Prevention and Treatment of Influenza in Immunocompromised Patients
Section snippets
General Prevention Measures
Although community acquisition of infection accounts for the majority of reported cases of influenza, many patients have apparently acquired their infections nosocomially.1, 2, 11, 12, 13, 14Small particle aerosols appear to be important in the spread of influenza viruses, although transmission by large droplets, fomites, and hands contaminated with infectious secretions is also possible. Respiratory isolation of hospitalized patients and restriction of ill staff members and visitors should
Immunization
Inactivated influenza virus vaccines are available for prevention. Patients with chronic immunosuppression, including that caused by medications, are considered one of the risk groups for which influenza immunization is indicated.[22]Most of the severe cases of influenza reported in transplant recipients have occurred in those without prior immunization. The immunogenicity and, particularly, efficacy of influenza vaccines have been incompletely characterized for many groups of immunosuppressed
Antiviral Chemoprophylaxis
Amantadine and rimantadine inhibit influenza A viruses and are highly effective in preventing influenza illness in immunocompetent persons.[40]Chemoprophylaxis has not been rigorously studied in transplant and highly immunocompromised patients. However, results from several trials indicate that these agents should provide at least partial protection against influenza illness in such patients. In one study, seasonal amantadine prophylaxis was 71% effective in preventing confirmed influenza A
Antiviral Therapy
Treatment of established infection in immunocompromised patients presents an especially severe test for an antiviral intervention. No randomized, controlled data concerning antiviral treatments exist, and the limited information available about the natural history of these infections makes it difficult to determine if treatment has affected outcome. Most patients have recovered from influenza without specific antiviral therapy (Table 3). The patients who are most ill may also be those most
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Cited by (93)
Influenza Viruses
2018, Principles and Practice of Pediatric Infectious DiseasesHow I treat respiratory viral infections in the setting of intensive chemotherapy or hematopoietic cell transplantation
2016, BloodCitation Excerpt :In outbreak settings, HCT recipients should receive vaccine immediately if ≥4 months posttransplant, and chemoprophylaxis with oseltamivir or zanamivir should be initiated for 2 weeks after vaccination while immunity develops.19 Chemoprophylaxis is also recommended for patients <24 months after HCT or who are ≥24 months post-HCT and substantially immunocompromised, regardless of vaccination history.91,92 Oseltamivir resistance may emerge when using widespread prophylaxis93,94; drug resistance patterns of circulating strains should be considered when initiating prophylaxis and/or preemptive therapy.
Toll-like receptor 9 ligand D-type oligodeoxynucleotide D35 as a broad inhibitor for influenza A virus replication that is associated with suppression of neuraminidase activity
2016, Antiviral ResearchCitation Excerpt :Influenza viruses cause annual epidemics and occasional pandemics in humans, resulting in high mortality primarily in the elderly and other high-risk populations (Hayden, 1997; Whitley and Monto, 2006).
Dextran sulfate-resistant A/Puerto Rico/8/34 influenza virus is associated with the emergence of specific mutations in the neuraminidase glycoprotein
2014, Antiviral ResearchCitation Excerpt :Influenza viruses cause annual epidemics and occasional pandemics in humans, resulting in high mortalities primarily in the elderly and other high-risk populations (Hayden, 1997; Whitley and Monto, 2006).
Vaccination in solid organ transplant patients
2014, VacunasInfluenza Viruses
2012, Principles and Practice of Pediatric Infectious Diseases, Fourth Edition