Influenza Vaccination in Cancer Patients Undergoing Systemic Therapy

Background Cancer patients often experience preventable infections, including influenza A and B. These infections can be a cause of significant morbidity and mortality. The increased risk of infection may be because of either cancer itself or treatment-induced immunosuppression. 1 Influenza immunization has been shown to decrease the risk of influenza infection in patients with intact immunity. 2 In cancer patients, active immunization has been shown to confer protective immunity against several infections at similar rates to healthy individuals, which has translated into decreased duration and severity of infection and potentially improved morbidity and mortality. 3 Objectives 1. To assess the efficacy of influenza vaccination in stimulating immunological response in patients with cancer during chemotherapy compared to control groups. 2. To assess the efficacy of influenza vaccination in preventing confirmed influenza and influenza-like illness and/or stimulating immunological response in children with cancer treated with chemotherapy, compared to placebo, no intervention, or different dosage schedules. 3. To determine the adverse effects associated with influenza vaccination in patients with cancer. Search Methods We searched MEDLINE/PubMed database for articles published from 1964 to 2013 using the search terms “cancer,” “adult,” “influenza vaccination,” and “chemotherapy.” Selection Criteria We included studies based on systematic sampling with defined clinical criteria irrespective of the vaccination status of cancer patients. Studies measure the serological response or clinical response to compare between the study group and the control group. Studies assessed the inactivated influenza vaccines and live attenuated influenza vaccine (LAIV) protective serological reaction and the clinical outcomes after vaccination. Data Collection and Analysis Two independent authors assessed the methodological quality of included studies and extracted data. Main Results We included 16 studies (total number of participants = 1,076). None of the included studies reported clinical outcomes. All included studies reported on influenza immunity and adverse reaction on vaccination. We included 6 solid tumor studies and 10 hematological studies. In 12 studies, the serological response to influenza vaccine was compared in patients receiving chemotherapy (n = 425) versus those not receiving chemotherapy (n = 376). In three studies, the serological responses to influenza vaccination in patients receiving chemotherapy are compared to that in healthy adult. Measures used to assess the serological responses included a four-fold rise increase in antibody titer development of hemagglutination inhibition (HI) titer >40, and pre- and post-vaccination geometric mean titers (GMTs). Immune responses in patients receiving chemotherapy were consistently weaker (four-fold rise of 17–52%) than in those who had completed chemotherapy (50–83%) and healthy patients (67–100%). Concerning adverse effects, oncology patients received influenza vaccine, and the side effects described were mild local reactions and low-grade fever. No life-threatening or persistent adverse effects were reported. Authors’ Conclusion Patients with solid and some of hematological tumors are able to mount a serological response to influenza vaccine, but it remains unclear how much this response protects them from influenza infection or its complications. Meanwhile, influenza vaccine appears to be safe in these patients. While waiting results of randomized controlled trials to give us more details about the clinical benefits of the influenza vaccination, the clinicians should consider the currently proved benefits of influenza vaccination on management of the cancer patients undergoing systematic chemotherapy such as decrease in the duration and severity of the of the disease, and significant decrease in influenza-associated morbidity and mortality in these high-risk patients. 3

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Efficacy of the Two-Dose Influenza Vaccine in Cancer Patients Receiving Chemotherapy: A Prospective Study

Blood ◽

10.1182/blood.v124.21.4131.4131 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4131-4131

Author(s):

Yukinari Sanada ◽

Kimikazu Yakushijin ◽

Tetsuhiko Nomura ◽

Katsuya Yamamoto ◽

Keiji Kurata ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Cancer Patients ◽

