1
|
Cetin M, Gumy-Pause F, Gualtieri R, Posfay-Barbe KM, Blanchard-Rohner G. Vaccine Immunity in Children After Hematologic Cancer Treatment: A Retrospective Single-center Study. J Pediatr Hematol Oncol 2024; 46:e51-e59. [PMID: 37922437 PMCID: PMC10756701 DOI: 10.1097/mph.0000000000002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/20/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND Children lose their vaccine-induced protection and are particularly vulnerable to vaccine-preventable diseases after chemotherapy. However, revaccination guidelines are heterogeneous, and there is often a lack of revaccination post-treatment. AIMS We conducted a retrospective study of children with hematologic cancer to evaluate vaccine immunity before and after the end of treatment and to determine whether the current institutional revaccination program based on vaccine serology results was followed and effective. MATERIALS AND METHODS Data of all children treated by chemotherapy between April 2015 and July 2021 were extracted from hospital medical records for analysis. Serum antibody levels and time of vaccination were evaluated for diphtheria, tetanus, Streptococcus pneumoniae , Haemophilus influenzae type b (Hib), measles, varicella, and hepatitis B. RESULTS We included 31 patients (median age, 9 years). At cancer diagnosis, 90% of children were protected against tetanus, diphtheria, and measles; 65% to 67% were protected against pneumococcus and varicella; and 25% against hepatitis B. At the end of chemotherapy, 67% to 71% of patients were protected against tetanus, varicella, and measles; 40% remained protected against hepatitis B; and 27% to 33% against pneumococcus and diphtheria. Patients were revaccinated at various times after the end of treatment but not systematically. During the first-year post-treatment, 20% to 25% of children remained unprotected against pneumococcus, measles, and hepatitis B, one third against diphtheria, but all were protected against tetanus and varicella. CONCLUSIONS An effective individualized vaccination program post-cancer based on serology results should be accompanied by an appropriate serology tracking method and follow-up to assess if booster doses are necessary. Our study supports vaccinating all children with a dose of the 13-valent pneumococcal conjugate at cancer diagnosis and at 3 months post-treatment with the combined diphtheria-tetanus-acellular pertussis/poliomyelitis vaccine/hepatitis B virus plus or minus Hib and 13-valent pneumococcal conjugate and meningococcal vaccine, including measles/mumps/rubella-varicella zoster virus vaccine if good immune reconstitution is present.
Collapse
Affiliation(s)
| | - Fabienne Gumy-Pause
- Pediatric Oncology and Hematology Unit, Department of Women, Child and Adolescent, University Hospitals of Geneva
- CANSEARCH Research Platform for Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva
| | - Renato Gualtieri
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gynecology and Obstetrics, Division of General Pediatrics, Geneva University Hospitals and Faculty of Medicine
| | - Geraldine Blanchard-Rohner
- Immunology and Vaccinology Unit, Department of Pediatrics, Gynecology and Obstetrics, Division of General Pediatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| |
Collapse
|
2
|
MacDonald SE, Palichuk A, Slater L, Tripp H, Reifferscheid L, Burton C. Gaps in knowledge about the vaccine coverage of immunocompromised children: a scoping review. Hum Vaccin Immunother 2021; 18:1-16. [PMID: 34270376 PMCID: PMC8920240 DOI: 10.1080/21645515.2021.1935169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.
Collapse
Affiliation(s)
| | | | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Hailey Tripp
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Catherine Burton
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Canada
| |
Collapse
|
3
|
Guilcher GMT, Rivard L, Huang JT, Wright NAM, Anderson L, Eissa H, Pelletier W, Ramachandran S, Schechter T, Shah AJ, Wong K, Chow EJ. Immune function in childhood cancer survivors: a Children's Oncology Group review. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:284-294. [PMID: 33600774 PMCID: PMC8725381 DOI: 10.1016/s2352-4642(20)30312-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/20/2022]
Abstract
Childhood cancer and its treatment often impact the haematopoietic and lymphatic systems, with immunological consequences. Immunological assessments are not routinely included in surveillance guidelines for most survivors of childhood cancer, although a robust body of literature describes immunological outcomes, testing recommendations, and revaccination guidelines after allogeneic haematopoietic cell transplantation. Survivorship care providers might not fully consider the impaired recovery of a child's immune system after cancer treatment if the child has not undergone haematopoietic cell transplantation. We did a scoping review to collate the existing literature describing immune function after childhood cancer therapy, including both standard-dose chemotherapy and high-dose chemotherapy with haematopoietic cell rescue. This Review aims to summarise: the principles of immunology and testing of immune function; the body of literature describing immunological outcomes after childhood cancer therapy, with an emphasis on the risk of infection, when is testing indicated, and preventive strategies; and knowledge gaps and opportunities for future research.
Collapse
Affiliation(s)
- Gregory M T Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Linda Rivard
- Pediatric Hematology and Oncology, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Jennifer T Huang
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Nicola A M Wright
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Hesham Eissa
- Department of Pediatrics, University of Colorado, Aurora, CO, USA; Center for Cancer and Blood Disorders, Children's Hospital of Colorado, Aurora, CO, USA
| | - Wendy Pelletier
- Section of Pediatric Oncology and BMT, Alberta Children's Hospital, Calgary, AB, Canada
| | - Shanti Ramachandran
- School of Paediatrics and Child Health, University of Western Australia, Nedland, WA, Australia; Department of Oncology, Haematology, Blood and Marrow Transplantation, Child and Adolescent Health Services, Perth Children's Hospital, Nedland, WA, Australia
| | - Tal Schechter
- Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ami J Shah
- Department of Pediatrics, Stem Cell Transplantation and Regenerative Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - Ken Wong
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Children's Hospital Los Angeles, Cancer and Blood Disease Institute, Los Angeles, CA, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Clinical Research and Public Health Sciences Divisions, Seattle, WA, USA
| |
Collapse
|
4
|
Kabir A, Newall AT, Randall D, Menzies R, Sheridan S, Jayasinghe S, Fathima P, Liu B, Moore H, McIntyre P, Gidding HF. Estimating pneumococcal vaccine coverage among Australian Indigenous children and children with medically at-risk conditions using record linkage. Vaccine 2021; 39:1727-1735. [PMID: 33622589 DOI: 10.1016/j.vaccine.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Risk-based recommendations are common for pneumococcal vaccines but little is known about their uptake. In Australia, pneumococcal conjugate vaccine (PCV) was funded only for Aboriginal or Torres Strait Islander (Indigenous) children and those with underlying medical conditions in 2001, and then there were different booster dose recommendations depending on risk after the introduction of universal PCV vaccination in 2005. METHODS We measured coverage of PCV dose 3 and additional PCV and 23-valent pneumococcal polysaccharide vaccine (PPV23) doses by risk group among children born in July 2001-December 2012 in two Australian states using linked immunisation and hospitalisation data (available until December 2013). We ascertained medical risk conditions using hospitalisation diagnosis codes and Indigenous status using an established algorithm, comparing coverage for children born pre (2001-2004) and post (2005-2012) universal PCV funding. RESULTS Among 1.3 million children, 63,897 (4.9%) were Indigenous and 32,934 (2.5%) had at least one medically at-risk condition identified by age 6 months. For births in 2001-2004, coverage for PCV dose 3 by 1 year of age was 37% for Indigenous, 15% for medically at-risk and 11% in other children, increasing to 83%, 91% and 92%, respectively for births in 2005-2012. In children with medically at-risk conditions, PCV dose 4 coverage by 2 years was 1% for 2001-2004 births, increasing to 9% for 2005-2012 births, with PPV23 coverage by 6 years 3% in both cohorts. Among eligible Indigenous children, PPV23 coverage by 3 years was 45% for 2001-2004 births and 51% for 2005-2012 births. CONCLUSIONS Coverage with additional recommended booster doses was very low among children with medical conditions, and only modest among Indigenous children. If additional PCV doses are recommended for some risk groups, especially in the context of routine schedules with reduced doses (e.g. 2 + 1 and 1 + 1), measures to improve implementation will be required.
