Influenza in immunosuppressed populations: A review of infection frequency, morbidity, mortality, and vaccine response

Pulmonary Section, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
The Lancet Infectious Diseases (Impact Factor: 22.43). 09/2009; 9(8):493-504. DOI: 10.1016/S1473-3099(09)70175-6
Source: PubMed


Patients that are immunosuppressed might be at risk of serious influenza-associated complications. As a result, multiple guidelines recommend influenza vaccination for patients infected with HIV, who have received solid-organ transplants, who have received haemopoietic stem-cell transplants, and patients on haemodialysis. However, immunosuppression might also limit vaccine responses. To better inform policy, we reviewed the published work relevant to incidence, outcomes, and prevention of influenza infection in these patients, and in patients being treated chemotherapy and with systemic corticosteroids. Available data suggest that most immunosuppressed populations are indeed at higher risk of influenza-associated complications, have a general trend toward impaired humoral vaccine responses (although these data are mixed), and can be safely vaccinated--although longitudinal data are largely lacking. Randomised clinical trial data were limited to one study of HIV-infected patients with high vaccine efficacy. Better trial data would inform vaccination recommendations on the basis of efficacy and cost in these at-risk populations.

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    • "Influenza virus infection is very common and although usually self-limiting, it remains a significant cause of morbidity in specific vulnerable populations like immunocompromised patients [1] [2]. Treatment with neuraminidase inhibitors is recommended, but viral mutations that reduce susceptibility to oseltamivir occur more often in this group of patients [3] [4]. "
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    ABSTRACT: Immunocompromised patients are at increased risk of complications of influenza virus infection. We report on two critically ill patients on immunosuppressive medication with influenza pneumonia. In both patients, oseltamivir monotherapy did not result in clearance of the virus after 18 and five days, respectively. After adding zanamivir and amantadine to the treatment, PCRs on pharyngeal and/or plasma specimens turned negative in both patients after four and three days, respectively. We suggest, that in critically ill patients with influenza A H1N1 infection, treatment efficacy should be monitored closely and treatment with a combination of antiviral drugs should be considered.
    09/2015; 2015(5, article 2):1-4. DOI:10.1155/2015/504975
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    • "Progressed influenza infections can lead to severe complications including bronchitis, pneumonia, secondary bacterial infections, acute respiratory distress and cardiovascular complications, which all can lead to death if left untreated. Individuals with a weakened immune system, such as immunocompromised patients, elderly and young children [1] [2] [3], are particularly vulnerable to influenza infections and are thus classified as high-risk populations. Global influenza epidemics emerge seasonally and typically occur during the winter seasons of the northern and southern hemispheres. "
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    ABSTRACT: Vaccination is the most effective method to prevent influenza infection. However, current influenza vaccines have several limitations. Relatively long production times, limited vaccine capacity, moderate efficacy in certain populations and lack of cross-reactivity are important issues that need to be addressed. We give an overview of the current status and novel developments in the landscape of influenza vaccines from an interdisciplinary point of view. The feasibility of novel vaccine concepts not only depends on immunological or clinical outcomes, but also depends on biotechnological aspects, such as formulation and production methods, which are frequently overlooked. Furthermore, the next generation of influenza vaccines is addressed, which hopefully will bring cross-reactive influenza vaccines. These developments indicate that an exciting future lies ahead in the influenza vaccine field. Copyright © 2015. Published by Elsevier B.V.
    European journal of pharmaceutics and biopharmaceutics: official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V 06/2015; 9. DOI:10.1016/j.ejpb.2015.05.023 · 3.38 Impact Factor
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    • "In the U.S. general population, influenza has been associated with an estimated 36,000 deaths each year (Durham et al., 2011). In PLWH, influenza infection may have an increased severity of symptoms and be of a prolonged duration when compared with the general population (Kunisaki & Janoff, 2009). While vaccination has been shown to be safe and effective for the prevention of influenza infection in PLWH, there is limited evidence that vaccination lowers the risk of all-cause pneumonia, hospitalization, or mortality (Remschmidt, Wichmann, & Harder, 2014). "

    The Journal of the Association of Nurses in AIDS Care: JANAC 03/2015; 26(2):201-7. DOI:10.1016/j.jana.2014.11.006 · 1.27 Impact Factor
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