Vaccine and Infectious Disease Division

Novel H1N1 virus in the immunocompromised

As a new player on the viral scene, novel influenza A/H1N1 still presents many mysteries.  Like many infectious viruses, novel H1N1 is likely more dangerous to immunocompromised people, such as stem cell transplant recipients, than to the general public.  But few data exist on how this infection manifests in the immunocompromised and how to best manage their treatment.  VIDD associate in clinical research Dr. Angela Campbell and colleagues presented a case study of one such patient, a transplant recipient at the SCCA who became ill with H1N1 influenza infection.  The researchers found viral RNA in the patient’s nasal washes as well as in her blood; viral presence in the blood may be a sign of severe disease.  The patient initially received oral antiviral medication for influenza, but her condition worsened, so she was treated with IV antiviral drugs and she eventually improved.  Further studies are needed, but Campbell and colleagues speculate that presence of H1N1 RNA in the bloodstream of immunocompromised patients may be an early marker of severe illness, and could help clinicians treat these cases earlier and more aggressively.

Campbell AP, Jacob ST, Kuypers J, Wald A, Englund JA, Corey L, Boeckh M.  Respiratory failure caused by 2009 novel influenza A/H1N1 in a hematopoietic stem-cell transplant recipient: Detection of extrapulmonary H1N1 RNA and use of intravenous peramivir.   Ann Intern Med. 2010 May 4;152(9):619-20.