Collapse
Affiliation(s)
- Alamgir Kabir
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia.
| | - Anthony T Newall
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia
| | - Rob Menzies
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Sheridan
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia
| | - Bette Liu
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, WA, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Heather F Gidding
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia; Northern Sydney Local Health District, Kolling Institute, St Leonards, NSW, Australia; National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| |
Collapse
|
5
|
Yilmazbas P, Susam Sen H, Ocak S. Revaccination in Pediatric Oncology Patients: One Center Experience. Eurasian J Med 2021; 53:5-8. [PMID: 33716522 PMCID: PMC7929592 DOI: 10.5152/eurasianjmed.2020.20047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE After chemotherapy, cancer survivors suffer from acquired immunological defects and become vulnerable to vaccine-preventable diseases. There are no universally approved revaccination guidelines for non-transplanted oncology patients. This study aimed to share our experience of revaccination in childhood cancer survivors to plan future vaccination schedules. MATERIALS AND METHODS This retrospective study was conducted in a Pediatric Oncology Department of a university-affiliated hospital. Patients who were diagnosed with malignancy other than leukemia constituted the study population. Patients were directed for revaccination 6 months after the cessation of treatment. Revaccination was performed according to patients' vaccination status before chemotherapy and seronegativity. RESULTS Of the 64 patients in the study, 44 (68.75%) were boys. The mean age at the time of diagnosis and at start of vaccination was 8.8±5.3 years and 10.6±5.1 years, respectively. Hodgkin's lymphoma was the most common diagnosis. The vaccination schedule of 7 patients was interrupted because of chemotherapy; after completing the missing vaccine doses, the serology of 2 patients was negative for at least 2 antigens. The vaccination schedule of 57 patients was completed before beginning chemotherapy and 52 of them were seronegative for at least 1 antigen. No adverse reactions or life-threatening infections were observed because of vaccinations. CONCLUSION There are different approaches when vaccinating the oncology patients after chemotherapy. Watching out for the four touchstones mentioned in our study will protect the patient and do no harm. More studies are needed to constitute universal and standardized revaccination guidelines for these patients.
Collapse
Affiliation(s)
- Pinar Yilmazbas
- Department of Pediatrics, Health Science University, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Hilal Susam Sen
- Department of Pediatric Hematology Oncology, Health Science University, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Suheyla Ocak
- Department of Pediatric Hematology Oncology, Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
6
|
Choi DK, Strzepka JT, Hunt SR, Tannenbaum VL, Jang IE. Vaccination in pediatric cancer survivors: Vaccination rates, immune status, and knowledge regarding compliance. Pediatr Blood Cancer 2020; 67:e28565. [PMID: 32706498 DOI: 10.1002/pbc.28565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vaccination recommendations for childhood cancer survivors are ambiguous. Limited data exist on vaccination rates and patient/caregiver knowledge of vaccination postchemotherapy. PROCEDURE A single-institution study of childhood cancer survivors treated from 1996 to 2018. Study included a retrospective chart review assessing patient's vaccination status, survey of patient's/caregiver's knowledge/beliefs regarding vaccination postchemotherapy, and assessment of immunoglobulin titers. RESULTS A total of 120 patient charts were included. Vaccination records were available for 82% (98/120) of patients, 57% (56/98) were up to date with vaccinations before chemotherapy, and 83% (81/98) received vaccinations after chemotherapy. Children who resumed vaccination postchemotherapy were younger at cancer diagnosis compared to those who did not resume vaccination (2 vs 4 years, P < .02). Median time since chemotherapy was higher in vaccinated versus unvaccinated patients (107 vs 60 months, P < .02). Immunoglobulin titers were assessed in 27 patients, and 74% (20/27) were not immune to one or more infections tested. Lack of immunity to pneumococcal strains was the most common. There was no difference in median age at diagnosis or time since chemotherapy completion in immune versus nonimmune patients. In 33 surveyed patients/caregivers, 33% (11/33) were not advised about resuming vaccinations postchemotherapy. Over one-third (12/33) of respondents were concerned about vaccination safety after chemotherapy, although 88% (29/33) agreed they would vaccinate if recommended by their pediatrician/pediatric oncologist. CONCLUSIONS Most childhood cancer survivors resume vaccinations postchemotherapy. Considerable variability exists in vaccination timing after chemotherapy. Pediatric oncologists play a central role in educating patients/pediatricians about vaccination recommendations postchemotherapy.
Collapse
Affiliation(s)
- Daniel K Choi
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Advocate Children's Hospital, Park Ridge, Illinois.,University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Jessica T Strzepka
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Samantha R Hunt
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | - Inae E Jang
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| |
Collapse
|
7
|
Toret E, Yel SE, Suman M, Duzenli Kar Y, Ozdemir ZC, Dinleyici M, Bor O. Immunization status and re-immunization of childhood acute lymphoblastic leukemia survivors. Hum Vaccin Immunother 2020; 17:1132-1135. [PMID: 32882157 DOI: 10.1080/21645515.2020.1802975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Intensive chemotherapy can cause long-lasting immunosuppression in children who survived cancer. The immunosuppression varies according to the type of cancer, intensity of chemotherapy and age of the patient. A sufficient immune reconstruction when has been completed in childhood cancer survivors, the re-vaccination program can achieve sufficient antibody levels for some of the life-threatening vaccine-preventable infectious diseases. This study evaluates the serological status of pediatric acute lymphoblastic leukemia (ALL) cases before and after the intensive chemotherapy treatment. Antibodies against measles, mumps, rubella, varicella, hepatitis A and B were tested with the enzyme-linked immunosorbent assay (ELISA) method. Antibody titers were measured firstly at the leukemia diagnosis time when the chemotherapy was not started. The second evaluation of antibody titers was studied at 6 months after the cessation of chemotherapy for all patients. Forty-six patients with the mean age of 6.1 ± 4.5 years were participated in this study. Changing to seronegative after treatment was significantly different in measles, rubella, hepatitis A and hepatitis B (p < .05). Seventy-eight (28%) antibody levels in the patients were non-protective for all diseases. Only three (7%) patients had protective antibody levels for all diseases in the sixth month of chemotherapy cessation. There was a negative correlation between patient's age and losing protective antibody levels for any vaccine-preventable disease (p < .05). Antibody levels against vaccine-preventable diseases have evident that reduced after ALL treatment at childhood. Pediatric ALL survivors must be re-vaccinated for vaccine-preventable diseases after achieving immune reconstruction.
