THE MANAGEMENT OF A HOSPITAL-ACQUIRED INFLUENZA AH1N1 OUTBREAK IN ONCOLOGICAL PATIENTS. A CASE SERIES REPORT
Abstract
Despite prevailing concerns about the risk of influenza infection in immunocompromised patients, the actual rate and effect of infection in this population are not well characterized. We report a fulminant course of a hospital-acquired influenza AH1N1 infection in a public hospital for oncological patients. From a total of 60 persons (40 patients and 20 symptomatic health care workers - HCWs) screened by collecting nasal and pharyngeal swab samples, a number of 33 (24 patients and 9 HCWs) were found positive for respiratory viruses. Of them, 23 cases had influenza A virus (20 patients and 3 HCWs), all contacts with in-hospital influenza cases. The 4 first cases were diagnosed with influenza type A and subtype H1N1. In the epidemiological context we presumed all the other influenza A patients had the subtype H1N1. 9 influenza A patients were managed in the ICU: 5 patients for severe and 4 patients for mild/moderate ARDS. Oseltamivir treatment was instituted in all symptomatic patients and HCWs and in asymptomatic high-risk immune-compromised contacts. All ICU influenza patients and contacts were strictly isolated, had dedicated vaccinated HCWs wearing protective equipment and received oseltamivir treatment for prolonged periods until virus clearance or death. 5 patients died: 3 patients due to severe ARDS and intractable hypoxemia and 2 patients due to unrelated causes. The influenza-related death occurred in the first patients due to late diagnosis and late antiviral treatment institution. The epidemiological measures are described along with the hospital-acquired influenza outbreak course.
References
2. World Health Organization. Pandemic (H1N1) 2009 - update 112. 2010 Aug. Information Page. Available from: https://www.who.int/csr/don/2010_08_06/en/.
3. Kunisaki KM, Janoff EN. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. Lancet Infect Dis 2009; 9(8): 493-504.
4. Drozd-Sokołowska JE, Dulny G, Waszczuk-Gajda A, Wiktor-Jędrzejczak W. An isolated outbreak of influenza A H1N1 in a hematological department during post-pandemic period. Przegl Epidemiol. 2014; 68(4): 621-626.
5. Couch RB, Englund JA, Whimbey E. Respiratory viral infections in immunocompetent and immuno-compromised persons. Am J Med. 1997; 102(3A): 2-9.
6. Schepetiuk S, Papanaoum K, Qiao M. Spread of influenza A virus infection in hospitalized patients with cancer. Aust N Z J Med 1998; 28(4): 475-476.
7. Elting LS, Whimbey E, Lo W, Couch R, Andreeff M, Bodey GP. Epidemiology of influenza A virus infection in patients with acute or chronic leukemia. Support Care Cancer 1995; 3(3): 198-202.
8. Benjamin H, Chin-Yee, Katherine Mookman, ZafarHussain and Leonard A. Attitudes toward Vac-cination for Pandemic H1N1 and seasonal Influenza in patients with hematologic malignancies. J Support Oncol 2011; 9(4): 156-160.
9. Eibach D, Casalegno JS, Bouscambert M, Bénet T, Regis C, Comte B et al. Routes of transmission during a nosocomial influenza A(H3N2) outbreak among geriatric patients and healthcare workers. J Hosp Infect 2014; 86(3): 188-193.
10. Perez-Garcia F, Vásquez V, de Egea V, Catalán P, Rodríguez-Sánchez B, Bouza E. Influenza A and B Co-Infection: A Case-Control Study and Review of the Literature. Eur J of Clin Microbiol Infect Dis 2016; 35(6): 941-946.
11. Souza TM, Salluh JI, Bozza FA, Mesquita M, Soares M, Motta F et al. H1N1 pdm influenza infection in hospitalized cancer patients: clinical evolution and viral analysis. PLoS One 2010; 5(11): e14158.
12. Yousuf HM, Englund J, Couch R, Rolston K, Luna M, Goodrich J et al. Influenza among hospitalized adults with leukemia. Clin Infect Dis 1997; 24(6): 1095-1099.
13. Peck AJ, Englund JA, Kuypers J, Guthrie KA, Corey L, Morrow R, et al. Respiratory virus infection among hematopoietic cell transplant recipients: evidence for asymptomatic parainfluenza virus infection. Blood 2007; 110(5): 1681-1688.
14. Chemaly RF, Vigil KJ, Saad M, Vilar-Compte D, Cornejo-Juarez P, Perez-Jimenez C et al. A multi-center study of pandemic influenza A (H1N1) infection in patients with solid tumors in 3 countries: early therapy improves outcomes. Cancer. 2012; 118(18): 4627-4633.
15. Saad M, Hayajneh W, Mubarak S, Yousef I, Awad H, Elbjeirami W et al. Clinical presentations and outcomes of influenza infection among hematology/oncology patients from a single cancer center: pandemic and post-pandemic seasons. Scand J Infect Dis 2014; 46(11): 770-778.
16. Arrowood JR, Hayney MS. Immunization recommendations for adults with cancer. Ann Pharmacother 2002; 36(7-8): 1219-1229.
17. Melcher L. Recommendations for influenza and pneumococcal vaccinations in people receiving chemotherapy. Clin Oncol (R CollRadiol) 2005; 17(1): 12-15.
18. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host. Clin Infect Dis. 2014; 58(3): e44-100.
Additional Files
Published
Issue
Section
License
COPYRIGHT
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.
COPYRIGHT TRANSFER FORM FOR
REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /
THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI
We, the undersigned authors of the manuscript entitled
_____________________________________________________________________________________
_____________________________________________________________________________________
warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.
- we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
- the manuscript does not break the intellectual property rights of any other person.
- we have read the submitted version of the manuscript and we are fully responsible for the content.
Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):
- ______________________________/_________________________
- ______________________________/_________________________
- ______________________________/_________________________
N.B. All the authors must sign this form
