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Influenza a outbreak in an ambulatory stem cell transplant center.

Apewokin S, Vyas K, Lester LK, Grazzuitti M, Haselow DT, Wolfe F, Roberts M, Bellamy W, Kumar NS, Hunter D, Lee J, Laudadio J, Wheeler JG, Bradsher R - Open Forum Infect Dis (2014)

Bottom Line: Specimens were analyzed by using eSensor Respiratory Viral Panel.Twelve (39%) patients were hospitalized (median stay, 10 days; range, 2-20).No deaths occurred.

View Article: PubMed Central - PubMed

Affiliation: Myeloma Institute for Research and Therapy.

ABSTRACT

Background: In the era of cost-consciousness regarding healthcare , provision of medical services in an outpatient setting has become increasingly attractive. We report an influenza outbreak in an ambulatory stem cell transplant center in 2013 that highlights unique identification and infection control challenges in this setting.

Methods: Nasopharyngeal swabs were performed on patients with suspected influenza-like illnesses (ILI), defined by subjective fever or measured temperature of ≥37.7°C (≥100°F) with cough or sore throat during July 25, 2013 through August 7, 2013. In addition, testing was triggered by an elevated C-reactive protein (CRP). Specimens were analyzed by using eSensor Respiratory Viral Panel. Clinical and epidemiologic information was collected in real time, and frequencies were calculated on demographics, baseline clinical parameters, treatment methods, comorbidities, and symptoms of affected persons.

Results: Thirty-one patients had influenza A (H3N2) infection during July 25, 2013 through August 7, 2013. Only 7 patients (23%) met the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists ILI case definition. Twenty-five patients (81%) had received ≥1 transplant, with 13 (42%) having occurred within 1 year before the outbreak. Twenty-five patients (81%) had received B-cell active chemotherapy <60 days before influenza diagnosis, 6 (19%) were neutropenic, and 25 (81%) lymphopenic. Among clinical and laboratory markers analyzed, abnormal CRP was the most sensitive screening tool for influenza. Twelve (39%) patients were hospitalized (median stay, 10 days; range, 2-20). No deaths occurred.

Conclusions: Immunocompromised hosts with influenza have atypical presentations. Existing surveillance case definitions might be insufficient to reliably identify influenza outbreaks in such patients.

No MeSH data available.


Related in: MedlinePlus

Epidemiologic curve for influenza A (H3N2) cases in cancer treatment center, July 25–August 7, 2013.
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OFU050F2: Epidemiologic curve for influenza A (H3N2) cases in cancer treatment center, July 25–August 7, 2013.

Mentions: Thirty-one patients, 1 employee, and 4 family members tested positive for influenza A (H3N2) by the RVP among 124 persons tested during July 25, 2013 through August 7, 2013. Of the persons tested, 98 (79%) had received care in the outpatient transplant center, and positive results were only found among these. The characteristics of the 31 patients who tested positive are displayed in Table 1 and associated comorbidities in Table 2. The majority of these patients were male (22; 71%) and aged >60 years (21; 68%), typical of the demographics of the center's myeloma patient populations. The primary underlying cancer was MM in 26 (84%) of these patients, whereas lymphoma was present in 3 (10%) and acute myelogenous leukemia in 1 patient (3%). Fourteen (45%) patients had received influenza vaccination during the prior year. Twenty-five patients (81%) also had received at least 1 transplant, and 13 (42%) of these had been transplanted <1 year before the outbreak. Twenty-five patients (81%) had received B-cell active chemotherapy <60 days before their influenza diagnosis, and 6 (19%) were neutropenic. Four of 6 nontransplant patients identified had other underlying immunosuppressive states (eg, hepatitis C with no cirrhosis, human immunodeficiency virus infection, chronic renal failure, or diabetes). The symptom distribution reported by the influenza-positive patients is illustrated in Figure 1. The most common symptom at the time of presentation was cough (17; 55%), followed by sinus congestion (13; 42%). Fever was uncommon and was documented in only 8 (26%) patients and subjectively reported in 6 (19%) patients. Shortness of breath was present in 6 (19%) patients. A majority (21; 68%) of these patients also had elevated CRP values, in spite of ongoing corticosteroid therapy, which triggered testing for infectious agents, including community respiratory viruses. Only 7 (23%) patients met the CDC-CSTE definition for ILI. Of those patients with complete evaluations that included radiologic studies, 9 of 24 (37.5%) developed lower respiratory tract disease defined by the presence of new radiological abnormalities and/or oxygen saturation of 92% or less. Twelve (39%) patients were hospitalized in relation to their ILI symptoms for a median of 10 days (range, 2–20). Three patients required an intensive care unit stay, and although 1 of these patients required ventilatory support, that patient ultimately made a full recovery and was discharged. The timeline of the outbreak is displayed in Figure 2. All patients identified during the outbreak made a full recovery from the influenza infection and were in their usual state of health up to 5 months later. The involved employees and family members were asked to follow up with their primary physicians.Table 1.


