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Kinslow CJ, Wang Y, Liu Y, Zuev KM, Chaudhary KR, Wang TJC, Donalek C, Amori M, Cheng SK. Influenza activity and regional mortality for non-small cell lung cancer. Sci Rep 2023; 13:21674. [PMID: 38065996 PMCID: PMC10709588 DOI: 10.1038/s41598-023-47173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in patients with cancer remains largely unknown. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015. Influenza-like illness (ILI) activity, provided by the Outpatient Influenza-like Illness Surveillance Network of the Center of Disease for Control and Prevention, was merged with the SEER dataset on the state-month level. Regional monthly mortality rates were compared during low versus high flu months in this ecological cohort study. 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1049 state-months (5.1%) had high flu activity. Monthly mortality rates during low and high flu months were 0.041 (95% CI 0.041-0.042) and 0.051 (95% CI 0.050-0.053), respectively (RR 1.24 [95% CI 1.21-1.27]). The association between ILI activity and mortality was observed at the individual state level and in all clinical and regional subgroups. Increased regional influenza activity is associated with higher mortality rates for patients with NSCLC. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related lung cancer deaths in the U.S.
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Affiliation(s)
- Connor J Kinslow
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Yuankun Wang
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Yi Liu
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Konstantin M Zuev
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
- California Institute of Technology, 1200 E. California Blvd., Pasadena, CA, 91125, USA
| | - Kunal R Chaudhary
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Ciro Donalek
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Michael Amori
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
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2
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Ishak AR, Hsieh YC, Srinivasan H, See KC. Review of Vaccination Recommendations in Guidelines for Non-Communicable Diseases with Highest Global Disease Burden among Adults 75 Years Old and Above. Vaccines (Basel) 2023; 11:1076. [PMID: 37376465 DOI: 10.3390/vaccines11061076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
This scientific review paper explores international and country-specific healthcare guidelines for non-communicable diseases with the highest burden among individuals aged 75 years and above. The study aims to identify the best vaccination practices and standardize healthcare practices to improve vaccination adherence in this vulnerable population. Given that older people are more prone to infectious illnesses and have higher rates of morbidity and mortality, vaccinations are essential for disease prevention. Despite the proven efficacy of vaccinations, adherence has plateaued in recent years, partly due to a lack of accessibility, public education, and variability in disease-specific guidelines. This paper highlights the need for a more robust and standardized international vaccination model to improve quality of life and reduce disability-adjusted life years among the elderly. The findings of this study call for further research to review the guidelines as more implementations are put in place, including non-English guidelines.
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Affiliation(s)
- Abdul Rahman Ishak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Yu Chun Hsieh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Harshitha Srinivasan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Kay Choong See
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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3
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Pedrazzoli P, Lasagna A, Cassaniti I, Piralla A, Squeri A, Bruno R, Sacchi P, Baldanti F, Di Maio M, Beretta GD, Cinieri S, Silvestris N. Vaccination for seasonal flu, pneumococcal infection, and SARS-CoV-2 in patients with solid tumors: recommendations of the Associazione Italiana di Oncologia Medica (AIOM). ESMO Open 2023; 8:101215. [PMID: 37104930 PMCID: PMC10067463 DOI: 10.1016/j.esmoop.2023.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
Patients with cancer have a well-known and higher risk of vaccine-preventable diseases (VPDs). VPDs may cause severe complications in this setting due to the immune system impairment, malnutrition and oncological treatments. Despite this evidence, vaccination rates are inadequate. The Italian Association of Medical Oncology (AIOM) has been involved in vaccination awareness since 2014. Based on a careful review of the available data about the immunogenicity, effectiveness and safety of flu, pneumococcal and anti-SARS-CoV-2 vaccines, we report the recommendations of the Associazione Italiana di Oncologia Medica about these vaccinations in adult patients with solid tumors. AIOM recommends comprehensive education on the issue of VPDs. We believe that a multidisciplinary care model may improve the vaccination coverage in immunocompromised patients. Continued surveillance, implementation of preventive practices and future well-designed immunological prospective studies are essential for a better management of our patients with cancer.
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Affiliation(s)
- P Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - I Cassaniti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Squeri
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy; School of Specialization in Medical Oncology, University of Messina, Messina, Italy
| | - R Bruno
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Sacchi
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Baldanti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Division of Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - G D Beretta
- Medical Oncology Unit, Santo Spirito Hospital, Pescara, Italy
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - N Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
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Wang KY, Shah P, Skavla B, Fayaaz F, Chi J, Rhodes JM. Vaccination efficacy in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2023; 64:42-56. [PMID: 36270021 DOI: 10.1080/10428194.2022.2133538] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a disorder of mature malignant B cells with multiple elements of immune dysfunction. Infections are common in CLL patients due to complex immunodeficiency. Vaccines are used as preventative measures for common diseases including influenza, pneumococcus, tetanus/diphtheria and shingles in the general population. Vaccines are utilized to mitigate this risk, although there have been some concerns regarding the efficacy of vaccines in the CLL population due to the inherent complex immune dysfunction associated with the disease. In this review, we describe the clinical and laboratory indicators for efficacy of the vaccines in the CLL population (including COVID-19, influenza, pneumonia, herpes zoster, and tetanus) and discuss immunization recommendations for patients with CLL.