Solid Tumors ◽

Vaccine Efficacy ◽

Hematological Malignancies ◽

Conflicts Of Interest ◽

Lymphoblastic Leukemia ◽

Influenza Infection ◽

Cytotoxic Agents

Abstract Background: Cancer patients who are receiving chemotherapy are at risk for influenza infections and its severe complications. Although influenza vaccination is recommended, preliminary data have raised questions about the immune response to vaccination in such patients. Furthermore, recent studies suggest that some tyrosine kinase inhibitors (TKIs) induce significant impairment of B cell responses and reduce vaccine efficacy. The two-dose influenza vaccination is proposed to be one of the strategies to increase the efficacy of influenza vaccination in cancer patients, but its efficacy has yet to be confirmed. Methods: This was a prospective multicenter study to evaluate the efficacy of the two-dose influenza vaccination in cancer patients receiving chemotherapy. We administered a triple-strain (A/California/7/2009 [H1N1], A/Texas/50/2012 [H3N2], and B/Massachusetts/2/2012) 2013/14 influenza vaccine to patients with pathologically confirmed malignancies. All patients were under the treatment with chemotherapy including cytotoxic agents, rituximab, or TKIs. Vaccination was performed on days when chemotherapy was not given (except for TKIs). The second vaccination was performed in patients who did not respond to all three strains after the first vaccination. Hemagglutination inhibition (HI) titers were measured, and 1:40 or greater HI titers were considered protective because these titers were reported to be associated with at least a 50% reduction in influenza infection in general populations. HI titers were measured within two weeks prior to the first vaccination, within 3-5 weeks after each vaccination, and at the end of the influenza season in May 2014. Results: A total of 109 patients (median age 61 years [range 21–89 years]) were enrolled; 55 females and 54 males, 36 hematological malignancies (multiple myeloma [n=15], malignant lymphoma [n=10], chronic myeloid leukemia [n=10], and acute lymphoblastic leukemia [n=1]), 70 solid tumors (breast [n=14], colorectal [n=11], biliary tract [n=10], and others [n=35]), and both cancer types (n=3). The flow chart of patients is shown in Figure. Table lists the proportions of patients with protective titers. The proportion of patients who had protective titers against all three strains was increased from 2 to 24% by the first vaccination. Similarly patients with protective titers against individual strains were increased; further 3-10% of patients achieved protective titers against individual strains after the second vaccination. When we compared the proportion of patients with protective titers against all strains after the first vaccination between the two disease types, the efficacy was similar; 22% (8/36) in hematological malignancies and 24% (17/70) in solid tumors (p=1.0). Similarly, there were no significant differences after the second vaccination between the two disease types. We also assessed differences in the response between patients treated with TKIs alone and those treated with other therapies. After the first vaccination, the proportion of patients who had protective titers against all three strains was 32% (6/19) for TKIs alone while it was 22% (20/90) for other therapies (p=0.39). Also there were no differences after the second vaccination regardless of the use of TKIs. When the effect on immunization of age, leukocyte and lymphocyte counts, and duration from chemotherapy to the first vaccination was evaluated, none of these factors influenced vaccine response. Serious adverse events associated with influenza vaccination were not reported, even among patients who received the two-dose vaccination. Conclusions: We recommend influenza vaccination for cancer patients who are receiving chemotherapy, and two-dose vaccination might be an effective strategy to augment vaccine efficacy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Improving the rate of influenza vaccination in pediatric patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.49 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 49-49

Author(s):