Collapse
Affiliation(s)
- Ersin Toret
- Faculty of Medicine, Department of Pediatric Hematology-Oncology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sumeyye Emel Yel
- Faculty of Medicine, Department of Pediatric Hematology-Oncology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Murat Suman
- Faculty of Medicine, Department of Pediatric Hematology-Oncology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Yeter Duzenli Kar
- Faculty of Medicine, Department of Pediatric Hematology-Oncology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Zeynep Canan Ozdemir
- Faculty of Medicine, Department of Pediatric Hematology-Oncology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Meltem Dinleyici
- Faculty of Medicine, Department of Social Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozcan Bor
- Faculty of Medicine, Department of Pediatric Hematology-Oncology, Eskisehir Osmangazi University, Eskisehir, Turkey
| |
Collapse
|
8
|
Heo J, Jung HJ, Noh OK, Kim L, Park JE. Incidence of Influenza Among Childhood Cancer Survivors in South Korea: A Population-based Retrospective Analysis. In Vivo 2020; 34:929-933. [PMID: 32111806 PMCID: PMC7157854 DOI: 10.21873/invivo.11860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We quantified the incidence, and identified risk factors for influenza infection among childhood cancer survivors in South Korea, an at-risk population. PATIENTS AND METHODS Nationwide health insurance claims data were used to assess the frequency of influenza among childhood cancer survivors (aged <20 years) diagnosed between January 2009 and April 2016. A multivariable logistic regression was constructed to identify risk factors for influenza. RESULTS Of 6,457 children cancer survivors, 1,704 (27.0%) were diagnosed with influenza. Influenza was common in children <5 years old and infections were highest between late October and April. Over 60% of influenza treatment claims came from private clinics. Risk factors for influenza included age <9 years. CONCLUSION Childhood cancer survivors are particularly at-risk for influenza infection during the traditional influenza season. Identifying risks for influenza infection will help to establish countermeasures for reducing the influenza infections in at-risk cancer surviving children.
Collapse
Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Logyoung Kim
- Health Insurance Review and Assessment Service, Seoul, Republic of Korea
| | - Jun Eun Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| |
Collapse
|
9
|
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]
|
10
|
Abstract
Pediatric oncology patients treated with antineoplastic therapy have impaired immune systems that lead to loss of protective antibodies. They require reimmunization to protect against vaccine-preventable diseases. There are a paucity of studies on the clinical practice of pediatric oncologists and the available recommendations are heterogenous. This study describes current reimmunization practices among pediatric oncologists. We surveyed the Children's Oncology Group (COG)-identified principle investigators to capture clinical practices among pediatric oncologists within their institutions regarding reimmunization of non-hematopoietic stem cell transplantation patients. The majority of respondents did not routinely assess vaccine-related immune status; those who did most frequently assessed 6 months after cessation of therapies. Methods of assessment included type of therapy received, vaccine titers, and absolute lymphocyte counts. Providers from smaller institutions were more likely to check vaccine titers than those from larger institutions. More than half of the surveyed institutions did not have standardized guidelines available for practitioners. There are variations in reimmunization practices among pediatric oncologists despite available guidelines on recommended schedules. Further research is needed to identify the safest and most cost-effective way to insure immunity to infectious disease after the treatment of childhood cancer.
Collapse
|
11
|
Doganis D, Kafasi A, Dana H, Spanakis N, Baka M, Pourtsidis A, Sdogou T, Vintila A, Rafailidou V, Chantzi P, Servitzoglou M, Bouhoutsou D, Varvoutsi M, Kosmidis H, Tsolia M. Immune response to influenza vaccination in children with cancer. Hum Vaccin Immunother 2018; 14:2310-2317. [PMID: 29708816 DOI: 10.1080/21645515.2018.1470734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The aim of this study was to evaluate the ability of influenza immunization to evoke a protective immune response among children with cancer. We evaluated 75 children with cancer who received influenza vaccination. Hemagglutination Inhibition Antibody titers were determined before and after vaccination. The protective rates after vaccination were 79% for H1N1, 75% for H3N2 and 59% for influenza B virus whereas the seroconversion rates were 54%, 44% and 43% respectively. The differences pre- and post-vaccination were significant regardless the method which was used: seroprotection changes, seroconversion and geometric mean titers analyses. Variables such as the pre-vaccination antibody titers, the time when the responses were measured after the vaccination, the age and the type of malignancy as well as the absolute lymphocyte count were found to be correlated with the immune response but the findings were different for each vaccine subunit. In conclusion, influenza vaccination provides protection in a remarkable proportion of pediatric cancer patients whereas this protection is more obvious against H1N1 and H3N2 compared to influenza B. The immune response after vaccination is significant and seems to be influenced by a variety of factors.
Collapse
Affiliation(s)
- Dimitrios Doganis
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Athanasia Kafasi
- b Department of Microbiology , National and Kapodistrian University of Athens (NKUA), School of Medicine , Athens , Greece
| | - Helen Dana
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Nikolaos Spanakis
- b Department of Microbiology , National and Kapodistrian University of Athens (NKUA), School of Medicine , Athens , Greece
| | - Margarita Baka
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | | | - Triantafyllia Sdogou
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
| | - Artemis Vintila
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
| | - Vaia Rafailidou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Panagiota Chantzi
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Marina Servitzoglou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Despina Bouhoutsou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Maria Varvoutsi
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Helen Kosmidis
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Maria Tsolia
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
| |
Collapse
|
12
|
Weil BR, Madenci AL, Liu Q, Howell RM, Gibson TM, Yasui Y, Neglia JP, Leisenring WM, Smith SA, Tonorezos ES, Friedman DN, Constine LS, Tinkle CL, Diller LR, Armstrong GT, Oeffinger KC, Weldon CB. Late Infection-Related Mortality in Asplenic Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2018; 36:1571-1578. [PMID: 29664715 DOI: 10.1200/jco.2017.76.1643] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Infection-related outcomes associated with asplenia or impaired splenic function in survivors of childhood cancer remains understudied. Methods Late infection-related mortality was evaluated in 20,026 5-year survivors of childhood cancer (diagnosed < 21 years of age from 1970 to 1999; median age at diagnosis, 7.0 years [range, 0 to 20 years]; median follow-up, 26 years [range, 5 to 44 years]) using cumulative incidence and piecewise-exponential regression models to estimate adjusted relative rates (RRs). Splenic radiation was approximated using average dose (direct and/or indirect) to the left upper quadrant of the abdomen (hereafter, referred to as splenic radiation). Results Within 5 years of diagnosis, 1,354 survivors (6.8%) had a splenectomy and 9,442 (46%) had splenic radiation without splenectomy. With 62 deaths, the cumulative incidence of infection-related late mortality was 1.5% (95% CI, 0.7% to 2.2%) at 35 years after splenectomy and 0.6% (95% CI, 0.4% to 0.8%) after splenic radiation. Splenectomy (RR, 7.7; 95% CI, 3.1 to 19.1) was independently associated with late infection-related mortality. Splenic radiation was associated with increasing risk for late infection-related mortality in a dose-response relationship (0.1 to 9.9 Gy: RR, 2.0; 95% CI, 0.9 to 4.5; 10 to 19.9 Gy: RR, 5.5; 95% CI, 1.9 to 15.4; ≥ 20 Gy: RR, 6.0; 95% CI, 1.8 to 20.2). High-dose alkylator chemotherapy exposure was also independently associated with an increased risk of infection-related mortality (RR, 1.9; 95% CI, 1.1 to 3.4). Conclusion Splenectomy and splenic radiation significantly increase risk for late infection-related mortality. Even low- to intermediate-dose radiation exposure confers increased risk, suggesting that the spleen is highly radiosensitive. These findings should inform long-term follow-up guidelines for survivors of childhood cancer and should lead clinicians to avoid or reduce radiation exposure involving the spleen whenever possible.
