Influenza: Preparedness for an Inevitable “Emergency” for Oncology and BMT Units

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John R. Wingard From Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida.

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Influenza is a seasonal and pandemic threat to the general population. The effects can be devastating for cancer patients and those who have undergone blood and marrow transplantation (BMT). However, this impact can be minimized. Emergency preparedness is the key to mitigating the impact on the oncology and BMT services. Having a plan that provides a framework of preparedness and outlines steps to take in the event of a community outbreak is crucial. A vigorous immunization campaign for patients, household contacts, and health care staff early in the season is the single most important action. In the midst of an outbreak, the oncology and BMT teams should act to quickly identify patients with suspected infections, move infected patients and staff away from noninfected patients to prevent contact, and decide which patients require prevention or treatment with antiviral agents. Ongoing engagement by the entire team to evaluate the effectiveness of its actions and modify its plan as necessary will ensure success.

Correspondence: John R. Wingard, MD, Division of Hematology/Oncology, University of Florida College of Medicine, P.O. Box 103633, 1376 Mowry Road, Gainesville, FL 32610-3633. E-mail: wingajr@medicine.ufl.edu
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  • 1.

    Adams PF, Hendershot GE, Marano MA. Current estimates from the National Health Interview Survey, 1996. Vital Health Stat 10. 1999;200:1203.

  • 2.

    Thompson WW, Shay DK, Weintraub E et al.. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003;289:179186.

  • 3.

    Thompson WW, Shay DK, Weintraub E et al.. Influenza-associated hospitalizations in the United States. JAMA 2004;292:13331340.

  • 4.

    Cox NJ, Subbarao K. Global epidemiology of influenza: past and present. Annu Rev Med 2000;51:407421.

  • 5.

    Morse SS. Pandemic influenza: studying the lessons of history. Proc Natl Acad Sci U S A 2007;104:73137314.

  • 6.

    World Health Organization. Epidemic and pandemic alert and response (EPR). Available at: http://www.who.int/csr/disease/avian_influenza/en/. Accessed December 17, 2007.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Treanor JJ. Influenza virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Philadelphia: Elsevier; 2005:20602085.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Peck AJ, Englund JA, Kuypers J et al.. Respiratory virus infection among hematopoietic cell transplantation recipients: evidence for asymptomatic parainfluenza virus infection. Blood 2007;110:16811688.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hicks KL, Chemaly RF, Kontoyiannis DP. Common community respiratory viruses in patients with cancer: more than just ``common colds''. Cancer 2003;97:25762587.

  • 10.

    Ison MG, Hayden FG. Viral infections in immunocompromised patients: what's new with respiratory viruses? Curr Opin Infect Dis 2002;15:355367.

  • 11.

    Whimbey E, Englund JA, Couch RB. Community respiratory virus infections in immunocompromised patients with cancer. Am J Med 1997;102:1018.

  • 12.

    Whimbey E, Elting LS, Couch RB et al.. Influenza A virus infections among hospitalized adult bone marrow transplant recipients. Bone Marrow Transplant 1994;13:437440.

  • 13.

    Schepetiuk S, Papanaoum K, Qiao M. Spread of influenza A virus infection in hospitalised patients with cancer. Aust N Z J Med 1998;28:475476.

  • 14.

    Chemaly RF, Ghosh S, Bodey GP et al.. Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients: a retrospective study at a major cancer center. Medicine (Baltimore) 2006;85:278287.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Kempe A, Hall CB, MacDonald NE et al.. Influenza in children with cancer. J Pediatr 1989;115:3339.

  • 16.

    Whimbey E, Champlin RE, Couch RB et al.. Community respiratory virus infections among hospitalized adult bone marrow transplant recipients. Clin Infect Dis 1996;22:778782.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Arola M, Ruuskanen O, Ziegler T et al.. Respiratory virus infections during anticancer treatment in children. Pediatr Infect Dis J 1995;14:690694.

  • 18.

    Yousuf HM, Englund J, Couch R et al.. Influenza among hospitalized adults with leukemia. Clin Infect Dis 1997;24:10951099.

  • 19.

    Long CE, McBride JT, Hall CB. Sequelae of respiratory syncytial virus infections. A role for intervention studies. Am J Respir Crit Care Med 1995;151:16781680.

  • 20.

    Erard V, Chien JW, Kim HW et al.. Airflow decline after myeloablative allogeneic hematopoietic cell transplantation: the role of community respiratory viruses. J Infect Dis 2006;193:16191625.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Elting LS, Whimbey E, Lo W et al.. Epidemiology of influenza A virus infection in patients with acute or chronic leukemia. Support Care Cancer 1995;3:198202.

  • 22.

    Couch RB, Englund JA, Whimbey E. Respiratory viral infections in immunocompetent and immunocompromised persons. Am J Med 1997;102:29.

  • 23.

    Nichols WG, Guthrie KA, Corey L et al.. Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy. Clin Infect Dis 2004;39:13001306.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Boivin G, Hardy I, Tellier G et al.. Predicting influenza infections during epidemics with use of a clinical case definition. Clin Infect Dis 2000;31:11661169.

  • 25.

    Beigel JH, Farrar J, Han AM et al.. Avian influenza A (H5N1) infection in humans. N Engl J Med 2005;353:13741385.

