Abstract
BackgroundCompared with immunocompetent patients, immunosuppressed patients have higher morbidity and mortality, a longer duration of viral shedding, more frequent complications, and more antiviral resistance during influenza infections. However, few data on this population in China have been reported. We analysed the clinical characteristics, effects of antiviral therapy, and risk factors for admission to the intensive care unit (ICU) and death in this population after influenza infections and explored the influenza vaccination situation for this population.MethodsWe analysed 111 immunosuppressed inpatients who were infected with influenza virus during the 2015–2020 influenza seasons. Medical data were collected through the electronic medical record system and analysed. Univariate analysis and multivariate logistics analysis were used to identify risk factors.ResultsThe most common cause of immunosuppression was malignancies being treated with chemotherapy (64.0%, 71/111), followed by haematopoietic stem cell transplantation (HSCT) (23.4%, 26/111). The most common presenting symptoms were fever and cough. Dyspnoea, gastrointestinal symptoms and altered mental status were more common in HSCT patients than in patients with immunosuppression due to other causes. Approximately 14.4% (16/111) of patients were admitted to the ICU, and 9.9% (11/111) of patients died. Combined and double doses of neuraminidase inhibitors did not significantly reduce the risk of admission to the ICU or death. Risk factors for admission to the ICU were dyspnoea, coinfection with other pathogens and no antiviral treatment within 48 h. The presence of dyspnoea and altered mental status were independently associated with death. Only 2.7% (3/111) of patients less than 12 months old had received a seasonal influenza vaccine.ConclusionFever and other classic symptoms of influenza may be absent in immunosuppressed recipients, especially in HSCT patients. Conducting influenza virus detection at the first presentation seems to be a good choice for early diagnosis. Clinicians should pay extra attention to immunosuppressed patients with dyspnoea, altered mental status, coinfection with other pathogens and no antiviral treatment within 48 h because these patients have a high risk of severe illness. Inactivated influenza vaccines are recommended for immunosuppressed patients.
Highlights
Compared with immunocompetent patients, immunosuppressed patients have higher morbidity and mortality, a longer duration of viral shedding, more frequent complications, and more antiviral resistance during influenza infections
The results showed that dyspnoea, gastrointestinal symptoms and altered mental status were more common in haemopoietic stem cell transplantation (HSCT) patients than in patients with immunosuppression due to other causes, with more complications, higher mortality and more hospitalization days
The most common cause of immunosuppression in this study was malignancies being treated with chemotherapy, which accounted for 64.0% of patients, including three patients with two different types of tumours
Summary
Compared with immunocompetent patients, immunosuppressed patients have higher morbidity and mortality, a longer duration of viral shedding, more frequent complications, and more antiviral resistance during influenza infections. Compared with immunocompetent patients, immunosuppressed patients have higher morbidity and mortality, a longer duration of viral shedding, more frequent complications, and more antiviral resistance, increasing the potential for nosocomial transmission [3, 5,6,7,8,9]. Few studies on influenza virus infections in immunosuppressed patients in China have been reported Neuraminidase inhibitors such as oseltamivir and peramivir are the mainstays of antiviral therapy. A previous study suggested high doses and a long duration of antiviral treatment for patients who were immunocompromised [7, 12]; specific data on the effect of antiviral therapy in immunosuppressed patients in China are rarely reported. We analysed the clinical characteristics of and risk factors and antiviral treatments for influenza in immunosuppressed inpatients in Beijing during the 2015–2020 influenza seasons and explored influenza vaccination strategies in immunosuppressed patients
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have