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Affiliation(s)
- Kevin Y Wang
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Pratik Shah
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Brandon Skavla
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Fatima Fayaaz
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA
| | - Jeffrey Chi
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA
| | - Joanna M Rhodes
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Lin EPY, Huang LC, Whisenant J, York S, Osterman T, Lewis J, Iams W, Skotte E, Cass A, Hsu CY, Shyr Y, Horn L. Associations of influenza vaccination with severity of immune-related adverse events in patients with advanced thoracic cancers on immune checkpoint inhibitors. ERJ Open Res 2022; 8:00684-2021. [PMID: 36225333 PMCID: PMC9549316 DOI: 10.1183/23120541.00684-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Whether influenza vaccination (FV) is associated with the severity of immune-related adverse events (IRAEs) in patients with advanced thoracic cancer on immune checkpoint inhibitors (ICIs) is not fully understood. Methods Patients enrolled in this retrospective cohort study were identified from the Vanderbilt BioVU database and their medical records were reviewed. Patients with advanced thoracic cancer who received FV within 3 months prior to or during their ICI treatment period were enrolled in the FV-positive cohort and those who did not were enrolled in the FV-negative cohort. The primary objective was to detect whether FV is associated with decreased IRAE severity. The secondary objectives were to evaluate whether FV is associated with a decreased risk for grade 3-5 IRAEs and better survival times. Multivariable ordinal logistic regression was used for the primary analysis. Results A total of 142 and 105 patients were enrolled in the FV-positive and FV-negative cohorts, respectively. There was no statistically significant difference in patient demographics or cumulative incidences of IRAEs between the two cohorts. In the primary analysis, FV was inversely associated with the severity of IRAEs (OR 0.63; p=0.046). In the secondary analysis, FV was associated with a decreased risk for grade 3-5 IRAEs (OR 0.42; p=0.005). Multivariable Cox regression showed that FV was not associated with survival times. Conclusions Our study showed that FV does not increase toxicity for patients with advanced thoracic cancer on ICIs and is associated with a decreased risk for grade 3-5 IRAEs. No statistically significant survival differences were found between patients with and without FV.
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Affiliation(s)
- Emily Pei-Ying Lin
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Dept of Medical Research, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Pulmonary Medicine, Dept of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Dept of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Ching Huang
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Whisenant
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sally York
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Travis Osterman
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Dept of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Lewis
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wade Iams
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Skotte
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda Cass
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chih-Yuan Hsu
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Shyr
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- These authors contributed equally
| | - Leora Horn
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- These authors contributed equally
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6
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Seasonal influenza vaccination among cancer patients during the COVID-19 pandemic in Poland. Contemp Oncol (Pozn) 2021; 25:168-173. [PMID: 34729036 PMCID: PMC8547183 DOI: 10.5114/wo.2021.109417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction In the era of the COVID-19 pandemic overlapping with the influenza season, the number of infections with the abovementioned viruses may result in overload in the healthcare system, difficulties in the diagnosis of respiratory diseases, poorer access to appropriate therapy, and increased mortality. Aim of the study The aim of this study was to analyze the influence of the COVID-19 pandemic on the decision to be vaccinated against seasonal influenza in cancer patients. Material and methods An anonymous survey prepared by the authors was made available to patients at the Chemotherapy Department at the Greater Poland Cancer Center. The survey covered 236 respondents, both female (67.4%, n = 159) and male (32.6%, n =77). A 0–10 point numerical scale was used to assess the fear of coronavirus infection and the influenza. Data were collected from June 8 to September 30, 2020. The survey included 25 questions. The patients were informed by physicians about the voluntary and anonymous nature of the survey, to which they gave their oral consent. IBM SPSS Statistics 26 was used for the analysis. Results The vast majority of patients (69.5%, n = 164) have never been vaccinated against influenza and 30.5% (n = 72) have been vaccinated at least once in the past. In the face of the COVID-19 pandemic, almost ¼ of the patients (24.6%, n = 58) stated that they wanted to be vaccinated against influenza. Only 33.5% (n = 79) of the respondents believed that the influenza vaccine was effective. Conclusions Action is needed to increase the percentage of cancer patients who will be regularly vaccinated against the influenza. The COVID-19 pandemic may raise the interest of cancer patients in influenza vaccination.
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7
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Spagnolo F, Boutros A, Croce E, Cecchi F, Arecco L, Tanda E, Pronzato P, Lambertini M. Influenza vaccination in cancer patients receiving immune checkpoint inhibitors: A systematic review. Eur J Clin Invest 2021; 51:e13604. [PMID: 34021591 PMCID: PMC8365730 DOI: 10.1111/eci.13604] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a concern that influenza vaccination may increase the incidence of immune-related adverse events in patients receiving immune checkpoint inhibitors (ICIs). The aim of this systematic review was to summarize the available data on the safety and efficacy of influenza vaccination in cancer patients receiving ICIs. METHODS Studies reporting safety and efficacy outcomes of influenza vaccination in cancer patients receiving ICIs were included. Only descriptive statistics were conducted to obtain a pooled rate of immune-related adverse events in vaccinated patients. RESULTS Ten studies assessing the safety and eight assessing the efficacy of influenza vaccination in cancer patients receiving ICIs were identified, for a total of 1124 and 986 vaccinated patients, respectively. Most patients had melanoma or lung cancer and received a single agent anti-PD-1, but also other tumour types and immunotherapy combinations were represented. No severe vaccination-related toxicities were reported. The pooled incidence of any grade immune checkpoint inhibitor-related adverse events was 28.9%. In the 6 studies specifying the incidence of grade 3-4 toxicities, the pooled incidence was 7.5%. No grade 5 toxicities were reported. No pooled descriptive analysis was conducted in studies reporting efficacy outcomes due to the heterogeneity of endpoints and data reporting. Nevertheless, among the eight studies included, seven reported positive efficacy outcomes of influenza vaccination. CONCLUSION The results of this systematic review support the safety and efficacy of influenza vaccination in cancer patients receiving ICIs. These results are particularly relevant in the context of the SARS-CoV-2 pandemic.
