Laboratório de vírus respiratórios e do sarampo, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil.
PLoS One. 2010 Nov 30;5(11):e14158. doi: 10.1371/journal.pone.0014158.
The novel influenza A pandemic virus (H1N1pdm) caused considerable morbidity and mortality worldwide in 2009. The aim of the present study was to evaluate the clinical course, duration of viral shedding, H1N1pdm evolution and emergence of antiviral resistance in hospitalized cancer patients with severe H1N1pdm infections during the winter of 2009 in Brazil.
We performed a prospective single-center cohort study in a cancer center in Rio de Janeiro, Brazil. Hospitalized patients with cancer and a confirmed diagnosis of influenza A H1N1pdm were evaluated. The main outcome measures in this study were in-hospital mortality, duration of viral shedding, viral persistence and both functional and molecular analyses of H1N1pdm susceptibility to oseltamivir.
A total of 44 hospitalized patients with suspected influenza-like illness were screened. A total of 24 had diagnosed H1N1pdm infections. The overall hospital mortality in our cohort was 21%. Thirteen (54%) patients required intensive care. The median age of the studied cohort was 14.5 years (3-69 years). Eighteen (75%) patients had received chemotherapy in the previous month, and 14 were neutropenic at the onset of influenza. A total of 10 patients were evaluated for their duration of viral shedding, and 5 (50%) displayed prolonged viral shedding (median 23, range=11-63 days); however, this was not associated with the emergence of a resistant H1N1pdm virus. Viral evolution was observed in sequentially collected samples.
Prolonged influenza A H1N1pdm shedding was observed in cancer patients. However, oseltamivir resistance was not detected. Taken together, our data suggest that severely ill cancer patients may constitute a pandemic virus reservoir with major implications for viral propagation.
新型甲型 H1N1 流感病毒（H1N1pdm）于 2009 年在全球范围内引起了相当大的发病率和死亡率。本研究的目的是评估巴西 2009 年冬季住院癌症患者中严重 H1N1pdm 感染的临床病程、病毒脱落持续时间、H1N1pdm 进化以及出现抗流感病毒药物耐药性的情况。
我们在巴西里约热内卢的一家癌症中心进行了一项前瞻性单中心队列研究。评估了确诊为甲型流感 H1N1pdm 的癌症住院患者。本研究的主要结局指标为住院死亡率、病毒脱落持续时间、病毒持续存在以及对奥司他韦敏感性的 H1N1pdm 的功能和分子分析。
共筛查了 44 例疑似流感样疾病的住院患者。共有 24 例患者被诊断为 H1N1pdm 感染。本队列的总体住院死亡率为 21%。13 例（54%）患者需要重症监护。研究队列的中位年龄为 14.5 岁（3-69 岁）。18 例（75%）患者在发病前一个月接受了化疗，14 例患者在流感发病时中性粒细胞减少。共评估了 10 例患者的病毒脱落持续时间，其中 5 例（50%）表现为病毒脱落时间延长（中位数 23 天，范围=11-63 天）；然而，这与耐药性 H1N1pdm 病毒的出现无关。在连续采集的样本中观察到病毒进化。
在癌症患者中观察到甲型 H1N1pdm 病毒脱落时间延长。然而，未检测到奥司他韦耐药性。综上所述，我们的数据表明，重症癌症患者可能构成大流行病毒的储存库，对病毒传播有重大影响。
