveness of oseltamivir for treatment of influenza in transplant recipients [14,15], and some support its use for seasonal prophylaxis [16] rational use of antiviral agents is necessary, since monotherapy may predispose to mutational pressure and selection of antiviral-resistant strains [47]. New antiviral agents for influenza treatment for the general population and specifically for transplant recipients are awaited [48].…”

mentioning

confidence: 99%

Characteristics of Transplant Recipients Who Developed Influenza in 2007-08 Despite Influenza Vaccination

Mossad

Yen‐Lieberman

Shrestha

et al. 2013

J Vaccines Vaccin 2013

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Background: Influenza vaccination may be less immunogenic in transplant recipients than in healthy people. Influenza A (H1N1) and B circulating viruses during the 2007-2008 epidemic were different from those contained in that season's vaccine. In that epidemic, influenza vaccine effectiveness against culture-confirmed influenza was 44%.Objective: To describe clinical, immunological, and virological characteristics of 18 transplant recipients who developed influenza during the 2007-08 epidemic despite influenza vaccination (tx-vac-flu), and compare them to 6 transplant recipients who developed influenza in the absence of influenza vaccination (tx-no vac-flu), 12 previously healthy people who developed influenza (healthy-flu), and 13 transplant recipients who received influenza vaccination and did not develop influenza (tx-vac-no flu). Methods:Case ascertainment was through microbiology and electronic medical records. A case of influenza was defined by a clinical presentation of an influenza-like illness, plus a positive influenza A or B multiplex real time polymerase chain reaction (Prodesse, Inc. Waukesha, WI) on a nasopharyngeal swab. Results:Of the 36 patients with influenza, 22 had influenza A, and 15 had influenza B (1 transplant recipient had both serotypes simultaneously). Types of transplant were lung (11), hematopoietic stem cell (8), heart (7), liver (3), kidney (3), kidney + pancreas Immunoglobulin G levels and immune function assay levels were not significantly different between the 3 transplant groups. There were no statistically significant differences in the incidence of fever, headache, cough, rhinorrhea, sore throat, malaise, shortness of breath, exposure to contacts with similar symptoms, presence of infiltrates on chest roentgenograms, or the estimated influenza viral loads among the 3 groups who had influenza. Patients in the tx-vac-flu group were treated with oseltamivir significantly more frequently than the healthy-flu group [94% vs. 50% (P=0.0006)], but not the tx-no vac-flu group [100% (P=0.7)]. Duration of treatment with oseltamivir was not significantly different among the 3 groups who had influenza. Patients in the tx-vac-flu group had concomitant infections significantly more frequently than the healthy-flu group [44% vs. 8% (P=0.043)], but not the tx-no vac-flu group. Patients in the tx-vac-flu group developed pneumonia, and were hospitalized for management of influenza significantly more frequently than patients in the healthy-flu group (P=0.031 and P=0.00007; respectively). Only one patient (6%) in the tx-vac-flu group and none in the tx-no vac-flu or healthy-flu groups required admission to an intensive care unit and mechanical ventilation following influenza. No patients died as a result of influenza.Conclusions: Influenza vaccination did not alter clinical presentation of influenza in transplant recipients, but these patients were hospitalized and developed pneumonia more frequently than healthy people. Transplant recipients who developed influenza despite influenza vacc...

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Antivirals: Targets and use

Ison¹,

Hay²

2013

Textbook of Influenza

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Outcome of influenza infections in outpatients after allogeneic hematopoietic stem cell transplantation

Abstract: Oseltamivir is well tolerated and may reduce mortality of influenza virus-infected patients after HSCT. PCR may help to optimize diagnosis and to monitor treatment strategies.

Cited by 114 publications

References 13 publications

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

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

Characteristics of Transplant Recipients Who Developed Influenza in 2007-08 Despite Influenza Vaccination

Antivirals: Targets and use

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