Collapse
Affiliation(s)
- Brent R Weil
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Arin L Madenci
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Qi Liu
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Rebecca M Howell
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Todd M Gibson
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Yutaka Yasui
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Joseph P Neglia
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Wendy M Leisenring
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Susan A Smith
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Emily S Tonorezos
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Danielle N Friedman
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Louis S Constine
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Christopher L Tinkle
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Lisa R Diller
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Gregory T Armstrong
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Kevin C Oeffinger
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Christopher B Weldon
- Brent R. Weil, Arin L. Madenci, and Christopher B. Weldon, Boston Children's Hospital; Brent R. Weil, Arin L. Madenci, Lisa R. Diller, and Christopher B. Weldon, Harvard Medical School; Brent R. Weil, Lisa R. Diller, and Christopher B. Weldon, Dana-Farber Cancer Institute; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Qi Liu, University of Alberta, Edmonton, Alberta, Canada; Rebecca M. Howell and Susan A. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX; Todd M. Gibson, Yutaka Yasui, Christopher L. Tinkle, and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Emily S. Tonorezos and Danielle N. Friedman, Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; and Kevin C. Oeffinger, Duke University, Durham, NC
| |
Collapse
|
13
|
Fayea NY, Fouda AE, Kandil SM. Immunization status in childhood cancer survivors: A hidden risk which could be prevented. Pediatr Neonatol 2017; 58:541-545. [PMID: 27543381 DOI: 10.1016/j.pedneo.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/18/2016] [Accepted: 04/07/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A limited number of studies have examined the vaccine-specific antibody status of children with cancer. There are disagreements over the guidelines for postcancer immunization strategy. METHODS Our study was an observational, cross-sectional retrospective review of data collected on children who were seen in the outpatient clinic at King Abdullah Medical City, Oncology Center, Jeddah, the Kingdom of Saudi Arabia. Our aim was to evaluate the seropositive status to vaccine-preventable diseases: measles, mumps, rubella, diphtheria, tetanus, polio, and Haemophilus influenzae type B (HIB) in childhood cancer survivors at our center in order to plan future vaccination for these children and establish a simple revaccination schedule. RESULTS Forty-seven patients (21 boys and 26 girls) were included in the study. Age at the time of cancer diagnosis (mean±standard deviation) was 5.68±3.79 years and age at test sampling was 10.68±3.79 years. Acute leukemia was the most common cancer (49% of patients), followed by lymphoma (28%), brain tumors (13%), and solid tumors (10%). Treatment intensities (according to the Treatment Intensity Rating Scale, version 3.0; ITR-3) were 2, 3, and 4 for 26 patients (55%), 20 patients (43%), and one patient (2.1%), respectively. We found that 93% of our patients were considered seronegative (unprotected) for at least one vaccine-preventable disease. The seronegative rates for measles, mumps, rubella, diphtheria, tetanus, polio, and HIB were 46.8%, 36.2%, 36.2%, 46.8%, 61.7%, 17.1%, and 42.6%, respectively. Criteria including age at diagnosis, age at sampling, type of malignancy, and treatment intensity were not significantly different between seropositive and seronegative patients. CONCLUSION Seronegative rates for vaccine-preventable diseases were very high in childhood cancer survivors, which represented a subpopulation of high-risk patients who could benefit from revaccination. We suggest a universal revaccination approach for all childhood cancer survivors, which is easily applicable and of low cost.
Collapse
Affiliation(s)
- Najwa Yahya Fayea
- Oncology Center Jeddah, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ashraf Elsayed Fouda
- Pediatric Department, Mansoura Faculty of Medicine, Mansoura University Children Hospital, Mansoura University, Al-Mansoura, Egypt.
| | - Shaimaa Mohamed Kandil
- Pediatric Department, Mansoura Faculty of Medicine, Mansoura University Children Hospital, Mansoura University, Al-Mansoura, Egypt
| |
Collapse
|
14
|
Vaccination against influenza at a European pediatric cancer center: immunization rates and attitudes among staff, patients, and their families. Support Care Cancer 2017; 25:3815-3822. [DOI: 10.1007/s00520-017-3813-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/03/2017] [Indexed: 11/25/2022]
|
15
|
de de la Fuente Garcia I, Coïc L, Leclerc JM, Laverdière C, Rousseau C, Ovetchkine P, Tapiéro B. Protection against vaccine preventable diseases in children treated for acute lymphoblastic leukemia. Pediatr Blood Cancer 2017; 64:315-320. [PMID: 27718310 DOI: 10.1002/pbc.26187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND The objective of this retrospective study was to assess protection against vaccine preventable diseases (VPDs) in children treated for acute lymphoblastic leukemia (ALL). PROCEDURE Clinical characteristics and vaccination records were collected. Antibodies against VPDs were measured after completion of chemotherapy and after a booster dose of vaccine. Immunization status of household members was evaluated. RESULTS Sixty children were included. Median interval between the end of chemotherapy and enrolment in the study was 13 months (range 1-145). At ALL diagnosis, 81.3% of the children were up to date with their vaccination schedule. This proportion decreased to 52.9% at enrolment. Among the parents, 21% were up to date with their immunization schedule and 42% had received seasonal influenza vaccination. After chemotherapy, less than 50% of the patients were seroprotected against tetanus, diphtheria, polio 3, Haemophilus influenzae type b (Hib), and mumps and no more than 80% were seroprotected against polio 1 and 2, measles, rubella, and varicella. After a booster dose of vaccine, the rate of protection increased to over 90% for each of the following antigens: TT, DT, polio 1, Hib, measles, and rubella. Nevertheless, polio 3, mumps, and varicella-zoster virus antibodies titers/concentrations remained below seroprotective thresholds in over 20% of the patients. CONCLUSIONS After chemotherapy for ALL, most of the children were not protected against VPDs. As the majority mounted a robust response to booster vaccines, efforts need to be done to improve protection against VPDs by implementing a systematic vaccine booster schedule. This could also be helped by reinforcing household members' immunization.
