A multicenter evaluation of pandemic influenza A/H1N1 in hematopoietic stem cell transplant recipients

G. Reid, S. Huprikar, G. Patel, R. R. Razonable, S. Mossad, M. Levi, K. Gregg, S. Shoham, A. Humar, W. Adams, D. Kumar

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14 Scopus citations

Abstract

Background: Hematopoietic stem cell transplant (HSCT) recipients have increased morbidity from respiratory viral infections. Pandemic influenza A - A(H1N1)/pdm09 - in 2009-2010 was associated with increased severity of illness in patients with underlying co-morbidities including HSCT, but the factors that contribute to severe disease in HSCT patients are not well characterized. Methods: We conducted a multicenter review of microbiologically proven influenza A(H1N1)pdm09 in the HSCT population between April 2009 and April 2010 to determine factors that are associated with severe disease. Results: We identified 37 adult patients (26 allogeneic and 11 autologous HSCT recipients). Median time from transplant to diagnosis was 411 days (range 4 days-14.9 years). Three cases were hospital acquired. Twenty-eight of 37 (75.7%) had confirmed A(H1N1)pdm09. Presumed viral lower respiratory tract infection was present in 12/37 (32.4%) patients. Antiviral therapy was given to 33/37 (89%) patients, primarily oseltamivir (n = 24) and oseltamivir before or after another antiviral (n = 8). Excluding those with nosocomial A(H1N1)pdm09, 18/34 (52.9%) were hospitalized and 6 (33%) required admission to an intensive care unit. Mortality within 30 and 60 days of symptom onset was 7/37 (18.9%) and 11/37 (29.7%), respectively. Factors associated with mortality included nosocomial acquisition (P = 0.023), receipt of mycophenolate mofetil (P = 0.001), or antilymphocyte antibody (P = 0.005) within the past 6 months, reduced-intensity conditioning (P = 0.027), and bacteremia (P = 0.021). Conclusions: A(H1N1)pdm09 infection was particularly severe in HSCT recipients, specifically among those receiving augmented immunosuppression for graft-versus-host disease. The high mortality of the nosocomial cases highlights the need for strict infection-control measures in hospitals during influenza outbreaks.

Original languageEnglish (US)
Pages (from-to)487-492
Number of pages6
JournalTransplant Infectious Disease
Volume15
Issue number5
DOIs
StatePublished - Oct 1 2013

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Keywords

  • Antiviral therapy
  • H1N1
  • HSCT
  • Viral infection

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

Cite this

Reid, G., Huprikar, S., Patel, G., Razonable, R. R., Mossad, S., Levi, M., Gregg, K., Shoham, S., Humar, A., Adams, W., & Kumar, D. (2013). A multicenter evaluation of pandemic influenza A/H1N1 in hematopoietic stem cell transplant recipients. Transplant Infectious Disease, 15(5), 487-492. https://doi.org/10.1111/tid.12116