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Óskarsson Ý, Thors V, Vias RD, Lúðvíksson BR, Brynjólfsson SF, Gianchecchi E, Razzano I, Montomoli E, Gísli Jónsson Ó, Haraldsson Á. Adequate immune responses to vaccines after chemotherapy for leukaemia diagnosed in childhood. Acta Paediatr 2024; 113:606-614. [PMID: 38140806 DOI: 10.1111/apa.17070] [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: 08/17/2023] [Revised: 10/17/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
AIM The survival rate after treatment for childhood leukaemia has greatly improved, but could result in protracted immune deficiency. This study examined the immune status of children after chemotherapy and evaluated their responses to immunisation. METHODS Subjects who had completed their treatment for acute lymphoblastic leukaemia at The Children's Hospital Reykjavík, Iceland, during 2011-2020 had blood drawn and were then immunised for influenza in October 2021. Blood was drawn again 4 weeks later and their humoral and cellular responses were measured with a haemagglutination inhibition assay and lymphocyte stimulation test. Antibodies to other immunisations were also evaluated. RESULTS We studied 18 patients (10 male) who had completed their treatment at 3.7-20.3 years of age (mean 9.1), 11-84 months (mean 36.9) before enrolment. Conventional immunological evaluation did not reveal notable abnormalities. The responses to several childhood vaccinations, including the pneumococcal conjugate vaccination, were adequate in most patients. Humoral responses to the influenza vaccine confirmed adequate reactions in all but one patient. Considerable variations were observed in the lymphocyte stimulations tests. CONCLUSION Most patients reacted adequately to immunisation, especially against annual influenza and Streptococcus pneumoniae, reiterating the usefulness of vaccinations. The most appropriate timing for vaccination after treatment still needs to be determined.
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Affiliation(s)
- Ýmir Óskarsson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Valtýr Thors
- The Children's Hospital Iceland, Landspítali University Hospital, Reykjavík, Iceland
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Rafael Daníel Vias
- Department of Mathematics, Faculty of Physical Sciences, University of Iceland, Reykjavík, Iceland
| | - Björn Rúnar Lúðvíksson
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Department of Immunology, Landspítali University Hospital, Reykjavík, Iceland
| | - Siggeir Fannar Brynjólfsson
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Department of Immunology, Landspítali University Hospital, Reykjavík, Iceland
| | | | | | - Emanuele Montomoli
- VisMederi Srl, Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Ólafur Gísli Jónsson
- The Children's Hospital Iceland, Landspítali University Hospital, Reykjavík, Iceland
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ásgeir Haraldsson
- The Children's Hospital Iceland, Landspítali University Hospital, Reykjavík, Iceland
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
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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.
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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
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Neemann KA, Sato AI. Vaccinations in children with hematologic malignancies and those receiving hematopoietic stem cell transplants or cellular therapies. Transpl Infect Dis 2023; 25 Suppl 1:e14100. [PMID: 37436808 DOI: 10.1111/tid.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
Children who are immune compromised are uniquely threatened by a higher risk of infections, including vaccine-preventable diseases (VPDs). Children who undergo chemotherapy or cellular therapies may not have preexisting immunity to VPDs at the time of their treatment including not yet receiving their primary vaccine series, and additionally they have higher risk of exposures (e.g., due to family structures, daycare and school setting) with decreased capacity to protect themselves using nonpharmaceutic measures (e.g., masking). In the past, efforts to revaccinate these children have often been delayed or incomplete. Treatment with chemotherapy, stem cell transplants, and/or cellular therapies impair the ability of the immune system to mount a robust vaccine response. Ideally, protection would be provided as soon as both safe and effective, which will vary by vaccine type (e.g., replicating versus nonreplicating; conjugated versus polysaccharide). While a single approach revaccination schedule following these therapies would be convenient for providers, it would not account for patient specific factors that influence the timing of immune reconstitution (IR). Evidence suggests that many of these children would mount a meaningful vaccine response as early as 3 months following completion of treatment. Here within, we provide updated guidance on how to approach vaccination both during and following completion of these therapies.
