Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses.
Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses.
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DOI：
10.1016/s1473-3099(09)70175-6
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发表时间：
2009-08
影响因子：
56.3
通讯作者：
Janoff, Edward N.
中科院分区：
文献类型：
--
作者：
Kunisaki, Ken M.;Janoff, Edward N.
免疫抑制的患者可能有患严重流感相关并发症的风险。因此，多个指南建议感染艾滋病毒的患者、接受实体器官移植的患者、接受造血干细胞移植的患者以及血液透析患者接种流感疫苗。然而，免疫抑制也可能限制疫苗的反应。为了更好地为政策提供信息，我们回顾了已发表的与这些患者以及接受化疗和全身皮质类固醇治疗的患者的流感感染的发生率、结果和预防相关的工作。现有数据表明，大多数免疫抑制人群确实有更高的流感相关并发症风险，有体液疫苗反应受损的总体趋势(尽管这些数据喜忧参半)，可以安全接种--尽管很大程度上缺乏纵向数据。随机临床试验数据仅限于对具有高疫苗效力的艾滋病毒感染患者的一项研究。更好的试验数据将根据这些高危人群的疗效和成本提供疫苗接种建议。
Patients that are immunosuppressed might be at risk of serious influenza-associated complications. As a result, multiple guidelines recommend influenza vaccination for patients infected with HIV, who have received solid-organ transplants, who have received haemopoietic stem-cell transplants, and patients on haemodialysis. However, immunosuppression might also limit vaccine responses. To better inform policy, we reviewed the published work relevant to incidence, outcomes, and prevention of influenza infection in these patients, and in patients being treated chemotherapy and with systemic corticosteroids. Available data suggest that most immunosuppressed populations are indeed at higher risk of influenza-associated complications, have a general trend toward impaired humoral vaccine responses (although these data are mixed), and can be safely vaccinated—although longitudinal data are largely lacking. Randomised clinical trial data were limited to one study of HIV-infected patients with high vaccine efficacy. Better trial data would inform vaccination recommendations on the basis of efficacy and cost in these at-risk populations.