Jason Lawrence Freedman ◽

Anne F. Reilly ◽

L. Charles Bailey

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Cancer Patients ◽

Pediatric Cancer ◽

Pediatric Patients ◽

Provider Education ◽

Clinical Process ◽

Patients With Cancer ◽

Increased Risk ◽

Pediatric Cancer Patients

49 Background: Pediatric patients with cancer are at increased risk of influenza, with high mortality, morbidity, and delay of cancer therapy. CDC guidelines support yearly vaccination in these patients. In prior years at our center, only 53-56% of pediatric cancer patients received at least one dose of the vaccine. Our objective was to increase the rates of influenza vaccination in pediatric cancer patients through a multi-faceted QI initiative. Methods: Five interventions were instituted concomitantly, in eligible patients (>6 months old, >100 days from BMT if applicable, and within 1 year of chemotherapy) over a 6-month period (9/1/12 to 3/31/13). 1) Family education: provision of influenza/vaccine handouts to families in clinic waiting rooms; 2) Health informatics intervention: via electronic health records, generation of daily lists of patients due for doses with automated email lists to triage and nurses; 3) Clinical process interventions: standardization of triage process to identify patients needing vaccination and provision of colored wristbands to such patients alerting providers to order the vaccine, or document refusals, during the encounter; 4) Inpatient orders: influenza vaccine order built into computerized physician admission order set to trigger vaccination upon discharge; and 5) Provider education: printed materials and tutorials for staff at conferences on proper screening of patients, vaccine ordering/dose, and correct documenting of refusals/contraindications. These processes were iteratively refined over the 6-month timeframe. Results: Influenza immunization rates increased by 20% after the changes were implemented; this was seen across all tumor subgroups. Overall, 74% of patients received at least one dose as compared with 52% in the prior year. 61% of patients were fully immunized (vs. 42% in 2011-12). Immunizations were deferred due to allergy/refusal in 8% of patients (vs. 7% in 2011-12). Consequently, only 18% of eligible patients were unimmunized as compared to 41% in the prior year. Conclusions: Technology, education, and clinical process changes led to a successful increase in influenza vaccination rates. Ongoing efforts will target subgroups with lowest overall rates of immunization.

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1104 Immunological response to influenza vaccine in cancer patients undergoing treatment with sunitinib or sorafenib

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(09)70397-0 ◽

2009 ◽

Vol 7 (2) ◽

pp. 116 ◽

Cited By ~ 3

Author(s):

S.F. Mulder ◽

J.F.M. Jacobs ◽

M.A.M. Olde Nordkamp ◽

I.K. Kremer ◽

P.F.A. Mulders ◽

...

Keyword(s):

Influenza Vaccine ◽

Cancer Patients ◽

Immunological Response

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Impact of Severe Acute Respiratory Syndrome and the Perceived Avian Influenza Epidemic on the Increased Rate of Influenza Vaccination Among Nurses in Hong Kong

Infection Control and Hospital Epidemiology ◽

10.1086/527507 ◽

2008 ◽

Vol 29 (3) ◽

pp. 256-261 ◽

Cited By ~ 20

Author(s):

Dennise K. P. Tam ◽

Shui-Shan Lee ◽

Sing Lee

Keyword(s):

Hong Kong ◽

Avian Influenza ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Influenza Infection ◽

Vaccination Rate ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Major Barrier ◽

Vaccination Rates

Objective.To determine the rate of influenza vaccination and the factors associated with the vaccination's acceptance among nurses in Hong Kong.Design.Cross-sectional survey.Participants.Nurses practicing between 2003 and 2007.Methods.A questionnaire was sent to all nurses registered with any of the 3 nursing associations that participated in this study.Results.A total of 941 completed questionnaires were available for analysis, though not all nurses responded to every question (response rate, 33.5%-36.3%). Vaccination rates in 2006 and 2007 were 57.2% and 46.2%, respectively. Nurses who were vaccinated in 2006 were more likely to get vaccinated in 2007 (P<.01); 56% of the nurses perceived influenza vaccine as being effective against influenza. The perceived effectiveness of influenza vaccine was a consistent predictor of rates of vaccination in 2006 (odds ratio [OR], 8.47 [95% confidence interval {CI}, 6.13-11.70];P<.01) and 2007 (OR, 6.05 [95% CI, 3.79-9.67];P<.01). Concern about contracting avian influenza was a predictor of the vaccination rate in 2006 but not in 2007 (OR, 1.47 [95% CI, 1.03-2.09];P<.05), as was the perceived lack of control over avian influenza infection (OR, 1.52 [95% CI, 1.06-2.18];P<.05).Conclusions.The overall influenza vaccination rate for nurses in Hong Kong was about 50%. It was affected by the perceived threat of an impending outbreak. The attitudes of nurses toward the effectiveness of and rationale for vaccination were a major barrier to increasing the rate of vaccination.