Collapse
Affiliation(s)
- Isabel de de la Fuente Garcia
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Montréal, Québec, Canada
| | - Léna Coïc
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Montréal, Québec, Canada
| | - Jean-Marie Leclerc
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Montréal, Québec, Canada
| | - Caroline Laverdière
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Montréal, Québec, Canada
| | - Céline Rousseau
- Department of Microbiology and Immunology, CHU Sainte-Justine-Université de Montréal, Montréal, Québec, Canada
| | - Philippe Ovetchkine
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Montréal, Québec, Canada
| | - Bruce Tapiéro
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine-Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
16
|
Cheng DR, Barton R, Greenway A, Crawford NW. Rituximab and protection from vaccine preventable diseases: applying the evidence to pediatric patients. Expert Rev Vaccines 2016; 15:1567-1574. [PMID: 27216827 DOI: 10.1080/14760584.2016.1193438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION This article analyses and highlights the challenge of immunization and preventing vaccine preventable diseases in pediatric patients on rituximab. Rituximab is a chimeric anti-CD 20 monoclonal antibody that is an immunosuppressant affecting both cellular and humoral immunity. Children and adolescents on rituximab are at increased risk of infection and vaccine preventable diseases, and require additional strategies to optimize and maximize their protection against such illnesses. Areas covered: This article provides a comprehensive MEDLINE and Pubmed review of existing literature regarding vaccine immunogenicity and safety in patients on rituximab, and assists in providing an evidence base to develop immunization guidelines. Of particular note, the use of live-attenuated vaccines and optimum timing of vaccines post rituximab is considered and discussed. Expert commentary: The increasing use of rituximab in a variety of novel areas within pediatrics must be accompanied by informed discussion around mitigating the risks. These include immunosuppression, and potential susceptibility to infection. Optimizing vaccine status by establishing adequate antibody titers prior to commencement remains the best preventative strategy.
Collapse
Affiliation(s)
- Daryl R Cheng
- a General Medicine , The Royal Children's Hospital , Melbourne , VIC , Australia.,b Department of Paediatrics , The University of Melbourne , Melbourne , VIC , Australia.,c SAEFVIC , Murdoch Children's Research Institute , Melbourne , VIC , Australia
| | - Rebecca Barton
- d Haematology Department , The Royal Children's Hospital , Melbourne , VIC , Australia
| | - Anthea Greenway
- d Haematology Department , The Royal Children's Hospital , Melbourne , VIC , Australia.,e Haematology Research Group , Murdoch Children's Research Institute , Melbourne , VIC , Australia
| | - Nigel W Crawford
- a General Medicine , The Royal Children's Hospital , Melbourne , VIC , Australia.,b Department of Paediatrics , The University of Melbourne , Melbourne , VIC , Australia.,c SAEFVIC , Murdoch Children's Research Institute , Melbourne , VIC , Australia
| |
Collapse
|
17
|
Kotecha RS, Wadia UD, Jacoby P, Ryan AL, Blyth CC, Keil AD, Gottardo NG, Cole CH, Barr IG, Richmond PC. Immunogenicity and clinical effectiveness of the trivalent inactivated influenza vaccine in immunocompromised children undergoing treatment for cancer. Cancer Med 2015; 5:285-93. [PMID: 26715492 PMCID: PMC4735770 DOI: 10.1002/cam4.596] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/23/2022] Open
Abstract
Influenza is associated with significant morbidity and mortality in children receiving therapy for cancer, yet recommendation for, and uptake of the seasonal vaccine remains poor. One hundred children undergoing treatment for cancer were vaccinated with the trivalent inactivated influenza vaccine according to national guidelines in 2010 and 2011. Influenza‐specific hemagglutinin inhibition antibody titers were performed on blood samples taken prior to each vaccination and 4 weeks following the final vaccination. A nasopharyngeal aspirate for influenza was performed on all children who developed an influenza‐like illness. Following vaccination, seroprotection and seroconversion rates were 55 and 43% for H3N2, 61 and 43% for H1N1, and 41 and 33% for B strain, respectively. Overall, there was a significant geometric mean fold increase to H3N2 (GMFI 4.56, 95% CI 3.19–6.52, P < 0.01) and H1N1 (GMFI 4.44, 95% CI 3.19–6.19, P < 0.01) strains. Seroconversion was significantly more likely in children with solid compared with hematological malignancies and in children <10 years of age who received a two‐dose schedule compared to one. Influenza infection occurred in 2% of the vaccinated study population, compared with 6.8% in unvaccinated controls, providing an adjusted estimated vaccine effectiveness of 72% (95% CI −26–94%). There were no serious adverse events and a low reactogenicity rate of 3%. The trivalent inactivated influenza vaccine is safe, immunogenic, provides clinical protection and should be administered annually to immunosuppressed children receiving treatment for cancer. All children <10 years of age should receive a two‐dose schedule.
Collapse
Affiliation(s)
- Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.,Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Ushma D Wadia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia
| | - Anne L Ryan
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Christopher C Blyth
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.,Department of Infectious Diseases, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Anthony D Keil
- Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Nicholas G Gottardo
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.,Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Catherine H Cole
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.,Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia
| | - Ian G Barr
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia
| | - Peter C Richmond
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.,School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.,Department of Paediatrics, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia
| |
Collapse
|
18
|
Klosky JL, Russell KM, Simmons JL, Foster RH, Peck K, Green DM, Hudson MM. Medical and sociodemographic factors associated with human papillomavirus (HPV) vaccination adherence among female survivors of childhood cancer. Pediatr Blood Cancer 2015; 62:1630-6. [PMID: 25900433 PMCID: PMC4834844 DOI: 10.1002/pbc.25539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among those 9-26 years of age, vaccination can prevent specific types of genital human papillomavirus (HPV), the most common sexually transmitted infection and cause of cervical and other cancers. The objective of this study was to estimate the prevalence of and factors associated with HPV vaccine initiation and completion among females surviving childhood cancer. PROCEDURE One-hundred fourteen young adults and 230 mothers with daughters surviving childhood cancer completed surveys querying HPV vaccination history along with medical and sociodemographic factors potentially associated with vaccination outcomes. Vaccination rate differences by age necessitated analysis of outcomes by age group: 9-13 years (preadolescents), 14-17 years (adolescents), and 18-26 years (young adults). Multivariable logistic regression was utilized to identify factors associated with HPV vaccination outcomes. RESULTS Overall, 34.6% (119/344) of survivors initiated and 20.9% (72/344) completed HPV vaccination. Preadolescents were least likely to have initiated vaccination (P < 0.001). Physician recommendation was associated with initiation across age groups (OR = 6.81-11.96, Ps < 0.001-.01), whereas older age at diagnosis (≥12 years of age) was associated with lower vaccination initiation among young adults only (OR = 0.28; 95%CI, 0.10-0.76, P = 0.012). Physician recommendation (OR = 7.54; 95%CI, 1.19-47.69, P = 0.032; adolescent group) and greater treatment intensity (OR = 5.25; 95%CI, 1.00-27.61, P = 0.050; young adult group) were associated with vaccine completion, whereas being non-White was associated with decreased vaccination completion (OR = 0.17; 95%CI, 0.05-0.66, P = 0.010; adolescent group). CONCLUSIONS A minority of youths surviving childhood cancer have initiated or completed HPV vaccination. Strategies to increase vaccination among survivors are discussed.
