Published 29 September 2009, doi:10.1136/bmj.b3958
Cite this as: BMJ 2009;339:b3958

Letters

A/H1N1 flu pandemic

A/H1N1 and other viruses affecting cystic fibrosis

For over 12 months all patients attending our regional cystic fibrosis unit have had throat swabs analysed routinely for viruses with the polymerase chain reaction before starting intravenous antibiotics. We assessed the prevalence of A/H1N1 flu virus¹ in acute severe exacerbations of cystic fibrosis.

The first case of A/H1N1 flu in Leeds was confirmed on the 7 June 2009. Since then, 187 adult patients have had pulmonary exacerbations requiring intravenous antibiotics. Fifteen had positive viral swabs. Four of them tested positive for A/H1N1 flu virus, one of whom was immunosuppressed after lung transplantation and presented with fever, breathlessness, vomiting, and headache. Eight patients were positive for rhinovirus, two for adenovirus, and one for parainfluenza virus. Repeat swabs remained positive in two patients with A/H1N1 flu virus four and six weeks later.

A/H1N1 flu virus has caused only a few acute pulmonary exacerbations of cystic fibrosis. If the prevalence of viral infections was similar in the community, antiviral drugs are likely to have been overprescribed and people might decline vaccination because they believe that they have already had the infection. Prolonged infection in at risk patients needs further investigation² but shows the importance of vaccination in vulnerable groups.

Cite this as: BMJ 2009;339:b3958

¹ Regional Adult Cystic Fibrosis Unit, St James’s Hospital, Leeds LS9 7TF, ² Department of Microbiology, Leeds General Infirmary, Leeds LS1 3EX

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Competing interests: None declared.

References

1. Elliot AJ, Powers C, Thornton A, Obi C, Hill C, Simms I, et al. Monitoring the emergence of community transmission of influenza A/H1N1 2009 in England: a cross sectional opportunistic survey of self sampled telephone callers to NHS Direct. BMJ 2009;339:b3403. (27 August.)[Abstract/Free Full Text]
2. Kling S, Donninger H, Williams Z, Vermeulen J, Weinberg E, Latiff K, et al. Persistence of rhinovirus RNA after asthma exacerbation in children. Clin Exp Allergy 2005;35:672-8.[CrossRef][Web of Science][Medline]

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Relevant Article

Monitoring the emergence of community transmission of influenza A/H1N1 2009 in England: a cross sectional opportunistic survey of self sampled telephone callers to NHS Direct

Alex J Elliot, Cassandra Powers, Alicia Thornton, Chinelo Obi, Caterina Hill, Ian Simms, Pauline Waight, Helen Maguire, David Foord, Enid Povey, Tim Wreghitt, Nichola Goddard, Joanna Ellis, Alison Bermingham, Praveen Sebastianpillai, Angie Lackenby, Maria Zambon, David Brown, Gillian E Smith, and O Noel Gill
BMJ 2009 339: b3403. [Abstract] [Full Text] [PDF]

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