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Clin Infect Dis. 2018 Apr 7. doi: 10.1093/cid/ciy294. [Epub ahead of print]
A Five-year Prospective Multi-center Evaluation of Influenza Infection in Transplant Recipients.
Kumar D1, Ferreira VH1, Blumberg E2, Silveira F3, Cordero E4, Perez-Romero P4, Aydillo T4, Danziger-Isakov L5, Limaye AP6, Carratala J7, Munoz P8, Montejo M9, Lopez-Medrano F10, Farinas MC11, Gavalda J12, Moreno A13, Levi M14, Fortun J15, Torre-Cisneros J16, Englund JA17, Natori Y1, Husain S1, Reid G18, Sharma TS19, Humar A1.
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Abstract
Background:
Seasonal influenza infection may cause significant morbidity and mortality in transplant patients. The purpose of this study was to assess the epidemiology of symptomatic influenza infection post-transplant and determine risk factors for severe disease.
Methods:
Twenty centers in the U.S., Canada and Spain prospectively enrolled solid organ transplant (SOT) or stem cell transplant (HSCT) patients with microbiologically-confirmed influenza over five consecutive years (2010-15). Demographics, microbiology data, and outcomes were collected. Serial nasopharyngeal swabs were collected at diagnosis (day 0),3,6,11,18, 28 days and quantitative PCR for influenza A was performed.
Results:
We enrolled 616 patients with confirmed influenza (477 SOT; 139 HSCT); Most infections (77.3%) were influenza A. Pneumonia at presentation was seen in 134/606(22.1%). Antiviral therapy was given to 94.1% for a median of 5 days (range 1-42). 66.5% patients were hospitalized and 11.0% required ICU care with 8.0% needing mechanical ventilation. The receipt of vaccine in the same influenza season was associated with a decrease in disease severity as determined by the presence of pneumonia (OR 0.34 (95%CI 0.21-0.55), p<0.001) and ICU admission (OR 0.49 (95%CI 0.26-0.90), p=0.023). Similarly, early antiviral treatment (within 48 hours) was associated with improved outcomes. In patients with influenza A, pneumonia, ICU admission, and not being immunized were also associated with higher viral loads at presentation (p=0.018, p=0.008, p=0.024 respectively).
Conclusion:
Annual influenza vaccination and early antiviral therapy are associated with a significant reduction in influenza-associated morbidity, and should be emphasized as strategies to improve outcomes of transplant recipients.
PMID: 29635437 DOI: 10.1093/cid/ciy294
A Five-year Prospective Multi-center Evaluation of Influenza Infection in Transplant Recipients.
Kumar D1, Ferreira VH1, Blumberg E2, Silveira F3, Cordero E4, Perez-Romero P4, Aydillo T4, Danziger-Isakov L5, Limaye AP6, Carratala J7, Munoz P8, Montejo M9, Lopez-Medrano F10, Farinas MC11, Gavalda J12, Moreno A13, Levi M14, Fortun J15, Torre-Cisneros J16, Englund JA17, Natori Y1, Husain S1, Reid G18, Sharma TS19, Humar A1.
Author information
Abstract
Background:
Seasonal influenza infection may cause significant morbidity and mortality in transplant patients. The purpose of this study was to assess the epidemiology of symptomatic influenza infection post-transplant and determine risk factors for severe disease.
Methods:
Twenty centers in the U.S., Canada and Spain prospectively enrolled solid organ transplant (SOT) or stem cell transplant (HSCT) patients with microbiologically-confirmed influenza over five consecutive years (2010-15). Demographics, microbiology data, and outcomes were collected. Serial nasopharyngeal swabs were collected at diagnosis (day 0),3,6,11,18, 28 days and quantitative PCR for influenza A was performed.
Results:
We enrolled 616 patients with confirmed influenza (477 SOT; 139 HSCT); Most infections (77.3%) were influenza A. Pneumonia at presentation was seen in 134/606(22.1%). Antiviral therapy was given to 94.1% for a median of 5 days (range 1-42). 66.5% patients were hospitalized and 11.0% required ICU care with 8.0% needing mechanical ventilation. The receipt of vaccine in the same influenza season was associated with a decrease in disease severity as determined by the presence of pneumonia (OR 0.34 (95%CI 0.21-0.55), p<0.001) and ICU admission (OR 0.49 (95%CI 0.26-0.90), p=0.023). Similarly, early antiviral treatment (within 48 hours) was associated with improved outcomes. In patients with influenza A, pneumonia, ICU admission, and not being immunized were also associated with higher viral loads at presentation (p=0.018, p=0.008, p=0.024 respectively).
Conclusion:
Annual influenza vaccination and early antiviral therapy are associated with a significant reduction in influenza-associated morbidity, and should be emphasized as strategies to improve outcomes of transplant recipients.
PMID: 29635437 DOI: 10.1093/cid/ciy294
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