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Clin Infect Dis. 2018 Oct 15;67(9):1322-1329. doi: 10.1093/cid/ciy294.

A 5-Year Prospective Multicenter Evaluation of Influenza Infection in Transplant Recipients.

Author information

1
Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
2
Division of Infectious Diseases, University of Pennsylvania, Philadelphia.
3
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pennsylvania.
4
Hospital Universitario Virgen del Rocío and Biomedicine Research Institute, Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.
5
Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio.
6
Division of Infectious Diseases, University of Washington, Seattle.
7
Hospital Universitario de Bellvitge, Barcelona, Spain.
8
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
9
Hospital Universitario de Cruces, Vizcaya, Spain.
10
Hospital Universitario 12 de Octubre, Madrid, Spain.
11
Hospital Universitario Marqués de Valdecilla, Cantabria, Spain.
12
Hospital Vall d'Hebron, Spain.
13
Hospital Clinic, Barcelona, Spain.
14
Division of Infectious Diseases, University of Colorado Hospital, Aurora.
15
Hospital Universitario Ramón y Cajal, Madrid.
16
Hospital Universitario Reina Sofía, Cordoba, Spain.
17
Pediatric Infectious Diseases, Seattle Children's Hospital, Washington.
18
Division of Infectious Diseases, Loyola University Medical Center, Chicago, Illinois.
19
Pediatric Infectious Diseases, Boston Children's Hospital, Massachusetts.

Abstract

Background:

Seasonal influenza infection may cause significant morbidity and mortality in transplant recipients. The purpose of this study was to assess the epidemiology of symptomatic influenza infection posttransplant and determine risk factors for severe disease.

Methods:

Twenty centers in the United States, Canada, and Spain prospectively enrolled solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) recipients with microbiologically confirmed influenza over 5 consecutive years (2010-2015). Demographics, microbiology data, and outcomes were collected. Serial nasopharyngeal swabs were collected at diagnosis and upto 28 days, and quantitative polymerase chain reaction for influenza A was performed.

Results:

We enrolled 616 patients with confirmed influenza (477 SOT; 139 HSCT). Pneumonia at presentation was in 134 of 606 (22.1%) patients. Antiviral therapy was given to 94.1% for a median of 5 days (range, 1-42 days); 66.5% patients were hospitalized and 11.0% required intensive care unit (ICU) care. The receipt of vaccine in the same influenza season was associated with a decrease in disease severity as determined by the presence of pneumonia (odds ratio [OR], 0.34 [95% confidence interval {CI}, .21-.55], P < .001) and ICU admission (OR, 0.49 [95% CI, .26-.90], P = .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 = .018, P = .008, and P = .024, respectively).

Conclusions:

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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