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Affiliation(s)
- Francesco Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Boutros
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Elena Croce
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Federica Cecchi
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Enrica Tanda
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Pronzato
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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8
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Chebel R, Labaki C, Farhat M, Kattan J. Safety, efficacy and acceptability of SARS-CoV-2 vaccines in patients with cancer. Future Virol 2021. [PMID: 34249141 PMCID: PMC8246498 DOI: 10.2217/fvl-2021-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Roy Chebel
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Chris Labaki
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Maria Farhat
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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9
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Chong CR, Park VJ, Cohen B, Postow MA, Wolchok JD, Kamboj M. Safety of Inactivated Influenza Vaccine in Cancer Patients Receiving Immune Checkpoint Inhibitors. Clin Infect Dis 2021; 70:193-199. [PMID: 30874791 DOI: 10.1093/cid/ciz202] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cancer patients are at a higher risk for developing influenza (flu)- related complications. It is unclear if the flu vaccine exacerbates immune events in patients treated with immune checkpoint inhibitors (ICIs). METHODS We conducted an institutional review board-IRB-approved retrospective review of advanced cancer patients on ICIs who received the flu vaccine during three 3 consecutive seasons: 2014-2015, 2015-2016, and 2016-2017. The primary outcome assessed was any "new onset" immune-related adverse event (IRAE). A subset analysis of vaccinated patients newly treated with anti-programmed cell death protein 1 (PD-1) agents (nivolumab or pembrolizumab) was conducted to assess overall IRAE rates for comparison with published clinical trials. RESULTS During the three 3 seasons, 370 patients met criteria for ICI and vaccination within ~ twoapproximately 2 months (65 days). The most common underlying cancers were lung (46%) and melanoma (19%); 61% of patients received an anti-PD-1 agent only. In the entire cohort, 20% experienced an IRAE (any grade); incidence of grade 3 or 4 toxicity was 8%. No grade 5 events occurred. In the subset of 170 patients newly treated with anti-PD-1 agents, the overall IRAE rate was 18% and, grade 3/4 events occurred in 7.6%. Influenza was diagnosed in 2 patients. CONCLUSIONS No increase in incidence or severity of IRAEs was detected in patients on ICIs who received the inactivated influenza vaccine within ~ approximately 2 months of ICI. For newly treated patients on anti-PDI-1 agents, IRAE rates were comparable to those from published clinical trials and did not vary with order of administration. Routine seasonal flu vaccination is encouraged in patients on ICIs.
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Affiliation(s)
- Curtis R Chong
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Vivian J Park
- Department of Pharmacy, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Bevin Cohen
- Office of Nursing Research, Department of Nursing, Memorial Sloan-Kettering Cancer Center, New York, New York.,School of Nursing, Columbia University Medical Center
| | - Michael A Postow
- Melanoma & Immunotherapeutics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jedd D Wolchok
- Melanoma & Immunotherapeutics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mini Kamboj
- Infection Control, Memorial Sloan-Kettering Cancer Center, New York, New York.,Infectious Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
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10
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Laws HJ, Baumann U, Bogdan C, Burchard G, Christopeit M, Hecht J, Heininger U, Hilgendorf I, Kern W, Kling K, Kobbe G, Külper W, Lehrnbecher T, Meisel R, Simon A, Ullmann A, de Wit M, Zepp F. Impfen bei Immundefizienz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:588-644. [PMID: 32350583 PMCID: PMC7223132 DOI: 10.1007/s00103-020-03123-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hans-Jürgen Laws
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität FAU Erlangen-Nürnberg, Erlangen, Deutschland
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
| | - Gerd Burchard
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland
| | - Maximilian Christopeit
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrich Heininger
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Kern
- Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Kerstin Kling
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland.
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wiebe Külper
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maike de Wit
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Onkologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - Fred Zepp
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Deutschland
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11
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Buchy P, Badur S. Who and when to vaccinate against influenza. Int J Infect Dis 2020; 93:375-387. [DOI: 10.1016/j.ijid.2020.02.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022] Open
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12
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Influenza vaccination in caregivers of childhood cancer survivors. J Cancer Surviv 2019; 13:993-1001. [DOI: 10.1007/s11764-019-00825-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
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13
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Blanchette PS, Chung H, Pritchard KI, Earle CC, Campitelli MA, Buchan SA, Schwartz KL, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson DC, Richardson SE, Rosella LC, Simor A, Smieja M, Zahariadis G, Campigotto A, Kwong JC. Influenza Vaccine Effectiveness Among Patients With Cancer: A Population-Based Study Using Health Administrative and Laboratory Testing Data From Ontario, Canada. J Clin Oncol 2019; 37:2795-2804. [PMID: 31465264 DOI: 10.1200/jco.19.00354] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer. PATIENTS AND METHODS We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time. RESULTS We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies (P = .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer. CONCLUSION Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
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Affiliation(s)
- Phillip S Blanchette
- University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,ICES London and Toronto, Ontario, Canada
| | | | | | - Craig C Earle
- ICES London and Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Sarah A Buchan
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Katz
- University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Allison J McGeer
- University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Ontario, Canada
| | - James D McNally
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Susan E Richardson
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | | | | | - Aaron Campigotto
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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14
