1098. Epidemiology of Influenza and Poor Efficacy of Influenza Immunization in Hematopoietic Stem Cell transplantation (SCT) and non-SCT cancer patients (2009-2011)
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • POSTER IDSA Urday.pdf (722.2 kB)
  • Background:  

     The epidemiology of 2009 H1N1 influenza (H1N1) and effectiveness of influenza immunization in hematopoietic stem cell transplantation (SCT) patients (pts) and non-SCT cancer pts poorly defined. We report our recent experience with influenza at the Karmanos Cancer Center (KCC).

    Methods: 

    Medical records were reviewed of SCT and non-SCT cancer pts with influenza (2009-2011 seasons). The study was done at the KCC, a 120 bed cancer hospital.

    Results:  

    32 pts had symptomatic laboratory-confirmed influenza; 59% SCT and 41% non-SCT cancer pts. Non-H1N1 influenza A 56%, H1N1 28% and influenza B 16% were the viruses identified. Overall, median age was 50 yr (range 21-81), 44% were obese (BMI>30kg/m2), 46% had chronic lung disease, 75% were on immunosuppressive therapy. Cough 81% and fever 66% were the common symptoms. Lymphopenia during influenza was noted in 69%. Lower airway disease was evident in 8/23 (35%) pts with chest radiographs. Nineteen (59%) pts required hospitalization (median stay- 9.5 days), 3/19 (16%) needed mechanical ventilation and 1 died. In the 19 SCT pts (84% allogeneic), influenza occurred at median 489 d post-SCT; 79% had GVHD, 36% had bronchiolitis obliterans.

    Characteristic

    SCT pts (n=19)

    Non-SCT cancer pts (n=13)

    Median age (yr)

    44 (range 26-65)

    56 (range 21-76)

    Duration of symptoms

    7 d (range 1-30)

    3 d (range 1-14)

    Hospitalization

    42%

    84%

    Lymphopenia

    53%

    76%

    Non-H1N1 influenza A

    63% (13/17 pts vaccinated=76%)

    46% (4/6 pts vaccinated=67%)

    H1N1

    11%

    54% (4/7 pts vaccinated=57%)

    influenza B

    26%

    0

    ICU / mechanical ventilation

    2 / 1

    2 / 2

    Deaths

    1

    0

    Conclusion:

    Influenza causing lymphopenia and lower airway disease necessitating hospitalization is common in SCT and non-SCT cancer pts especially those with underlying lung disease. Break-through influenza despite influenza vaccination occurs frequently. Better preventive strategies for influenza are needed in this immunocompromised population.


    Subject Category: O. Transplant infectious diseases

    Varinia Urday-Cornejo1, Christopher Croswell2, Odaliz Abreu-Lanfranco, MD3, Teena Chopra, MD4, Lisa Engles, MT ASCP, CIC5, MaryEllen Lesperance, RN, MSN, CHSP5, Sanjay Revankar, MD3, Pranatharthi Chandrasekar, MD6 and George Alangaden, MD4, (1)Infectious Diseases, Wayne State University, Detroit , MI, (2)School of Medicine, Wayne State University, Detroit, MI, (3)Infectious diseases, Wayne State University, Detroit, MI, (4)Detroit Medical Center/Wayne State University, Detroit, MI, (5)Karmanos Cancer Institute, Detroit, MI, (6)Infectious diseases, Wayne State Univiversity, Detroit, MI

    Disclosures:

    V. Urday-Cornejo, None

    C. Croswell, None

    O. Abreu-Lanfranco, None

    T. Chopra, None

    L. Engles, None

    M. Lesperance, None

    S. Revankar, None

    P. Chandrasekar, None

    G. Alangaden, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.