Collapse
Affiliation(s)
- James L. Klosky
- Department of Psychology, St. Jude Children's Research Hospital
| | | | | | - Rebecca H. Foster
- Department of Psychology, St. Louis Children's Hospital,Department of Pediatrics, Washington University School of Medicine
| | - Kelly Peck
- Department of Psychology, St. Jude Children's Research Hospital,Department of Psychology, University of Mississippi
| | - Daniel M. Green
- Department of Oncology, St. Jude Children's Research Hospital,Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children's Research Hospital,Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital
| |
Collapse
|
19
|
Eibl MM, Wolf HM. Vaccination in patients with primary immune deficiency, secondary immune deficiency and autoimmunity with immune regulatory abnormalities. Immunotherapy 2015; 7:1273-92. [PMID: 26289364 DOI: 10.2217/imt.15.74] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Vaccination has been an important healthcare measure in preventing infectious diseases. The response to vaccination is reduced in immunocompromised patients, primary immune deficiency (PID) and secondary immune deficiency (SID), but vaccination studies still demonstrated a protective effect resulting in reducing complications, hospitalization, treatment costs and even mortality. The primary physician and the specialist directing patient care are responsible for vaccination. Live vaccines are contraindicated in patients with severe immune impairment, killed vaccines are highly recommended in PID and SID. Criteria have been defined to distinguish high- or low-level immune impairment in the different disease entities among PID and SID patients. For patients who do not respond to diagnostic vaccination as characterized by antibody failure immunoglobulin replacement is the mainstay of therapy.
Collapse
Affiliation(s)
- Martha M Eibl
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
| | - Hermann M Wolf
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
| |
Collapse
|
20
|
Abstract
BACKGROUND Pediatric leukemia patients are at high risk of invasive pneumococcal disease. The study aim was to determine the antibody response to a 10-valent pneumococcal conjugate vaccine (PCV10) administered during chemotherapy. METHODS An open-label study in pediatric leukemia patients: Group 1 had completed a primary 7-valent (PCV7) course and received a single PCV10 dose. Group 2 were PCV immunization naïve and received 3 doses of PCV10, administered 2 months apart. Serum samples were taken at baseline and 1 month post each PCV10 dose. Antipneumococcal serotype-specific IgG to 10 serotypes were measured by enzyme-linked immunosorbent assay and the functional response to 4 serotypes (1, 6B, 19F and 23F) was measured using opsonophagocytic assays. RESULTS Thirty-nine participants were recruited between May 2010 and January 2011; group 1 (n = 27) and group 2 (n = 12). The diagnosis was acute lymphoblastic leukemia (38) and acute myeloid leukemia (1). Median age was 6.2 years (1.7-17.2 years) with 62% male. The median time from diagnosis to baseline serology was 7.4 months (1.6-36.8 months). At baseline, protective geometric mean concentration above the threshold (>0.35 μg/mL) ranged from 5.3% (serotype 4) to 71% (serotype 19F). More than 60% of participants in both groups were above threshold postimmunization for 7 of the 10 PCV serotypes. Opsonophagocytic assay correlated with enzyme-linked immunosorbent assay for 3 of the 4 serotypes and r ranged from 0.51 to 0.84. An injection-site reaction was reported in 73% (27/37). CONCLUSIONS It is safe to administer PCV10 vaccine during therapy for pediatric leukemia. It provided a satisfactory serum immune response for the majority of vaccine serotypes.
Collapse
|
21
|
Patterson P, McDonald FEJ, Zebrack B, Medlow S. Emerging issues among adolescent and young adult cancer survivors. Semin Oncol Nurs 2014; 31:53-9. [PMID: 25636395 DOI: 10.1016/j.soncn.2014.11.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To review the characteristics of cancer in the adolescence and young adult age group; the medical, psychosocial and behavioral late effects; survivorship care planning and transition; current research priorities; and practice implications. DATA SOURCE Published articles, research studies and position statements. CONCLUSION Survivors of cancers that occurred during adolescence and young adulthood (AYA) are confronted with the dual demands of managing their transition to independent adulthood, concurrently with their transition from cancer patient to cancer survivors, with an associated reduction in support from medical services. AYA survivors also face complex medical, psychosocial and behavioral late effects, including fertility and mental health issues. IMPLICATIONS FOR NURSING PRACTICE An understanding of the impact of cancer diagnoses among this age group, including survivors' abilities to reintegrate into 'normal' life and potential long term consequences, is necessary to provide the best support. This care and support can be enhanced through multidisciplinary teams who work together to address the medical and psychosocial needs of AYAs diagnosed with cancer.
Collapse
|
22
|
Bochennek K, Allwinn R, Langer R, Becker M, Keppler OT, Klingebiel T, Lehrnbecher T. Differential loss of humoral immunity against measles, mumps, rubella and varicella-zoster virus in children treated for cancer. Vaccine 2014; 32:3357-61. [DOI: 10.1016/j.vaccine.2014.04.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 04/12/2014] [Accepted: 04/17/2014] [Indexed: 11/30/2022]
|
23
|
Ojha RP, Offutt-Powell TN, Gurney JG. Influenza vaccination coverage among adult survivors of pediatric cancer. Am J Prev Med 2014; 46:552-8. [PMID: 24842731 DOI: 10.1016/j.amepre.2014.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/23/2013] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A large proportion of long-term survivors of childhood cancer have treatment-related adverse cardiac and pulmonary late-effects, with related mortality. Consequently, this population of approximately 379,000 individuals in the U.S. is at high risk of complications from influenza infections. PURPOSE To estimate influenza vaccination coverage overall and among subgroups of adult survivors of pediatric cancer aged 18-64 years and to compare coverage with the general adult U.S. population. METHODS Data from the 2009 Behavioral Risk Factor Surveillance System were analyzed in 2013 using binomial regression to estimate influenza vaccination coverage differences (CDs) and corresponding 95% confidence limits (CLs) between adult survivors of pediatric cancer and the general U.S. population. Analyses were stratified by demographic characteristics and adjusted for design effects, non-coverage, and non-response. RESULTS Influenza vaccination coverage was 37% for adult pediatric cancer survivors overall and 31% for the general adult U.S. population (CD=6.3%, 95% CL=0.04%, 13%). Dramatically lower coverage was observed for non-Hispanic black survivors (6%) than for non-Hispanic blacks in the general U.S. population (26%; CD=-18%, 95% CL=-25%, -11%). CONCLUSIONS Although influenza vaccination coverage was modestly higher among adult survivors of pediatric cancer than the general U.S. population, coverage was less than desirable for a population with a high prevalence of cardiopulmonary conditions and early mortality, and far lower than the Healthy People 2010 goal of 60% or Healthy People 2020 goal of 80% for the general population.
