International Society for Heart & Lung Transplantation (ISHLT) Issues Important New Novel 2009 H1N1 Flu Advisory for Cardiopulmonary Transplantation

New York - Each year 3-5 million people have severe cases and 250-500,000 die from complications of seasonal influenza world-wide. This year, the novel 2009 H1N1 (nH1N1) influenza, previously called swine flu, has reached pandemic status. Since novel 2009 H1N1 is a viral infection of the respiratory tract, there are additional challenges for cardiopulmonary transplant recipients and donors, as well as for the healthcare workers involved in the transplant process. In an article published online today in The Journal of Heart and Lung Transplantation, physicians representing the International Society for Heart & Lung Transplantation (ISHLT) Infectious Disease Council issue an advisory for all programs in cardiothoracic transplantation.

Mandeep R. Mehra, MBBS, FACC, FACP, Editor-in-Chief, The Journal of Heart and Lung Transplantation observes, “Nowhere is the threat of H1N1 more real than in cardiopulmonary transplantation. The ISHLT’s Infectious Disease Council has developed what is assuredly the most comprehensive and clinically relevant direction for prevention and management of H1N1 flu in donors, recipients, care providers and family members.”

Recognition of the novel 2009 H1N1 influenza virus, aggressive diagnosis and early treatment need be paired with active preventative measures to stem the impact of infection in the transplant population. This special advisory addresses issues relevant to cardiothoracic transplant candidates, selection of donors, recipient management and patients with mechanical circulatory support devices. Since transplant recipients are treated with anti-rejection drugs, the advisory provides clear directions for specific dosing of antiviral drugs and management of the background immunosuppression. Specific guidelines for evaluation and management of post-surgical transplant patients are also given, as well as recommendations for how and when to administer vaccines. On the donor side, the advisory provides guidelines for how to evaluate and treat donors so that organs can be safely used and not wasted. Finally, it provides specific guidelines for the healthcare teams managing such patients.

Writing in the article, Lara A. Danziger-Isakov MD MPH, Cleveland Clinic Children’s Hospital, states, “Interaction with organ procurement organizations for organ selection must take into account emerging data on the use of organs from patients infected and treated for the novel 2009 H1N1 Influenza virus. Improved diagnostic testing with shorter turnaround times is needed in donor evaluation. Individual patient education, prevention measures and treatment strategies will also require attention to the local patterns of infection, availability of the novel 2009 H1N1 Influenza virus vaccination, and emerging patterns of antiviral resistance. Finally, efforts to contain and prevent the novel 2009 H1N1 Influenza virus from spreading within the cardiothoracic transplant setting can be accomplished through infection control measures.”

“This article is an initiative of the Infectious Disease (ID) council of ISHLT to provide timely practical guidance for cardiothoracic transplant programs facing a winter pandemic of novel 2009 H1N1 influenza,” comments Dr Margaret M Hannan, Mater Misericordiae University Hospital, Dublin, Chairman of ID council for ISHLT. “Evolving diagnostic testing with limitations due to prolonged turnaround time and availability are considered in donor and recipient management. Ensuring that the most accurate diagnostic tests are being carried out in a timely and systematic manner will allow cardiothoracic transplant surgeons to make informed decisions in ‘real time’ and avoid waste of usable organs.” Education of staff and patients in infection control and prevention is fundamental to successful management of this virus in the transplant recipient population.

The article is “The Novel 2009 H1N1 Influenza Virus Pandemic: Unique Considerations for Programs in Cardiothoracic Transplantation” by Lara A. Danziger-Isakov MD MPH, Shahid Husain MD MS , Martha L. Mooney MD FACP, Margaret M. Hannan MD for the ISHLT Infectious Diseases Council. DOI 10.1016/j.healun.2009.10.001. Following advance online publication on October 23, 2009, the article will appear in The Journal of Heart and Lung Transplantation, Volume 28, Issue 12 (December 2009) published by Elsevier.

Notes to Editors:
Full text of the article is available upon request; contact l.gruner@elsevier.com.
To obtain additional information from the ISHLT regarding the new novel 2009 H1N1 flu advisory for cardiopulmonary transplantation or to arrange an author interview, please contact:
Margaret Hannan, MD
Mater Misericordiae University Hospital
Dublin, Ireland
+353 87 917 4000 (mobile)
mhannan@mater.ie
margarethannan102@hotmail.com

OR

Martha L. Mooney, MD
Sentara Norfolk General Hospital
Norfolk, VA USA
+1 757-446-8999
mooneyml@evms.edu

Authors
Lara A. Danziger-Isakov MD MPH, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA
Shahid Husain MD MS, Toronto General Hospital, Toronto, Canada
Martha L. Mooney MD FACP, Sentara Norfolk Transplant Center: East Virginia Medical Center, Norfolk, VA, USA
Margaret M. Hannan MD, Mater Misericordiae University Hospital, Dublin, Ireland

Key points Regarding Novel 2009 H1N1 Influenza Virus
Vaccination

* Vaccination for both seasonal trivalent inactivated influenza and novel 2009 H1N1 influenza vaccine should be given as soon as they become available.
* Live attenuated seasonal trivalent influenza virus vaccine (nasal flu vaccine) should be avoided in transplant candidates, transplant care providers and transplant recipients.
* Both seasonal trivalent inactivated and novel 2009 H1N1 influenza vaccine can be given simultaneously in transplant recipients but ideally when vaccine is given separately there should be a month between vaccine administration.
* Both seasonal trivalent inactivated influenza vaccine and novel 2009 H1N1 influenza vaccine can be given soon after transplant. However, the immune response of early vaccination post transplantation may only be partially protective.
* Vaccine should be administered as per manufacturer recommendations.

Donor Evaluation

* All potential donors should have nasopharyngeal swab and throat swabs done for novel 2009 H1N1 influenza virus testing prior to organ procurement.
* rRT-PCR is the preferred assay to diagnose influenza infection including novel 2009 H1N1 influenza virus infection.
* Negative rapid influenza detection assay does not exclude the diagnosis of novel 2009 H1N1 influenza virus infection.

About The Journal of Heart and Lung Transplantation
A forum that includes all aspects of pre-clinical and clinical science of the failing heart and lung

The Official Publication of the International Society for Heart & Lung Transplantation, The Journal of Heart and Lung Transplantation brings readers essential scholarly and timely information in the field of cardiopulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy; Importantly, the Journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.

About The International Society For Heart & Lung Transplantation (ISHLT)
The International Society for Heart & Lung Transplantation is a not-for-profit organization dedicated to the advancement of the science and treatment of end-stage heart and lung diseases. ISHLT was created in 1981 at a small gathering of about 15 cardiologists and cardiac surgeons. Today, ISHLT has over 2200 members from over 45 countries, representing over 10 different disciplines involved in the management and treatment of end-state heart and lung disease. Despite their differing specializations, all ISHLT members share a common dedication to the advancement of the science and treatment of end-stage heart and lung disease.

This multinational, multidisciplinary mix is one of the biggest strengths of the Society. It brings greater breadth and depth to ISHLT’s educational offerings and provides an exceptional environment for networking and exchanging information on an informal basis.

About Elsevier
Elsevier is a world-leading publisher of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier’s online solutions include ScienceDirect, Scopus, Reaxys, MD Consult and Nursing Consult, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai’s Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.

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