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Awadalla M, Golden DLA, Mahmood SS, Alvi RM, Mercaldo ND, Hassan MZO, Banerji D, Rokicki A, Mulligan C, Murphy SPT, Jones-O'Connor M, Cohen JV, Heinzerling LM, Armanious M, Sullivan RJ, Damrongwatanasuk R, Chen CL, Gupta D, Kirchberger MC, Moslehi JJ, Shah SP, Ganatra S, Thavendiranathan P, Rizvi MA, Sahni G, Lyon AR, Tocchetti CG, Mercurio V, Thuny F, Ederhy S, Mahmoudi M, Lawrence DP, Groarke JD, Nohria A, Fradley MG, Reynolds KL, Neilan TG. Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors. J Immunother Cancer 2019; 7:53. [PMID: 30795818 PMCID: PMC6387531 DOI: 10.1186/s40425-019-0535-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/13/2019] [Indexed: 12/18/2022] Open
Abstract
Background Influenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious complication of ICIs and may also result from infection with influenza. There are no data testing the relationship between FV and the development of myocarditis on ICIs. Methods Patients on ICIs who developed myocarditis (n = 101) (cases) were compared to ICI-treated patients (n = 201) without myocarditis (controls). A patient was defined as having the FV if they were administered the FV from 6 months prior to start of ICI to anytime during ICI therapy. Alternate thresholds for FV status were also tested. The primary comparison of interest was the rate of FV between cases and controls. Patients with myocarditis were followed for major adverse cardiac events (MACE), defined as the composite of cardiogenic shock, cardiac arrest, hemodynamically significant complete heart block and cardiovascular death. Results The FV was administered to 25% of the myocarditis cases compared to 40% of the non-myocarditis ICI-treated controls (p = 0.01). Similar findings of lower rates of FV administration were noted among myocarditis cases when alternate thresholds were tested. Among the myocarditis cases, those who were vaccinated had 3-fold lower troponin levels when compared to unvaccinated cases (FV vs. No FV: 0.12 [0.02, 0.47] vs. 0.40 [0.11, 1.26] ng/ml, p = 0.02). Within myocarditis cases, those administered the FV also had a lower rate of other irAEs when compared to unvaccinated cases (36 vs. 55% p = 0.10) including lower rates of pneumonitis (12 vs. 36%, p = 0.03). During follow-up (175 [IQR 89, 363] days), 47% of myocarditis cases experienced a MACE. Myocarditis cases who received the FV were at a lower risk of cumulative MACE when compared to unvaccinated cases (24 vs. 59%, p = 0.002). Conclusion The rate of FV among ICI-related myocarditis cases was lower than controls on ICIs who did not develop myocarditis. In those who developed myocarditis related to an ICI, there was less myocardial injury and a lower risk of MACE among those who were administered the FV. Electronic supplementary material The online version of this article (10.1186/s40425-019-0535-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magid Awadalla
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - Doll Lauren Alexandra Golden
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Syed S Mahmood
- Cardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Raza M Alvi
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Nathaniel D Mercaldo
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Malek Z O Hassan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Dahlia Banerji
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Adam Rokicki
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Connor Mulligan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Sean P T Murphy
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Maeve Jones-O'Connor
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Justine V Cohen
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lucie M Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen, Germany
| | - Merna Armanious
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA
| | - Ryan J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Rongras Damrongwatanasuk
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA
| | - Carol L Chen
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Dipti Gupta
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen, Germany
| | - Javid J Moslehi
- Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sachin P Shah
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Sarju Ganatra
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad A Rizvi
- Division of Oncology and Hematology, Department of Medicine, Lehigh Valley Hospital, Allentown, PA, USA
| | | | | | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Franck Thuny
- Cardiovascular Division, Department of Medicine, Aix-Marseille Universite, Marseille, France
| | - Stephane Ederhy
- Cardio-Oncology Program, Division of Cardiology, Hopitaux Universitaires est Paris, Paris, France
| | - Michael Mahmoudi
- Division of Cardiology, Department of Medicine, Southampton General Hospital, Southampton, UK
| | - Donald P Lawrence
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John D Groarke
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael G Fradley
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, FL, USA
| | - Kerry L Reynolds
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.,Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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15
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Shang M, Chung JR, Jackson ML, Jackson LA, Monto AS, Martin ET, Belongia EA, McLean HQ, Gaglani M, Murthy K, Zimmerman RK, Nowalk MP, Fry AM, Flannery B. Influenza vaccine effectiveness among patients with high-risk medical conditions in the United States, 2012-2016. Vaccine 2018; 36:8047-8053. [PMID: 30420119 PMCID: PMC6282182 DOI: 10.1016/j.vaccine.2018.10.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Annual influenza vaccination has been recommended for persons with high-risk conditions since the 1960s. However, few estimates of influenza vaccine effectiveness (VE) for persons with high-risk conditions are available. METHODS Data from the U.S. Influenza Vaccine Effectiveness Network from 2012 to 2016 were analyzed to compare VE of standard-dose inactivated vaccines against medically-attended influenza among patients aged ≥6 months with and without high-risk medical conditions. Patients with acute respiratory illness were tested for influenza by RT-PCR. Presence of high-risk conditions and vaccination status were obtained from medical records. VE by influenza virus type/subtype and age group was calculated for patients with and without high-risk conditions using the test-negative design. Interaction terms were used to test for differences in VE by high-risk conditions. RESULTS Overall, 9643 (38%) of 25,369 patients enrolled during four influenza seasons had high-risk conditions; 2213 (23%) tested positive for influenza infection. For all ages, VE against any influenza was lower among patients with high-risk conditions (41%, 95% CI: 35-47%) than those without (48%, 95% CI: 43-52%; P-for-interaction = 0.02). For children aged <18 years, VE against any influenza was 51% (95% CI: 39-61%) and 52% (95% CI: 39-61%) among those with and without high-risk conditions, respectively (P-for-interaction = 0.54). For adults aged ≥18 years, VE against any influenza was 38% (95% CI: 30-45%) and 44% (95% CI: 38-50%) among those with and without high-risk conditions, respectively (P-for-interaction = 0.21). For both children aged <18 and adults aged ≥18 years, VEs against illness related to influenza A(H3N2), A(H1N1)pdm09, and influenza B virus infection were similar among those with and without high-risk conditions. CONCLUSIONS Influenza vaccination provided protection against medically-attended influenza among patients with high-risk conditions, at levels approaching those observed among patients without high-risk conditions. Results from our analysis support recommendations of annual vaccination for patients with high-risk conditions.
