How I treat influenza in patients with hematologic malignancies

Abstract

The 2009 H1N1 influenza pandemic has heightened the interest of clinicians for options in the prevention and management of influenza virus infection in immunocompromised patients. Even before the emergence of the novel 2009 H1N1 strain, influenza disease was a serious complication in patients with hematologic malignancies receiving chemotherapy or undergoing hematopoietic cell transplantation. Here we review the clinical manifestations of seasonal and 2009 H1N1 influenza and discuss current diagnosis, antiviral treatment, and prophylaxis options. We also summarize infection control and vaccination strategies for patients, family members, and caregivers.

Figure 1

Number of cases of influenza-like illness presenting to sentinel providers and reported to the Centers for Disease Control and Prevention. Number of visits of influenza-like illness (ILI) reported by the United States. Outpatient Influenza-Like Illness Surveillance Network (ILINet) National Summary 2008 to 2009, by age. Source: http://www.cdc.gov/flu/weekly/weeklyarchives2009-2010/data/senAllregt46.htm.

Figure 2

Pandemic influenza infection rates and mortality, by age (mainly immunocompetent). (A) Infection rates. (B) Mortality. Source: http://www.cdc.gov/H1N1FLU/surveillanceqa.htm.

Figure 3

Aggressive implementation of a novel Infection Control Program at the Seattle Cancer Care Alliance assisted in controlling influenza during the H1N1 pandemic of spring 2009. Influenza A detections in the Puget Sound Area and among SCCA inpatients and outpatients, November 2008 to August 2009.