Pandemic (H1N1) 2009 infection in adult solid organ transplant recipients in Singapore.
BACKGROUND
Influenza can produce significant complications in immunocompromised persons.


METHODS
We studied the effects of the pandemic (H1N1) 2009 (pH1N1) infection on solid organ transplant recipients in our hospital, with emphasis on clinical information, duration of viral culture positivity, polymerase chain reaction positivity, effects of oseltamivir therapy, and graft status at 6 months of follow-up.


RESULTS
Twenty-two cases of pH1N1 infection involving 18 renal, two lung, one heart, and one liver transplant recipients were seen from July 14 to September 8, 2009. Their median age was 50.5 years (range 20-70 years); 64% were women, and median time posttransplant was 40 months (range 6-204 months). Common symptoms were fever (86%), cough (77%), sore throat (55%), phlegm (32%), and myalgia (27%). The median duration of symptoms (n=21) and duration of polymerase chain reaction positivity (n=15) were 7 (range 4-13 days) and 8 days (range 4-16 days), respectively. Mean (± SD) duration of symptom resolution (7.4 ± 3.0 vs. 7.8 ± 3.0 days, P=0.76) and viral culture positivity (5.3 ± 2.8 vs. 4.3 ± 3.2 days, P=0.65) did not differ between those who received a 5-day (n=9) or 10-day (n=12) course of oseltamivir. Five patients (22.7%) developed pneumonia with three needing intensive care. Mortality rate was 4.5% (1/22). At 6 months, three graft rejections involving two renal and one lung developed.


CONCLUSIONS
Our findings indicate that the pH1N1 infection in solid organ transplant recipients is associated with some degree of morbidity and may affect the function of the transplanted organ. In this nonrandomized comparison, patients treated with 5 days of oseltamivir did not fare worse compared with those who received 10 days.
Low
Chian Yong
CY
Department of Infectious Diseases, Singapore General Hospital, Singapore.
Kee
Terence
T
Chan
Kwai Peng
KP
Oon
Lynette L E
LL
Tan
Chee Kiat
CK
Tee
Nancy W S
NW
Tan
Ban Hock
BH
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D053139:Oseltamivir / Q000627:therapeutic use; D058873:Pandemics; D016133:Polymerase Chain Reaction; D012846:Singapore / Q000453:epidemiology
D000998:Antiviral Agents; D053139:Oseltamivir