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Affiliation(s)
- Mei Shang
- Epidemic Intelligence Service, CDC, United States; Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, United States
| | - Jessie R Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, United States
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, United States
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, United States
| | - Arnold S Monto
- University of Michigan and Henry Ford Health System, United States
| | - Emily T Martin
- University of Michigan and Henry Ford Health System, United States
| | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine, United States
| | - Kempapura Murthy
- Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine, United States
| | - Richard K Zimmerman
- University of Pittsburgh Schools of the Health Sciences and UPMC, United States
| | | | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, United States
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, United States.
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16
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Nipp RD, Ruddy M, Fuh CX, Zangardi ML, Chio C, Kim EB, Li BKM, Long Y, Blouin GC, Lage D, Ryan DP, Greer JA, El-Jawahri A, Temel JS. Pilot Randomized Trial of a Pharmacy Intervention for Older Adults with Cancer. Oncologist 2018; 24:211-218. [PMID: 30341175 DOI: 10.1634/theoncologist.2018-0408] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Oncology clinicians often struggle with managing medications and vaccinations in older adults with cancer. We sought to demonstrate the feasibility and preliminary efficacy of integrating pharmacists into the care of older adults with cancer to enhance medication management and vaccination administration. METHODS We randomly assigned patients aged ≥65 years with breast, gastrointestinal, or lung cancer receiving first-line chemotherapy to the pharmacy intervention or usual care. Patients assigned to the intervention met with a pharmacist once during their second or third chemotherapy infusion. We obtained information about patients' medications and vaccinations via patient report and from the electronic health record (EHR) at baseline and week 4. We determined the number of discrepant (difference between patient report and EHR) and potentially inappropriate (Beers Criteria assessed by nonintervention pharmacists blinded to group assignment) medications. We defined the intervention as feasible if >75% of patients enrolled in the study and received the pharmacist visit. RESULTS From January 17, 2017, to October 27, 2017, we enrolled and randomized 60 patients (80.1% of patients approached). Among those assigned to the intervention, 96.6% received the pharmacist visit. At week 4, intervention patients had higher rates of acquiring vaccinations for pneumonia (27.6% vs. 0.0%, p = .002) and influenza (27.6% vs. 0.0%, p = .002) compared with usual care. Intervention patients had fewer discrepant (5.82 vs. 8.07, p = .094) and potentially inappropriate (3.46 vs. 4.80, p = .069) medications at week 4, although differences were not significant. CONCLUSION Integrating pharmacists into the care of older adults with cancer is feasible with encouraging preliminary efficacy for enhancing medication management and improving vaccination rates. IMPLICATIONS FOR PRACTICE Results of this study showed the feasibility, acceptability, and preliminary efficacy of an intervention integrating pharmacists into the care of older adults with cancer. Notably, patients assigned to the intervention had fewer discrepant medications and were more likely to acquire vaccinations for pneumonia and influenza. Importantly, this work represents the first randomized controlled trial involving the integration of pharmacists into the outpatient oncologic care of older adults with cancer. In the future, a larger randomized trial is needed to demonstrate the efficacy of this care model to enhance medication management and improve vaccination outcomes for older patients with cancer.
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Affiliation(s)
- Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Ruddy
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Charn-Xin Fuh
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark L Zangardi
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Chio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - E Bridget Kim
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Kong Mui Li
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ying Long
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Gayle C Blouin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Lage
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David P Ryan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
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17
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Abstract
Oncology patients are a unique patient population in the emergency department (ED). Malignancy and associated surgical, chemotherapeutic, or radiation therapies put them at an increased risk for infection. The most ominous development is neutropenic fever, which happens often and may not present with signs or symptoms other than fever. A broad differential diagnosis is essential when considering infectious disease pathology in both neutropenic and non-neutropenic oncology patients in the ED.
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Affiliation(s)
- Lauren Cantwell
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24014, USA
| | - Jack Perkins
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24014, USA.
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18
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Abstract
Immunocompromised persons are at high risk of complications from influenza infection. This population includes those with solid organ transplants, hematopoietic stem cell transplants, solid cancers and hematologic malignancy as well as those with autoimmune conditions receiving biologic therapies. In this review, we discuss the impact of influenza infection and evidence for vaccine effectiveness and immunogenicity. Overall, lower respiratory disease from influenza is common; however, vaccine immunogenicity is low. Despite this, in some populations, influenza vaccine has demonstrated effectiveness in reducing severe disease. Various strategies to improve influenza vaccine immunogenicity have been attempted including two vaccine doses in the same influenza season, intradermal, adjuvanted, and high-dose vaccines. The timing of influenza vaccine is also important to achieve optimal immunogenicity. Given the suboptimal immunogenicity, family members and healthcare professionals involved in the care of these populations should be vaccinated. Health care professional recommendation for vaccination is an important factor in vaccine coverage.
