Influenza in patients with cancer after 2009 pandemic AH1N1: An 8‐year follow‐up study in Mexico

Abstract

Background Immunosupressed patients are at high risk of influenza‐related complications. Influenza AH1N1 has been hypothesized to induce worse outcomes in patients with malignancies, but after the A(H1N1)pdm09 few publications have analyzed the presentation and complications related to influenza afterward. Objectives We aimed to describe the characteristics, risk factors, and outcomes of influenza in an oncologic center after the 2009 pandemic and to compare our case distribution to the National community acquired influenza databases in Mexico and the United States. Methods We reviewed the cases of confirmed influenza in patients with cancer from an oncological center in Mexico from April 2009 to April 2017. Data on severity and influenza type, malignancy, comorbidities, and outcomes were recorded. We correlated data between the Centers for Disease Control and Prevention (CDC) in the United States and SISVEFLU (Influenza Surveillance Program) in Mexico. Results One hundred eighty‐eight patients were included; 75 (39.9%) had a solid neoplasm and 113 (60.1%) had hematologic malignancies. AH1N1 was the most frequent influenza type (54.2%). Patients with hematologic malignancies had more pneumonia (55% vs 25%, P < .001), needed more hospitalizations (75% vs 39% P < .001), had higher all‐cause mortality at 30 days (20% vs 9% P = .048) and influenza‐associated mortality (17% vs 7% P = .041). Thirty (16%) patients died within 30 days, and 24 (12.7%) were related to influenza. Influenza type was not associated with worse outcomes. Yearly occurrence of influenza reported by the CDC and SISVEFLU showed a significant correlation (ρ = 0.823, P = .006). Conclusions AH1N1 was the dominant serotype. Patients with hematologic malignancies had more severe influenza and presented worse outcomes. Annual SISVEFLU and CDC surveillance information showed a similar distribution of cases along time but influenza serotypes did not match for all seasons.

Impact of comorbidities on mortality in hospitalized influenza patients with diabetes – Analysis of the Austrian Health Insurance

“…In contrast to our findings, a study of over 2 million elderly individuals reported that those with dementia and no diabetes surprisingly had a lower frequency of influenza infections and a shorter length of stay in the hospital [28]. In our study, the diagnosis of cancer also increased the likelihood of IRI hospitalization, which is in line with previous research [29]. Within the group of people with diabetes and cancer, it is almost impossible to assess whether cancer per se or its pharmacotherapy increases the infection risk and mortality rate following an IRI.…”

Management of cancer patients during COVID-19 pandemic at developing countries

“…Cancer patients with the A(H1N1) flu have similar symptoms as the general population, but tend to have haematological abnormalities as anaemia, neutropenia or leukopenia[ 32 ]. Different clinical series described that patients with solid or haematological tumours had a poor prognosis during the pandemic, such as increased hospitalization, bacterial infection, and death[ 33 - 36 ]. In fact, it has been described that patients who received chemotherapy in the last month or had neutropenia on admission had fatal outcomes[ 33 , 35 ].…”

Comparison between Patients Hospitalized with Influenza and COVID-19 at a Tertiary Care Center

“…2 Influenza generally achieves community spread nationwide and can strike all age groups, but mortality is consistently higher in patients who are elderly, immunocompromised, and/or have pre-existing comorbidities such as chronic obstructive pulmonary disease, chronic kidney injury, cirrhosis, or cardiac disease. [3][4][5][6][7][8][9] Decades of experience with influenza have led to vaccination programs which can mitigate the impact of influenza in years when the predominant circulating strain is accurately predicted. 10 Official CDC counts indicate that over one million people in the USA have contracted COVID-19 between the virus's first detected cases through April 30, 2020, with over 150,000 hospitalizations and over 63,000 deaths reported as of that date.…”