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Prevalence of influenza vaccination among adults with high-risk conditions, United States, 2019

10.1101/2020.12.21.20248635 ◽

2020 ◽

Author(s):

Saji Saraswathy Gopalan ◽

Devi Kalyan Mishra ◽

Ashis Kumar Das

Keyword(s):

High Risk ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Family Income ◽

Influenza Infection ◽

Insurance Coverage ◽

Age Groups ◽

National Sample ◽

Medical Conditions ◽

To Receive

AbstractBackgroundInfluenza could be associated with illnesses, severe complications, hospitalizations, and deaths among adults with high-risk medical conditions. Influenza vaccination reduces the risks and complications associated with influenza infection in high-risk conditions. We assessed the prevalence and predictors of influenza vaccination in a national sample of adults with high-risk medical conditions.MethodsUsing the nationally representative National Health Interview Survey of 2019, we estimated the prevalence of influenza vaccination among adults with high-risk conditions. We tested the associations between receipt of vaccination and sociodemographic predictors with adjusted multivariable logistic regression.ResultsOut of 15,258 adults with high-risk conditions, 56% reported receiving an influenza vaccine over the previous 12 months. Multivariable regressions show that respondents from older age groups, females, other race/ethnic group, married, higher annual family income, having a health insurance and those with more than two high-risk conditions are more likely to receive the influenza vaccine. However, adults from non-Hispanic Black race/ethnicity and living in the Southern census region are less likely to receive the vaccination. Education levels and living in a metro show no associations with vaccination status.ConclusionState authorities, primary physicians, specialists, and pharmacists have important roles in sensitizing and reminding individuals with high-risk conditions to receive timely vaccination. Similarly, affordability needs to be enhanced for influenza vaccination including better insurance coverage and reduced co-payment.

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Should safety of the flu vaccine for cancer patients be reexamined?

F1000Research ◽

10.12688/f1000research.13428.1 ◽

2018 ◽

Vol 7 ◽

pp. 1 ◽

Cited By ~ 4

Author(s):

Slobodan Paessler ◽

Veljko Veljkovic

Keyword(s):

Experimental Data ◽

Cell Proliferation ◽

Influenza Vaccine ◽

Cancer Patients ◽

Influenza Infection ◽

Cell Proliferation And Migration ◽

Seasonal Flu ◽

Flu Vaccine ◽

And Migration ◽

Proliferation And Migration

Seasonal flu vaccine is recommended as the best protection for cancer patients against influenza infection. Recent in silico and experimental data suggest that antibodies elicited with influenza vaccine could activate bradykinin receptor B2-associated signaling pathway, which is also involved in cell proliferation and migration of tumor cells. These results point to an urgent need for the reexamination of safety of influenza vaccine(s) in cancer patients.

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Considerations for the Care of Women with Gynecological Cancers during the COVID-19 Pandemic

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0040-1716924 ◽

2020 ◽

Vol 5 (03) ◽

pp. 256-259

Author(s):

Vinitha Reddy Palwai ◽

Monica Irukulla

Keyword(s):

Early Diagnosis ◽

Cancer Patients ◽

Early Stage ◽

Morbidity And Mortality ◽

Gynecological Cancers ◽

Management Guidelines ◽

Patients With Cancer ◽

Significant Challenge ◽

Advanced Stages ◽

Timely Treatment

AbstractDelivering care for patients with cancer during the COVID-19 pandemic can pose a significant challenge, given the fact that cancer patients face a higher risk of morbidity and mortality from the infection. Outcomes in gynecological cancers are heavily stage-dependent, ranging from 5-year survival 95% in early stage to less than 15% in advanced stages. Early diagnosis and timely treatment are therefore of the utmost importance, but they should be balanced, considering the availability of local expertise and resources and the local pandemic status. This article outlines the management guidelines for the care of women with gynecological malignancies during the COVID-19 pandemic.

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Effectiveness of influenza vaccination in preventing hospitalisation due to influenza in children: a systematic review and meta-analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciab270 ◽

2021 ◽

Author(s):

Nicki L Boddington ◽

Isabelle Pearson ◽

Heather Whitaker ◽

Punam Mangtani ◽

Richard G Pebody

Keyword(s):

Systematic Review ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Random Effects ◽