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Affiliation(s)
- Mohammad Bosaeed
- a Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network , Toronto , Ontario , Canada
| | - Deepali Kumar
- a Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network , Toronto , Ontario , Canada
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19
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Bitterman R, Eliakim‐Raz N, Vinograd I, Zalmanovici Trestioreanu A, Leibovici L, Paul M. Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database Syst Rev 2018; 2:CD008983. [PMID: 29388675 PMCID: PMC6491273 DOI: 10.1002/14651858.cd008983.pub3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND This is an update of the Cochrane review published in 2013, Issue 10.Immunosuppressed cancer patients are at increased risk of serious influenza-related complications. Guidelines, therefore, recommend influenza vaccination for these patients. However, data on vaccine effectiveness in this population are lacking, and the value of vaccination in this population remains unclear. OBJECTIVES To assess the effectiveness of influenza vaccine in immunosuppressed adults with malignancies. The primary review outcome is all-cause mortality, preferably at the end of the influenza season. Influenza-like illness (ILI, a clinical definition), confirmed influenza, pneumonia, any hospitalisations, influenza-related mortality and immunogenicity were defined as secondary outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and LILACS databases up to May 2017. We searched the following conference proceedings: ICAAC, ECCMID, IDSA (infectious disease conferences), ASH, ASBMT, EBMT (haematological), and ASCO (oncological) between the years 2006 to 2017. In addition, we scanned the references of all identified studies and pertinent reviews. We searched the websites of the manufacturers of influenza vaccine. Finally, we searched for ongoing or unpublished trials in clinical trial registry databases. SELECTION CRITERIA Randomised controlled trials (RCTs), prospective and retrospective cohort studies and case-control studies were considered, comparing inactivated influenza vaccines versus placebo, no vaccination or a different vaccine, in adults (16 years and over) with cancer. We considered solid malignancies treated with chemotherapy, haematological cancer patients treated or not treated with chemotherapy, cancer patients post-autologous (up to six months after transplantation) or allogeneic (at any time) haematopoietic stem cell transplantation (HSCT). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias and extracted data from included studies adhering to Cochrane methodology. Meta-analysis could not be performed because of different outcome and denominator definitions in the included studies. MAIN RESULTS We identified six studies with a total of 2275 participants: five studies comparing vaccination with no vaccination, and one comparing adjuvanted vaccine with non-adjuvanted vaccine. Three studies were RCTs, one was a prospective observational cohort study and two were retrospective cohort studies.For the comparison of vaccination with no vaccination we included two RCTs and three observational studies, including 2202 participants. One study reported results in person-years while the others reported results per person. The five studies were performed between 1993 and 2015 and included adults with haematological diseases (three studies), patients following bone marrow transplantation (BMT) (two studies) and solid malignancies (three studies).One RCT and two observational studies reported all-cause mortality; the RCT showed similar mortality rates in both arms (odds ratio (OR) 1.25 (95% CI 0.43 to 3.62; 1 study, 78 participants, low-certainty evidence)); and the observational studies demonstrated a significant association between vaccine receipt and lower risk of death, adjusted hazard ratio 0.88 (95% CI 0.78 to 1; 1 study, 1577 participants, very low-certainty evidence) in one study and OR 0.42 (95% CI 0.24 to 0.75; 1 study, 806 participants, very low-certainty evidence) in the other. One RCT reported a reduction in ILI with vaccination, while no difference was observed in one observational study. Confirmed influenza rates were lower with vaccination in one RCT and the three observational studies, the difference reaching statistical significance in one. Pneumonia was observed significantly less frequently with vaccination in one observational study, but no difference was detected in another or in the RCT. One RCT showed a reduction in hospitalisations following vaccination, while an observational study found no difference. No life-threatening or persistent adverse effects from vaccination were reported. The strength of evidence was limited by the low number of included studies and by their low methodological quality and the certainty of the evidence for the mortality outcome according to GRADE was low to very low.For the comparison of adjuvanted vaccine with non-adjuvanted vaccine, we identified one RCT, including 73 patients. No differences were found for the primary and all secondary outcomes assessed. Mortality risk ratio was 0.54 (95% CI 0.05 to 5.73; low-certainty evidence) in the adjuvanted vaccine group. The quality of evidence was low due to the small sample size and the large confidence intervals for all outcomes. AUTHORS' CONCLUSIONS Observational data suggest lower mortality and infection-related outcomes with influenza vaccination. The strength of evidence is limited by the small number of studies and low grade of evidence. It seems that the evidence, although weak, shows that the benefits overweigh the potential risks when vaccinating adults with cancer against influenza. However, additional placebo or no-treatment controlled RCTs of influenza vaccination among adults with cancer is ethically questionable.There is no conclusive evidence regarding the use of adjuvanted versus non-adjuvanted influenza vaccine in this population.
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Affiliation(s)
- Roni Bitterman
- Rambam Health Care CampusDivision of Infectious DiseasesHaifaIsrael
| | - Noa Eliakim‐Raz
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E; and Sackler Faculty of Medicine, Tel‐Aviv University, Israel39 Jabotinski StreetPetah TikvaIsrael49100
| | - Inbal Vinograd
- Schneider Children's Medical Centre of IsraelPharmacyPetah‐TikvaIsrael49100
| | | | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine EKaplan StreetPetah TikvaIsrael49100
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHaifaIsrael
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20
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Grivas PD, Devata S, Khoriaty R, Boonstra PS, Ruch J, McDonnell K, Hernandez-Aya L, Wilfong J, Smerage J, Ison MG, Eisenberg JNS, Silveira M, Cooney KA, Worden FP. Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:871-877. [PMID: 27055536 DOI: 10.1007/s13187-016-1017-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011-2012 and 2012-2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005-2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1 % (2011-2012) and 9.4 % (2012-2013) compared to an average 6.9 % during influenza seasons 2005-2011. Based on logistic regression analysis, there was a 37.6 % (95 % CI 35-40.3 %) and 56.1 % (95 % CI 40.9-73 %) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012-2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.