Influenza a outbreak in an ambulatory stem cell transplant center.

Apewokin S, Vyas K, Lester LK, Grazzuitti M, Haselow DT, Wolfe F, Roberts M, Bellamy W, Kumar NS, Hunter D, Lee J, Laudadio J, Wheeler JG, Bradsher R - Open Forum Infect Dis (2014)

Epidemiologic curve for influenza A (H3N2) cases in cancer treatment center, July 25–August 7, 2013.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4281787&req=5

OFU050F2: Epidemiologic curve for influenza A (H3N2) cases in cancer treatment center, July 25–August 7, 2013.
Mentions: Thirty-one patients, 1 employee, and 4 family members tested positive for influenza A (H3N2) by the RVP among 124 persons tested during July 25, 2013 through August 7, 2013. Of the persons tested, 98 (79%) had received care in the outpatient transplant center, and positive results were only found among these. The characteristics of the 31 patients who tested positive are displayed in Table 1 and associated comorbidities in Table 2. The majority of these patients were male (22; 71%) and aged >60 years (21; 68%), typical of the demographics of the center's myeloma patient populations. The primary underlying cancer was MM in 26 (84%) of these patients, whereas lymphoma was present in 3 (10%) and acute myelogenous leukemia in 1 patient (3%). Fourteen (45%) patients had received influenza vaccination during the prior year. Twenty-five patients (81%) also had received at least 1 transplant, and 13 (42%) of these had been transplanted <1 year before the outbreak. Twenty-five patients (81%) had received B-cell active chemotherapy <60 days before their influenza diagnosis, and 6 (19%) were neutropenic. Four of 6 nontransplant patients identified had other underlying immunosuppressive states (eg, hepatitis C with no cirrhosis, human immunodeficiency virus infection, chronic renal failure, or diabetes). The symptom distribution reported by the influenza-positive patients is illustrated in Figure 1. The most common symptom at the time of presentation was cough (17; 55%), followed by sinus congestion (13; 42%). Fever was uncommon and was documented in only 8 (26%) patients and subjectively reported in 6 (19%) patients. Shortness of breath was present in 6 (19%) patients. A majority (21; 68%) of these patients also had elevated CRP values, in spite of ongoing corticosteroid therapy, which triggered testing for infectious agents, including community respiratory viruses. Only 7 (23%) patients met the CDC-CSTE definition for ILI. Of those patients with complete evaluations that included radiologic studies, 9 of 24 (37.5%) developed lower respiratory tract disease defined by the presence of new radiological abnormalities and/or oxygen saturation of 92% or less. Twelve (39%) patients were hospitalized in relation to their ILI symptoms for a median of 10 days (range, 2–20). Three patients required an intensive care unit stay, and although 1 of these patients required ventilatory support, that patient ultimately made a full recovery and was discharged. The timeline of the outbreak is displayed in Figure 2. All patients identified during the outbreak made a full recovery from the influenza infection and were in their usual state of health up to 5 months later. The involved employees and family members were asked to follow up with their primary physicians.Table 1.

Bottom Line: Specimens were analyzed by using eSensor Respiratory Viral Panel.Twelve (39%) patients were hospitalized (median stay, 10 days; range, 2-20).No deaths occurred.

View Article: PubMed Central - PubMed

Affiliation: Myeloma Institute for Research and Therapy.

ABSTRACT

Background: In the era of cost-consciousness regarding healthcare , provision of medical services in an outpatient setting has become increasingly attractive. We report an influenza outbreak in an ambulatory stem cell transplant center in 2013 that highlights unique identification and infection control challenges in this setting.

Methods: Nasopharyngeal swabs were performed on patients with suspected influenza-like illnesses (ILI), defined by subjective fever or measured temperature of ≥37.7°C (≥100°F) with cough or sore throat during July 25, 2013 through August 7, 2013. In addition, testing was triggered by an elevated C-reactive protein (CRP). Specimens were analyzed by using eSensor Respiratory Viral Panel. Clinical and epidemiologic information was collected in real time, and frequencies were calculated on demographics, baseline clinical parameters, treatment methods, comorbidities, and symptoms of affected persons.

Results: Thirty-one patients had influenza A (H3N2) infection during July 25, 2013 through August 7, 2013. Only 7 patients (23%) met the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists ILI case definition. Twenty-five patients (81%) had received ≥1 transplant, with 13 (42%) having occurred within 1 year before the outbreak. Twenty-five patients (81%) had received B-cell active chemotherapy <60 days before influenza diagnosis, 6 (19%) were neutropenic, and 25 (81%) lymphopenic. Among clinical and laboratory markers analyzed, abnormal CRP was the most sensitive screening tool for influenza. Twelve (39%) patients were hospitalized (median stay, 10 days; range, 2-20). No deaths occurred.

Conclusions: Immunocompromised hosts with influenza have atypical presentations. Existing surveillance case definitions might be insufficient to reliably identify influenza outbreaks in such patients.

No MeSH data available.


Related in: MedlinePlus