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Transplant infectious disease experts provide pandemic guidance
Date:12/3/2009

the pandemic setting, raising concerns about transmission from donors to recipients.

"However, autopsy studies suggest that other organs, such as the brain, kidney, pancreas, spleen, liver and heart, can also become infected. This pandemic has important clinical implications for all stages of the solid organ transplant process."

Key points raised by the discussion document include:

  • All patients with influenza-like illnesses, and milder symptoms such as a persistent runny nose, should be tested for the virus and empiric antiviral therapy considered.

  • Some experts recommend continuing antiviral therapy until viral replication has ceased and clinicians should base their therapy decisions on current advice from the Centers for Disease Control (CDC) and individual patient assessments.

  • Some experts also recommend that the oseltamivir (Tamiflu) dose may be doubled in critically ill patients and a significant reduction of immunosuppression is recommended in patients with significant disease.

  • However it should be noted that a CDC study (August 2009) reported oseltamivir resistance in two immunocompromised patients.

  • Transplant patients and donors should receive at least one dose of H1N1 vaccine. Recent studies show that in healthy adults a single dose of inactive split-virus 2009 H1N1 vaccine had a seroconversion (antibody production) rate of 96.7 per cent, while a single dose of a vaccine containing adjuvant MF59 achieved 76 per cent.

  • People who receive a Live Attenuated Influenza Vaccine may shed the virus for up to 21 days after immunization.

  • There is currently no data on the duration of antiviral therapy that donors with H1N1 must undergo before organs can be safely used. If the donor has not completed a course of treatment, the current recommendation is to give the recipient five to ten days of antiviral therapy, at therapeutic not prophylaxis doses. <
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Contact: Annette Whibley
wizard.media@virgin.net
Wiley-Blackwell
Source:Eurekalert

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