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Affiliation(s)
- Petros D Grivas
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R35, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Sumana Devata
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Rami Khoriaty
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Joshua Ruch
- Hematology/Oncology, Munson Medical Center, Traverse City, MI, USA
| | - Kevin McDonnell
- Division of Hematology/Oncology, University of Southern California, Los Angeles, CA, USA
| | - Leonel Hernandez-Aya
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua Wilfong
- Hospice and Palliative Medicine, Stanford University, Stanford, CA, USA
| | - Jeffrey Smerage
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Maria Silveira
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen A Cooney
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Francis P Worden
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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21
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Leoni D, Encina B, Rello J. Managing the oncologic patient with suspected pneumonia in the intensive care unit. Expert Rev Anti Infect Ther 2017; 14:943-60. [PMID: 27573637 DOI: 10.1080/14787210.2016.1228453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Solid cancer patients are frequently admitted in intensive care units for critical events. Improving survival rates in this setting is considered an achievable goal today. Respiratory failure is the main reason for admission, representing a primary target for research. AREAS COVERED This review presents a diagnostic and therapeutic algorithm for pneumonia and other severe respiratory events in the solid cancer population. It aims to increase awareness of the risk factors and the different etiologies in this changing scenario in which neutropenia no longer seems to be a decisive factor in poor outcome. Bacterial pneumonia is the leading cause, but opportunistic diseases and non-infectious etiologies, especially unexpected adverse effects of radiation, biological drugs and monoclonal antibodies, are becoming increasingly frequent. Options for respiratory support and diagnostics are discussed and indications for antibiotics in the management of pneumonia are detailed. Expert commentary: Prompt initiation of critical care to facilitate optimal decision-making in the management of respiratory failure, early etiological assessment and appropriate antibiotic therapy are cornerstones in management of severe pneumonia in oncologic patients.
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Affiliation(s)
- D Leoni
- a Infectious Disease Department , Tor Vergata University Hospital, University of 'La Sapienza' , Rome , Italy.,b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - B Encina
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain
| | - J Rello
- b Clinical Research & Innovation in Pneumonia & Sepsis (CRIPS) , Vall d'Hebron Institute of Research , Barcelona , Spain.,c Centro de Investigación Biomédica En Red - Enfermedades Respiratorias (CIBERES) , Vall d'Hebron Institute of Research , Barcelona , Spain.,d Department of Medicine , Universitat Autònoma de Barcelona , Barcelona , Spain
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22
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Dulek DE, Halasa NB. Timing isn't everything: Influenza vaccination in cancer patients. Cancer 2016; 123:731-733. [DOI: 10.1002/cncr.30467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel E. Dulek
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
- Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee
| | - Natasha B. Halasa
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
- Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee
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23
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How I treat respiratory viral infections in the setting of intensive chemotherapy or hematopoietic cell transplantation. Blood 2016; 127:2682-92. [PMID: 26968533 DOI: 10.1182/blood-2016-01-634873] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/05/2016] [Indexed: 12/16/2022] Open
Abstract
The widespread use of multiplex molecular diagnostics has led to a significant increase in the detection of respiratory viruses in patients undergoing cytotoxic chemotherapy and hematopoietic cell transplantation (HCT). Respiratory viruses initially infect the upper respiratory tract and then progress to lower respiratory tract disease in a subset of patients. Lower respiratory tract disease can manifest itself as airflow obstruction or viral pneumonia, which can be fatal. Infection in HCT candidates may require delay of transplantation. The risk of progression differs between viruses and immunosuppressive regimens. Risk factors for progression and severity scores have been described, which may allow targeting treatment to high-risk patients. Ribavirin is the only antiviral treatment option for noninfluenza respiratory viruses; however, high-quality data demonstrating its efficacy and relative advantages of the aerosolized versus oral form are lacking. There are significant unmet needs, including data defining the virologic characteristics and clinical significance of human rhinoviruses, human coronaviruses, human metapneumovirus, and human bocavirus, as well as the need for new treatment and preventative options.
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Domínguez A, Godoy P, Torner N. The Effectiveness of Influenza Vaccination in Different Groups. Expert Rev Vaccines 2016; 15:751-64. [PMID: 26775669 DOI: 10.1586/14760584.2016.1142878] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Annual administration of the seasonal influenza vaccine, especially to persons known to be at elevated risk for developing serious complications, is the focus of current efforts to reduce the impact of influenza. The main factors influencing estimated inactivated influenza vaccine efficacy and effectiveness, the results obtained in different population groups, current vaccination strategies and the possible advantages of new vaccines are discussed. The available evidence suggests that influenza vaccines are less effective in the elderly than in young adults, but vaccination is encouraged by public health institutions due to higher mortality and complications. There is no consensus on universal vaccination of children yet economic studies suggest that yearly paediatric vaccination is cost saving. The benefits of herd immunity generated by paediatric vaccination require further study. Newer vaccines should be more and more-broadly protective, stable, easy to manufacture and administer and highly immunogenic across all population groups.
