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Vahid Lohrasbi et al
week during the period of prophylaxis, and it had been 2.34 per week during the 11 previous weeks, indicating continued screening of patients with influenza-like symptoms. One week after the end of prophylaxis, 1 case of influenza occurred in our unit. Our observational study shows it is feasible and safe to admin-
Fig. 1. The number of influenza cases per week is shown for the hospital (left axis) and the hemodialysis unit (right axis). The red box denotes the period the prophylaxis was administered to hemodialysis patients.
impaired immune response in hemodialysis patients to influenza vaccination, even after a booster vaccine dose, and its real effect on clinical outcomes and mortality is uncertain.2,3 Oseltamivir is a neuramidase inhibitor licensed for the treatment of and prophy- laxis for influenza. It is mainly renally eliminated and is cleared by hemodialysis (molecular mass 312,4 g/mol). The optimal dose for prophylaxis in hemodialysis patients in unknown. A population pharmacokinetic study suggested 30 mg every other hemodialysis session,4 whereas another clinical study on influenza A/H1N1 used 75mgevery 5 days.5 These studies, however, have been performed in the era of low-flux filters, while hemodiafiltration (HDF) and high- flux dialyzers are the current standard of care. In the 2017–2018 influenza season, we started oseltamivir 30
mg after each hemodialysis session in our dialysis unit because of an emerging outbreak, even though all our patients had been vaccinated with a standard-dose quadrivalent vaccine. More pre- cisely, 5 new infections occurred in week 8 (Figure 1). Additionally, the number of patients with influenza in our hospital, a 1,182-bed acute- and tertiary-care hospital, was rising sharply (Figure 1). In patients with influenza-like symptoms, testing for influenza A and B on combined nasopharyngeal-throat swabs was performed using real-time PCR on Taqman array cards. Of the 137 patients in our dialysis unit, 130 (mean age, 73.1 ± 12 y; 36% female) provided informed consent to start the prophylactic treatment. Prophylaxis was administered from week 10 up to week 14, given the dropping number of influenza cases in the hospital. Of these 130 patients, 7 (5%) stopped prophylaxis early because of their own decision (n=3) or reported adverse effects: stomachache (n=1) and muscle aches (n=3). During the period of prophylaxis, no case of influenza was detected in our dialysis unit (Figure 1).On average, the number of patients screened for influenza was 2.58 per
ister prophylaxis for influenza with oseltamivir in hemodialysis patients. To overcome potential enhanced elimination by high-flux dialysis and HDF, we chose 30 mg after each hemodialysis session in contrast to dosing every other hemodialysis session, as indicated in the packet insert and as suggested by a population pharmacoki- netic approach.4 Dosing after hemodialysis also allowed for opti- mal compliance. No major adverse effects were observed, and 95% of the patients continued the prophylaxis during the predeter- mined period. Although no control group was included, the absence of new influenza cases in our hemodialysis, despite the continuing intensive influenza epidemic in our hospital, indicates the effectiveness of this strategy. In light of recent findings that vaccination remains a subopti-
mal strategy to prevent influenza in hemodialysis patients,2,3 we propose to administer oseltamivir prophylaxis during influenza season as an additional protective measure. Further studies should confirm the effectiveness of this strategy and explore its cost- effectiveness.
Acknowledgments. None. Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
References 1. Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza A in human beings. Lancet Infect Dis 2007;7:257–265.
2. Liao Z, Xu X, Liang Y, Xiong Y, Chen R, Ni J. Effect of a booster dose of influ- enza vaccine in patients with hemodialysis, peritoneal dialysis and renal transplant recipients: a systematic literature review and meta-analysis. Hum Vaccin Immunother 2016;12:2909–2915.
3. Remschmidt C, Wichmann O, Harder T. Influenza vaccination in patients with end-stage renal disease: systematic review and assessment of quality of evidence related to vaccine efficacy, effectiveness, and safety. BMC Med 2014;12:244.
4. Kamal MA, Lien KY, Robson R, et al. Investigating clinically adequate con- centrations of oseltamivir carboxylate in end-stage renal disease patients undergoing hemodialysis using a population pharmacokinetic approach. Antimicrob Agents Chemother 2015;59:6774–6781.
5. Choo D, Hossain M, Liew P, Chowdhury S, Tan J. Side effects of oseltamivir in end-stage renal failure patients. Nephrol Dial Transplant 2011;26: 2339–2344.
Fifty years of success in controlling tuberculosis in Iran, the question is how?
Vahid Lohrasbi PhD1, Neda Shirmohammadlou Msc2 and Davood Darban-Sarokhalil PhD1 1Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran and 2Department of Microbiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Cite this article: Lohrasbi V, et al. (2019). Fifty years of success in controlling tuberculosis
Author for correspondence: Davood Darban-Sarokhalil, Email: davood_darban@yahoo. com or
darban.d@iums.ac.ir.
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
in Iran, the question is how?. Infection Control&Hospital Epidemiology, 40: 498–499, https://
doi.org/10.1017/ice.2019.30
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