Collapse
Affiliation(s)
- Rohit P Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Tabatha N Offutt-Powell
- Office of Infectious Disease Epidemiology, Division of Public Health, Delaware Health and Social Services, Dover, Delaware
| | - James G Gurney
- Department of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tennessee
| |
Collapse
|
24
|
Cesaro S, Giacchino M, Fioredda F, Barone A, Battisti L, Bezzio S, Frenos S, De Santis R, Livadiotti S, Marinello S, Zanazzo AG, Caselli D. Guidelines on vaccinations in paediatric haematology and oncology patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:707691. [PMID: 24868544 PMCID: PMC4020520 DOI: 10.1155/2014/707691] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/07/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. PATIENTS AND METHODS A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. RESULTS AND CONCLUSION During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.
Collapse
Affiliation(s)
- Simone Cesaro
- Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Ospedale Borgo Roma, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Mareva Giacchino
- Paediatric Hematology Oncology, Regina Margherita Hospital, P.zza Polonia 94, 10126 Torino, Italy
| | - Francesca Fioredda
- Paediatric Hematology, G. Gaslini Institute, Via Gerolamo Gaslini 5, 16148 Genova, Italy
| | - Angelica Barone
- Paediatric Hematology Oncology, Azienda Ospedaliera, Via Gramsci 14, 43100 Parma, Italy
| | - Laura Battisti
- Paediatrics, Azienda Ospedaliera, Via Lorenz Böhler 5, 39100 Bolzano, Italy
| | - Stefania Bezzio
- Paediatric Hematology Oncology, Regina Margherita Hospital, P.zza Polonia 94, 10126 Torino, Italy
| | - Stefano Frenos
- Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Meyer, Viale Pieraccini 24, 50139 Firenze, Italy
| | - Raffaella De Santis
- Paediatric Hematology Oncology, Casa Sollievo della Sofferenza Hospital, Viale Cappuccini 2, 71013 San Giovanni Rotondo, Italy
| | - Susanna Livadiotti
- Paediatric Immunology and Infectious Diseases, Ospedale Bambin Gesù, Piazza di Sant'Onofrio, 4, 00165 Roma, Italy
| | - Serena Marinello
- Infectious Diseases, Azienda Ospedaliera, Via Giustiniani, 35128 Padova, Italy
| | - Andrea Giulio Zanazzo
- Paediatric Hematology Oncology, Burlo Garofalo Institute, Via dell'Istria 65, 34137 Trieste, Italy
| | - Désirée Caselli
- Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Meyer, Viale Pieraccini 24, 50139 Firenze, Italy
- Medical Direction, A.O.U. Meyer, Children Hospital, Viale Pieraccini, 24, 50139 Firenze, Italy
| |
Collapse
|
25
|
Crawford NW, Barfield C, Hunt RW, Pitcher H, Buttery JP. Improving preterm infants' immunisation status: a follow-up audit. J Paediatr Child Health 2014; 50:314-8. [PMID: 24372963 DOI: 10.1111/jpc.12481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 11/29/2022]
Abstract
AIM Preterm infants are at increased risk of vaccine preventable diseases. An audit in 2007 identified suboptimal immunisation status of preterm infants. The aim of this study was to complete the 'audit loop', reviewing preterm infants' immunisation status at a single tertiary paediatric hospital. METHODS A retrospective follow-up immunisation audit was conducted at The Royal Children's Hospital, Melbourne, neonatal unit. The 'audit loop' included a preterm infants' reminder sticker and feedback of the original audit findings to Royal Children's Hospital health-care professionals. Immunisation status was determined using the Australian Childhood Immunisation Register record for all admitted preterm infants born <32 weeks gestation (July 2008-June 2009). RESULTS Conducted in March 2011, the median age of participants (n = 57) was 2.5 years (range 1.7-3.1 years). Forty-four per cent (25/57) had a history of chronic lung disease, 86% (49/57) were <1500 g and 42% (24/57) <28 weeks gestation. The majority (96% (55/57)) were up to date with routine immunisations at 12 months of age. There was a 2.4-fold increase, compared with the original audit, for receipt of the additional recommended hepatitis B vaccine at 12 months of age, as well as influenza vaccine in infants with chronic lung disease. CONCLUSION This study showed that a simple reminder combined with education strategies can improve vaccine delivery in special risk groups such as preterm infants.
Collapse
Affiliation(s)
- Nigel W Crawford
- SAEFVIC, Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia; Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | |
Collapse
|
26
|
A review of the evidence to support influenza vaccine introduction in countries and areas of WHO's Western Pacific Region. PLoS One 2013; 8:e70003. [PMID: 23875015 PMCID: PMC3713047 DOI: 10.1371/journal.pone.0070003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022] Open
Abstract
Background Immunization against influenza is considered an essential public health intervention to control both seasonal epidemics and pandemic influenza. According to the World Health Organization (WHO), there are five key policy and three key programmatic issues that decision-makers should consider before introducing a vaccine. These are (a) public health priority, (b) disease burden, (c) efficacy, quality and safety of the vaccine, (d) other inventions, (e) economic and financial issues, (f) vaccine presentation, (g) supply availability and (h) programmatic strength. We analyzed the body of evidence currently available on these eight issues in the WHO Western Pacific Region. Methodology/Principal Findings Studies indexed in PubMed and published in English between 1 January 2000 and 31 December 2010 from the 37 countries and areas of the Western Pacific Region were screened for keywords pertaining to the five policy and three programmatic issues. Studies were grouped according to country income level and vaccine target group. There were 133 articles that met the selection criteria, with most (90%) coming from high-income countries. Disease burden (n = 34), vaccine efficacy, quality and safety (n = 27) and public health priority (n = 27) were most frequently addressed by studies conducted in the Region. Many studies assessed influenza vaccine policy and programmatic issues in the general population (42%), in the elderly (24%) and in children (17%). Few studies (2%) addressed the eight issues relating to pregnant women. Conclusions/Significance The evidence for vaccine introduction in countries and areas in this Region remains limited, particularly in low- and middle-income countries that do not currently have influenza vaccination programmes. Surveillance activities and specialized studies can be used to assess the eight issues including disease burden among vaccine target groups and the cost-effectiveness of influenza vaccine. Multi-country studies should be considered to maximize resource utilization for cross-cutting issues such as vaccine presentation and other inventions.
Collapse
|
27
|
Doganis D, Tsolia M, Dana H, Bouhoutsou D, Pourtsidis A, Baka M, Varvoutsi M, Servitzoglou M, Kosmidis H. Compliance with immunization against H1N1 influenza virus among children with cancer. Pediatr Hematol Oncol 2013; 30:149-53. [PMID: 23301621 DOI: 10.3109/08880018.2012.753961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this report, we describe the experience with immunization against pandemic influenza A H1N1 in children with cancer treated at a pediatric oncology department during the pandemic season (2009). According to the guidelines, vaccination of all children with cancer receiving chemotherapy as well as those who had completed treatment was scheduled. Among the 140 children who were eligible for immunization, 122 were immunized, achieving a compliance rate of 87% despite negative publicity and low vaccine uptake in the general population. The vaccine was tolerated and none of the vaccinated children developed influenza. It is concluded that high immunization rates can be achieved among pediatric oncology patients.