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Affiliation(s)
- Angela Domínguez
- a Department de Salut Pública , Universitat de Barcelona , Barcelona , Spain.,b CIBER Epidemiologia y Salut Pública (CIBERESP) , Madrid , Spain
| | - Pere Godoy
- b CIBER Epidemiologia y Salut Pública (CIBERESP) , Madrid , Spain.,c Agencia de Salut Pública de Catalunya , Generalitat de Catalunya , Barcelona , Spain
| | - Nuria Torner
- a Department de Salut Pública , Universitat de Barcelona , Barcelona , Spain.,b CIBER Epidemiologia y Salut Pública (CIBERESP) , Madrid , Spain.,c Agencia de Salut Pública de Catalunya , Generalitat de Catalunya , Barcelona , Spain
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A Population-Based, Nationwide Cross-Sectional Study on Influenza Vaccination Status among Cancer Survivors in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10133-49. [PMID: 26308031 PMCID: PMC4555334 DOI: 10.3390/ijerph120810133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 12/03/2022]
Abstract
Cancer survivors are at increased risk of developing influenza-related complications. The purpose of this study was to investigate the vaccination coverage among cancer survivors in Korea using the Korea National Health and Nutrition Examination Survey (KNHANES). Adult cancer survivors were selected from fourth (2007–2009) and fifth (2010–2012) KNHANES (n = 1156) datasets. General characteristics, cancer-related data, and influenza vaccination status were collected using self-report questionnaires. Chi-square tests and multiple logistic regression analyses were performed to investigate the association between influenza vaccination coverage and associated factors. Overall, 51% of survivors were vaccinated. Vaccine prevalence exceeded 75% in those more than 65 years but was only 26% in survivors aged 19–44. Increasing age, low frequency of alcohol consumption, having poor self-rated health, and having a shorter duration since cancer diagnosis were significant predictors of vaccination status among cancer survivors under 65 years of age. Influenza vaccine coverage remains much lower than recommended among cancer survivors, particularly in the younger age groups. Further study is needed to determine the factors that contribute to the lack of vaccination in cancer survivors, despite their increased risk for influenza.
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26
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The association between infections and chemotherapy interruptions among cancer patients: Prospective cohort study. J Infect 2015; 70:223-9. [DOI: 10.1016/j.jinf.2014.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 10/16/2014] [Indexed: 12/25/2022]
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Vinograd I, Baslo R, Eliakim-Raz N, Farbman L, Taha A, Sakhnini A, Lador A, Stemmer S, Gafter-Gvili A, Fraser D, Leibovici L, Paul M. Factors associated with influenza vaccination among adult cancer patients: a case–control study. Clin Microbiol Infect 2014; 20:899-905. [DOI: 10.1111/1469-0691.12625] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 01/25/2023]
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Eliakim‐Raz N, Vinograd I, Zalmanovici Trestioreanu A, Leibovici L, Paul M. Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database Syst Rev 2013; 2013:CD008983. [PMID: 24166741 PMCID: PMC6457732 DOI: 10.1002/14651858.cd008983.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Immunosuppressed cancer patients are at increased risk of serious influenza-related complications. Guidelines, therefore, recommend influenza vaccination for these patients. However, data on vaccine effectiveness in this population is lacking, and the value of vaccination in this population remains unclear. OBJECTIVES To assess the effectiveness of influenza vaccine in immunosuppressed adults with malignancies. The primary review outcome is all-cause mortality, preferably at the end of the influenza season. Influenza-like illness (ILI, a clinical definition), confirmed influenza, pneumonia, any hospitalization and influenza-related mortality were defined as secondary outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS databases up to August 2013. We searched the following conference proceedings: ICAAC, ECCMID, IDSA (infectious disease conferences), ASH, ASBMT, EBMT (hematological), and ASCO (oncological) between the years 2006 to 2010. In addition, we scanned the references of all identified studies and pertinent reviews. We searched the websites of the manufacturers of influenza vaccine. Finally, we searched for ongoing or unpublished trials in clinical trial registry databases using the website. SELECTION CRITERIA Randomized controlled trials (RCTs), prospective and retrospective cohort studies and case-control studies were considered, comparing inactivated influenza vaccines versus placebo, no vaccination or a different vaccine, in adults (16 years and over) with cancer. We considered solid malignancies treated with chemotherapy, haematological cancer patients treated or not treated with chemotherapy, cancer patients post-autologous (up to six months after transplantation) or allogeneic (at any time) hematopoietic stem cell transplantation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias and extracted data from included studies adhering to Cochrane methodology. Meta-analysis could not be performed because of different outcome and denominator definitions in the included studies. MAIN RESULTS We identified four studies: one RCT and three observational studies, including 2124 participants. One study reported results in person-years while the other three reported per person. The studies were performed between 1993 and 2012 and included adults with haematological diseases (two studies), patients following bone marrow transplantation (one study) and solid malignancies (three studies). Only two observational studies reported all-cause mortality; one showing an adjusted hazard ratio (HR) of 0.88 (95% CI 0.77 to 0.99) for death with vaccination and the other reporting an odds ratio (OR) of 0.43 (95% CI 0.26 to 0.71). The RCT reported a statistically significant reduction in ILI with vaccination, while no difference was observed in one observational study. Confirmed influenza rates were lower with vaccination in the three observational studies, the difference reaching statistical significance in one. Pneumonia was observed significantly less frequently with vaccination in one observational study, but no difference was detected in another or in the RCT. The RCT showed a reduction in hospitalizations following vaccination, while an observational study found no difference. No life-threatening or persistent adverse effects from vaccination were reported. The strength of evidence is limited by the low number of included studies and by their low methodological quality (high risk of bias). AUTHORS' CONCLUSIONS Observational data suggests a lower mortality with influenza vaccination. Infection-related outcomes were lower or similar with influenza vaccination. The strength of evidence is limited by the small number of studies and by the fact that only one was a RCT. Influenza vaccination is safe and the evidence, although weak, is in favour of vaccinating adults with cancer receiving chemotherapy.
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Affiliation(s)
- Noa Eliakim‐Raz
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E39 Jabotinski StreetPetah TikvaIsrael49100
| | - Inbal Vinograd
- Schneider Children's Medical Centre of IsraelPharmacyPetah‐TikvaIsrael49100
| | | | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E39 Jabotinski StreetPetah TikvaIsrael49100
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHa‐aliya 8 StHaifaIsrael33705
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