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Alert Number 275

The flu bug is particularly nasty this year

Date: February 12, 2008

As some of you know, PC and I are getting ready to head out to the frozen tundra of Minneapolis early in March to initiate his double cord mini allo transplant.  More about that later.  This Alert is to bring to your attention something that is giving me the heebie jeebies.

The flu season is in full swing through most of the United States, majority of the states are at the highest level alert (see link below), and hospitals are packed with sick people.  It is a particularly nasty one this year, and to make matters worse the flu vaccine administered this year is not a good match.  They missed on 2 out of 3 of the varieties they were trying to target.  Moral of the story, if you are an immune compromised patient the flu vaccine would have had marginal benefit in any case, but now the news coming out of CDC (Center for Disease Control) is that even your healthy caregiver is more at risk because the vaccine was not particularly effective this year.

Flu Activity Map

This Year's Flu Vaccine Match

People, if you have CLL and you get this year’s version of the flu, it is not going to be a pretty sight.  We have written before on the subject of avoiding the annual flu.  Links are below for a quick refresher. 

You are still not convinced?  How about this quote: “The CDC recently urged clinicians to be alert for co-infections, particularly with MRSA.”  It got my attention, I can tell you that!

Topics Alert No. 265

Annual Flu Preparations

Bird Flu

Drug Resistant "Super Bug" Staph

In addition to the usual precautions, the abstract below suggests it might be a good idea to discuss getting Tamiflu (“Oseltamivir”) as insurance.  The suggested dosage is 75 mg capsule, once a day.  Even the FDA has approved giving preemptive prophylaxis of Tamiflu to help at-risk people.  Trust me, you are at risk.  The article below is about transplant patients, the worst case scenario in terms of at-risk folks, but us chickens are not far behind on the scale of immune suppression.  A bad case of the flu that escalates into a case of pneumonia that needs hospitalization – swarming with hordes of sick people – you can imagine the rest.

Don’t say I did not warn you.

Please try to stay well!



Clin Infect Dis. 2007 Jul 15;45(2):187-93. Epub 2007 Jun 5

Safety and tolerability of oseltamivir prophylaxis in hematopoietic stem cell transplant recipients: a retrospective case-control study.

Vu D, Peck AJ, Nichols WG, Varley C, Englund JA, Corey L, Boeckh M.

Fred Hutchinson Cancer Research Center, Seattle, WA, 98109-1024, USA.

BACKGROUND: Oseltamivir is safe and effective in immunocompetent persons, and prophylactic use is recommended during influenza outbreaks. However, no data exist regarding the use of oseltamivir as prophylaxis among patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS: In January 2002, an influenza A outbreak was identified when 4 cases occurred within 1 week at an outpatient residential facility for patients undergoing HSCT. Oseltamivir prophylaxis (75 mg per day) was initiated for all asymptomatic patients living in the housing facility. Retrospectively, 45 patients (25 of whom had undergone HSCT, and 20 of whom were pre-HSCT candidates) who received oseltamivir prophylaxis were evaluated for adverse events. These 45 patients were matched 1 : 1 with control subjects who received transplants during the period 1994-2003 and did not receive prophylaxis; they were matched according to donor type, conditioning regimen, cytomegalovirus serostatus, time after HSCT, and recipient age (+/-5 years). The frequency of clinical and laboratory adverse events was determined by chart review and graded using National Cancer Institute Common Terminology Criteria. RESULTS: Forty-five residents received oseltamivir for a median of 17 days (range, 10-81 days). No new cases of influenza A occurred in the facility. Seven weeks after initiation of prophylaxis, 1 resident who had been noncompliant to prophylaxis developed an influenza B infection, followed by an additional case of influenza B that occurred in a patient who had not received prophylaxis. No deaths occurred that were attributable to prophylaxis. The proportions of clinical and laboratory adverse events meeting common terminology criteria grades 2-4 or 3-4 were not significantly different between the case patients who received oseltamivir prophylaxis and control subjects. CONCLUSION: Oseltamivir prophylaxis appeared to be safe and well tolerated in managing an influenza outbreak in an HSCT outpatient residence.

PMID: 17578777 [PubMed - indexed for MEDLINE]


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