Collapse
Affiliation(s)
- Dimitrios Doganis
- Pediatric Oncology Department, P. & A. Kyriakou Children's Hospital, University of Athens, Athens, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Crawford NW, Catto-Smith AG, Oliver MR, Cameron DJS, Buttery JP. An Australian audit of vaccination status in children and adolescents with inflammatory bowel disease. BMC Gastroenterol 2011; 11:87. [PMID: 21798078 PMCID: PMC3160403 DOI: 10.1186/1471-230x-11-87] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 07/29/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Children and adolescents with inflammatory bowel disease (IBD) are at increased risk of vaccine preventable diseases (VPD). This includes invasive pneumococcal disease and influenza. The primary aim of this study was to describe compliance with current Australian guidelines for vaccination of children and adolescents diagnosed with IBD. A secondary aim was to review the serological screening for VPD. METHODS A random sample of patients (0-18 years at diagnosis), were selected from the Victoria Australia state based Pediatric Inflammatory Bowel Disease Register. A multi-faceted retrospective review of immunization status was undertaken, with hospital records audited, a telephone interview survey conducted with consenting parents and the vaccination history was checked against the primary care physician and Australian Childhood Immunization Register (ACIR) records. The routine primary childhood vaccinations and administration of the recommended additional influenza and pneumococcal vaccines was clarified. RESULTS This 2007 audit reviewed the immunization status of 101 individuals on the Victorian Pediatric IBD database. Median age at diagnosis was 12.1 years, 50% were on active immunosuppressive therapy. 90% (38/42) [95% confidence intervals (CI) 77%; 97%] with complete immunization information were up-to-date with routine primary immunizations. Only 5% (5/101) [95% CI 2%; 11%] received a recommended pneumococcal vaccine booster and 10% (10/101) [95% CI 5%; 17%] had evidence of having ever received a seasonal influenza vaccine. Those living in rural Victoria (p = 0.005) and younger at the age of diagnosis (p = 0.002) were more likely to have ever received an influenza vaccine Serological testing, reviewing historical protection from VPD, identified 18% (17/94) with evidence of at least one serology sample. CONCLUSION This study highlights poor compliance in IBD patients for additional recommended vaccines. A multi-faceted approach is required to maximize protection from VPD in this vulnerable special risk population.
Collapse
Affiliation(s)
- Nigel W Crawford
- SAEFVIC, Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria 3011, Australia.
| | | | | | | | | |
Collapse
|
29
|
Crawford NW, Bines JE, Royle J, Buttery JP. Optimizing immunization in pediatric special risk groups. Expert Rev Vaccines 2011; 10:175-86. [PMID: 21332267 DOI: 10.1586/erv.10.157] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article analyzes the current recommended practices and evidence in the immunization of pediatric 'special risk groups'. Special risk group patients are at higher risk of vaccine-preventable diseases and hence require additional strategies to maximize protection against these diseases. The special risk groups include those with an underlying chronic disease, some of whom are on immunosuppressive therapy to treat that condition. The article uses four special risk groups (acute lymphoblastic leukemia; preterm birth; juvenile idiopathic arthritis; and inflammatory bowel disease), to highlight the management considerations and potential vaccination strategies. The risks, benefits and timing of vaccination in the setting of immunosuppression require detailed discussion with treating clinicians, in particular the use of live-attenuated vaccines. The immunogenicity of vaccines in these special risk groups helps provide the evidence base for their immunization guidelines. Protection can include 'cocooning' (i.e., ensuring appropriate immunizations within the immediate family; e.g., varicella, influenza and pertussis vaccination). Improving timeliness and minimizing missed opportunities to vaccinate individuals with these special risk conditions will also optimize protection from vaccine-preventable diseases.
Collapse
Affiliation(s)
- Nigel W Crawford
- SAEFVIC, Murdoch Childrens Research Institute, Melbourne, Australia.
| | | | | | | |
Collapse
|
30
|
Paulides M, Stöhr W, Laws HJ, Graf N, Lakomek M, Berthold F, Schmitt K, Niggli F, Jürgens H, Bielack S, Koscielniak E, Klingebiel T, Langer T. Antibody levels against tetanus and diphtheria after polychemotherapy for childhood sarcoma: A report from the Late Effects Surveillance System. Vaccine 2011; 29:1565-8. [DOI: 10.1016/j.vaccine.2010.12.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/15/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
|
31
|
Bate J, Patel SR, Chisholm J, Heath PT. Immunisation practices of paediatric oncology and shared care oncology consultants: a United Kingdom survey. Pediatr Blood Cancer 2010; 54:941-6. [PMID: 20162684 DOI: 10.1002/pbc.22415] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In March 2002, the Royal College of Paediatrics and Child Health (RCPCH) introduced guidelines for re-immunisation of children after completion of standard-dose chemotherapy and after haematopoietic stem cell transplant (HSCT). AIMS To ascertain whether these guidelines form standard unit policy by undertaking a survey of UK paediatric principal treatment centre (PTC) consultants and shared care (SC) consultants. PROCEDURES In October 2008, a link to an on-line anonymised survey was sent by e-mail to all UK PTC consultants in Children's Cancer and Leukaemia Group (CCLG) centres and to SC consultants linked to eight of these centres. RESULTS Responses were received from 55 PTC consultants (representing all 21 CCLG centres) and 54 SC consultants. In accordance with the RCPCH guidelines, most PTC and SC consultants recommend initiating re-immunisation at 6 months after completion of standard-dose chemotherapy (99/105, 94.3%). Re-immunisation at the recommended time after HSCT for each transplant type was reported by 93-100% of respondents. Pneumococcal conjugate vaccine (PCV) was recommended after chemotherapy by 58.3% (35/60) of respondents and by 51.7% (30/58) after HSCT. There were distinct differences between PTC and SC consultants in their choice of varicella (VZV) post-exposure prophylaxis. CONCLUSIONS There is a high level of stated compliance with RCPCH guidelines. Recommendations for PCV after chemotherapy and HSCT were lower than expected. This may reflect the absence of specific guidelines after chemotherapy but not in HSCT patients where guidelines do exist. Variation in VZV post-exposure prophylaxis suggests further studies are required.
Collapse
Affiliation(s)
- Jessica Bate
- Division of Child Health, St. George's University of London, London, UK.
| | | | | | | |
Collapse
|
32
|
Human papillomavirus and cervical cancer: Gardasil® vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students. Vaccine 2010; 28:4416-22. [DOI: 10.1016/j.vaccine.2010.04.038] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 04/01/2010] [Accepted: 04/14/2010] [Indexed: 11/19/2022]
|