Influenza prevention and treatment in transplant recipients and immunocompromised hosts
Influenza prevention and treatment in transplant recipients and immunocompromised hosts
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DOI：
10.1111/irv.12170
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发表时间：
2013-11-01
影响因子：
4.4
通讯作者：
Ison, Michael G.
中科院分区：
文献类型：
--
作者：
Ison, Michael G.
宿主免疫应答对于初次感染后流感病毒的控制和清除至关重要。不幸的是，对流感的先天性和适应性反应的关键组分在实体器官和造血干细胞移植受者中受损。因此，这些关键患者人群中的流感与病毒脱落时间延长、更频繁的并发症（包括细菌和真菌双重感染和排斥反应）以及死亡率增加相关。虽然疫苗是其他人群的关键预防策略，但免疫功能低下患者的应答率降低，特别是移植后早期。前瞻性数据表明，抗病毒预防是一种有效和安全的替代疫苗的患者谁将被预测有不良反应的流感疫苗。虽然尚未在实体器官或造血干细胞患者人群中完成抗病毒治疗的随机对照研究，但观察数据表明，早期治疗与进展至下呼吸道受累、发病率和死亡率降低相关。需要进一步的研究来确定最佳方案、剂量、持续时间和终点，以确定成功的治疗。
The host immune response is critical for the control and clearance of influenza virus after initial infection. Unfortunately, key components of the innate and adaptive responses to influenza are compromised in solid organ and hematopoietic stem cell transplant recipients. As a result, influenza in these key patient populations is associated with prolonged viral shedding, more frequent complications, including bacterial and fungal superinfections and rejection, and increased mortality. While vaccine is the critical prophylaxis strategy in other populations, response rates are diminished, particularly early post-transplant, among immunocompromised patients. Prospective data suggest that antiviral prophylaxis represents an effective and safe alternative to vaccine in patients who would be predicted to have poor responses to influenza vaccine. While there have not been randomized, controlled studies of antiviral therapy completed in solid organ or hematopoietic stem cell patient populations, observational data suggest that early therapy is associated with reduced rates of progression to lower airway involvement, morbidity, and mortality. Further studies are needed to define the optimal regimen, dose, duration, and endpoint to define successful treatment.