Influenza A ◽

Influenza Infection ◽

Meta Analysis ◽

Vaccine Effectiveness ◽

Vaccine Type ◽

Inactivated Vaccines

Abstract This systematic review assesses the literature for estimates of influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalisation in children. Studies of any design to 08 June 2020 were included if the outcome was hospitalisation, participants were 17 years old or less and influenza infection was laboratory-confirmed. A random-effects meta-analysis of 37 studies that used a test-negative design gave a pooled seasonal IVE against hospitalisation of 53.3% (47.2-58.8) for any influenza. IVE was higher against influenza A/H1N1pdm09 (68.7%, 56.9-77.2) and lowest against influenza A/H3N2 (35.8%, 23.4-46.3). Estimates by vaccine type ranged from 44.3% (30.1-55.7) for LAIV to 68.9% (53.6-79.2) for inactivated vaccines. IVE estimates were higher in seasons when the circulating influenza strains were antigenically matched to vaccine strains (59.3%, 48.3-68.0). Influenza vaccination gives moderate overall protection against influenza-associated hospitalisation in children supporting annual vaccination. IVE varies by influenza subtype and vaccine type.

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Overview of Supportive Care in Patients Receiving Chemotherapy

Journal of Pharmacy Practice ◽

10.1177/0897190011431631 ◽

2012 ◽

Vol 25 (2) ◽

pp. 209-221 ◽

Cited By ~ 8

Author(s):

Liana Scialdone

Keyword(s):

United States ◽

Pain Management ◽

Side Effects ◽

Adverse Effects ◽

Supportive Care ◽

Clinical Outcomes ◽

Radiation Treatment ◽

The United States ◽

Patients With Cancer ◽

Living With Cancer

With advancements in the field of oncology, more and more people are living with cancer. The prevalence of invasive cancer in the United States is estimated to be almost 12 million. The treatment of cancer as well as the malignancy itself can cause an immense number of side effects and other complications. This article explores the fundamentals of supportive care in patients receiving chemotherapy and radiation treatment including prevention of nausea and vomiting, pain management, treatment of anemia and neutropenia. Proper supportive care can help improve clinical outcomes, reduce medical costs, and help patients with cancer live longer, happier, and healthier lives. For these reasons, it is important for pharmacists to possess a solid understanding of how to prevent and treat the adverse effects of chemotherapy and radiation treatment.

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Effectiveness of influenza vaccine among health care personnel in Thailand, 2018/19 season

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1096 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T Eamchotchawalit ◽

P Piyaraj ◽

P Narongdej ◽

S Charoensakulchai ◽

C Chanthowong

Keyword(s):

Health Care ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Influenza Season ◽

Influenza Infection ◽

Vaccine Effectiveness ◽

Health Care Personnel ◽

Seasonal Influenza Vaccine ◽

Influenza Like Illness

Abstract Background Influenza vaccination is the most effective way of preventing influenza infections and it is recommended for the entire health care personnel in Thailand. However, the evidence of influenza vaccine effectiveness (VE) among health care personnel is lacking in Thailand. The objective of this study was to estimate influenza vaccine effectiveness (VE) against laboratory confirmed medically attended influenza illness for the 2018/9 season among health care personnel who at risk for influenza infection in Bangkok, the capital of Thailand. Methods Throat swab specimens were collected from patients with influenza-like illness (ILI) presenting to outpatient clinics and tested for influenza virus by RT-PCR, between October 2018 and September 2019. A test-negative case-control design was used to estimate influenza VE against medically-attended laboratory-confirmed influenza in outpatient settings. Cases were influenza-like illness (ILI) patients who tested positive for influenza, and controls were influenza negative patients. Results During the 2018/19 season 373 samples were collected; 57 (15.3%) were positive for influenza, 70.2% A un-subtyped and 29.8% B. Adjusted VE against all influenza viruses for this influenza season was -31.7% (95% confidence interval (CI): -40.2 to 66.4), against influenza A un-subtyped, it was 43.9% (95% CI: -30.6 to 75.9) and against influenza B, it was 52.0% (95% CI: (-73.9 to 86.8). Conclusions The seasonal influenza vaccine was moderately effective against medically attended lab-confirmed influenza infection in health care personnel in Bangkok, Thailand in the 2018-19 influenza season. Key messages The seasonal influenza vaccine was moderately effective against medically attended lab-confirmed influenza infection in health care personnel in Bangkok. Increasing seasonal influenza vaccination among health care personnel in Thailand may decrease medically attended influenza-associated ILI cases in this population.

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