  • 26.

    Yuen KY, Chan PK, Peiris M et al.. Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus. Lancet 1998;351:467471.

  • 27.

    de Jong MD, Simmons CP, Thanh TT et al.. Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia. Nat Med 2006;12:12031207.

  • 28.

    Tsang KW, Shim YS, Wong TK et al.. Possible case scenarios and logistic issues in H5N1 pandemic. Respirology 2006;11:520522.

  • 29.

    Wingard JR, Leahigh AK, Confer D et al.. Preparing for the unthinkable: emergency preparedness for the hematopoietic cell transplant program. Biol Blood Marrow Transplant 2006;12:12291238.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Fiore AE, Shay DK, Haber P et al.. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Recomm Rep 2007;56:154.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Jackson LA, Neuzil KM, Baggs J et al.. Compliance with the recommendations for 2 doses of trivalent inactivated influenza vaccine in children less than 9 years of age receiving influenza vaccine for the first time: a Vaccine Safety Datalink study. Pediatrics 2006;118:20322037.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Esposito S, Tremolati E, Bellasio M et al.. Attitudes and knowledge regarding influenza vaccination among hospital health workers caring for women and children. Vaccine 2007;25:52835289.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Gross PA, Gould AL, Brown AE. Effect of cancer chemotherapy on the immune response to influenza virus vaccine: review of published studies. Rev Infect Dis 1985;7:613618.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Machado CM, Cardoso MR, da Rocha IF et al.. The benefit of influenza vaccination after bone marrow transplantation. Bone Marrow Transplant 2005;36:897900.

  • 35.

    Centers for Disease Control and Prevention; Infectious Disease Society of America; American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep 2000;49:1-125, CE1–7. Erratum in MMWR Recomm Rep 2004;53:396.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Wilde JA, McMillan JA, Serwint J et al.. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281:908913.

  • 37.

    Carman WF, Elder AG, Wallace LA et al.. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet 2000;355:9397.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Potter J, Stott DJ, Roberts MA et al.. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients. J Infect Dis 1997;175:16.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Nichol KL, Treanor JJ. Vaccines for seasonal and pandemic influenza. J Infect Dis 2006;194(Suppl 2):S111118.

  • 40.

    Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A 2007;104:75827587.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Kumar D, Humar A. Pandemic influenza and its implications for transplantation. Am J Transplant 2006;6:15121517.

  • 42.

    Baum SG. Oseltamivir and the influenza alphabet. Clin Infect Dis 2006;43:445446.

  • 43.

    Vu D, Peck AJ, Nichols WG et al.. Safety and tolerability of oseltamivir prophylaxis in hematopoietic stem cell transplant recipients: a retrospective case-control study. Clin Infect Dis 2007;45:187193.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Johny AA, Clark A, Price N et al.. The use of zanamivir to treat influenza A and B infection after allogeneic stem cell transplantation. Bone Marrow Transplant 2002;29:113115.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Machado CM, Boas LS, Mendes AV et al.. Use of Oseltamivir to control influenza complications after bone marrow transplantation. Bone Marrow Transplant 2004;34:111114.

  • 46.

    Hayden FG. Antivirals for influenza: historical perspectives and lessons learned. Antiviral Res 2006;71:372378.

  • 47.

    Moscona A. Oseltamivir resistance—disabling our influenza defenses. N Engl J Med 2005;353:26332636.

  • 48.

    Nicholson KG, Aoki FY, Osterhaus AD et al.. Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial. Neuraminidase Inhibitor Flu Treatment Investigator Group. Lancet 2000;355:18451850.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Hayden FG, Osterhaus AD, Treanor JJ et al.. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenzavirus infections. GG167 Influenza Study Group. N Engl J Med 1997;337:874880.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Moscona A. Neuraminidase inhibitors for influenza. N Engl J Med 2005;353:13631373.

  • 51.

    Monto AS, Fleming DM, Henry D et al.. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenza A and B virus infections. J Infect Dis 1999;180:254261.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Kaiser L, Wat C, Mills T et al.. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med 2003;163:16671672.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Kaiser L, Keene ON, Hammond JM et al.. Impact of zanamivir on antibiotic use for respiratory events following acute influenza in adolescents and adults. Arch Intern Med 2000;160:32343240.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Treanor JJ, Hayden FG, Vrooman PS et al.. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group. JAMA 2000;283:10161024.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Aoki FY, Macleod MD, Paggiaro P et al.. Early administration of oral oseltamivir increases the benefits of influenza treatment. J Antimicrob Chemother 2003;51:123129.

  • 56.

    Hayden FG, Atmar RL, Schilling M et al.. Use of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med 1999;341:13361343.

  • 57.

    Monto AS, Robinson DP, Herlocher ML et al.. Zanamivir in the prevention of influenza among healthy adults: a randomized controlled trial. JAMA 1999;282:3135.

  • 58.

    Welliver R, Monto AS, Carewicz O et al.. Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial. JAMA 2001;285:748754.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Hayden FG, Belshe R, Villanueva C et al.. Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexposure prophylaxis. J Infect Dis 2004;189:440449.

    • PubMed
    • Search Google Scholar
    • Export Citation

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