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Affiliation(s)
- Kari A Neemann
- Division of Infectious Diseases, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Children's Hospital & Medical Center, Omaha, Nebraska, USA
| | - Alice I Sato
- Division of Infectious Diseases, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Children's Hospital & Medical Center, Omaha, Nebraska, USA
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4
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Marlowe E, Pranikoff S, Borsheim B, Salafian K, Halvorson EE, Kram DE. Pilot study to determine effect of an altruism intervention focusing on herd immunity to enhance influenza vaccination rates. Vaccine 2022; 40:6625-6630. [PMID: 36210252 DOI: 10.1016/j.vaccine.2022.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE A prospective, single-arm clinical trial was conducted to evaluate an altruism-tailored educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents. METHODS Vaccine-hesitant parents at two primary care sites, spanning two influenza seasons from 2020 to 2021 were provided an intervention (spoken and written communication) which highlighted altruistic benefits of accepting the seasonal influenza vaccine to optimize herd immunity to help protect pediatric cancer patients. Eligible parents included those with children eligible for the seasonal influenza vaccine, those who were proficient in English, and those with scores on the adjusted Vaccine Hesitancy Scale (aVHS) suggesting vaccine hesitancy (score ≥ 3). Enrollees completed a demographic questionnaire, underwent the educational intervention, and repeated the aVHS. Vaccination status at that visit was assessed. The primary outcome was change in aVHS scores obtained pre- and post-intervention. Influenza vaccine acceptance, along with demographic information, were also analyzed. RESULTS We enrolled 510 parents of influenza vaccine eligible children and identified 73 vaccine-hesitant parents. There was an overall trend toward lower aVHS score, with a mean change in hesitancy score of -0.4 (P < 0.01). 43/73 (58.9 %) of the cohort experienced a positive effect toward a lower aVHS score, and 27/73 (37.0 %) of vaccine hesitant subjects became non-hesitant on the aVHS. Several demographic characteristics were associated with vaccine hesitancy in the screening population: educational level lower than bachelor's degree (p = 0.03), household income < 400 % of federal poverty level (p < 0.01), unmarried (p = 0.02), and identifying with a political affiliation other than Democrat (p < 0.01). However, no demographic characteristics were significantly associated with an individual becoming non-hesitant. Our altruism-tailored communication approach carried the largest positive impact on the altruism-specific question on the aVHS, decreasing the post-intervention response value by nearly 25 % (P < 0.01). CONCLUSIONS Our altruism-tailored communication approach significantly improved attitudes regarding childhood influenza vaccine among vaccine-hesitant parents. CLINICALTRIALS gov Identifier: NCT04568590.
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Affiliation(s)
- Elizabeth Marlowe
- Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Sarah Pranikoff
- Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Briana Borsheim
- Department of Pediatrics, Northwestern Feinberg School of Medicine, 225 E Chicago Ave, Chicago, IL 60611, USA
| | - Kiarash Salafian
- Department of Medicine, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - David E Kram
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, University of North Carolina School of Medicine, 170 Manning Drive, Chapel Hill, NC 27599, USA.
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Ocak S, Karaman S, Vural S, Keskindemirci G, Tugcu D, Unuvar A, Karakas Z. Hepatitis B Vaccination in Children With Ongoing Cancer Treatment: A Safety and Efficacy Study of Super-Accelerated Vaccination Scheme. Turk Arch Pediatr 2022; 56:469-473. [PMID: 35110116 PMCID: PMC8849218 DOI: 10.5152/turkarchpediatr.2021.21090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Children with cancer have an increased risk for hepatitis B virus (HBV) infections due to chemotherapy-induced secondary immunodeficiency and frequent blood transfusions. The aim of this study is to evaluate the efficacy and safety of hepatitis B vaccination during the intensive induction chemotherapy in children with cancer found to be seronegative for hepatitis B on admission. MATERIALS AND METHODS Children newly diagnosed with cancer were evaluated for the presence of hepatitis B surface antigen (HBsAg) and antibody on admission. The children negative for both were included in the study. A super-accelerated vaccination scheme (3 booster doses at days 1-5, 8-12, and 28-33) was administered to these seronegative children concurrently with induction chemotherapy. Antibody response was checked 4-8 weeks after the last vaccination and 6 months after the end of the treatment. RESULTS Eleven out of 122 children were seronegative for hepatitis B on admission (9%). Acute lymphoblastic leukemia, lymphoma, and solid tumors were diagnosed in 5, 4, and 2 children, respectively. Complete seroconversion was achieved in 4-8 weeks after the last vaccination with high titers of anti-HBs antibody, and all patients remained antibody-positive until 6 months after the completion of chemotherapy. CONCLUSION The risk of transfusion-related infections increases with a number of transfused products and donor exposures, and it is more significant for immunosuppressed children with hematologic and oncologic malignancies. Hepatitis B vaccination could safely be applied with brisk and sustained responses in this vulnerable population, based on the local epidemiological data.
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Affiliation(s)
- Suheyla Ocak
- Department of Pediatric Hematology-Oncology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Serap Karaman
- Department of Pediatric Hematology-Oncology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Sema Vural
- Department of Pediatric Hematology-Oncology, University of Health Sciences, Sisli Research and Training Hospital, Istanbul, Turkey
| | - Gonca Keskindemirci
- Department of Social Pediatrics, Istanbul University School of Medicine, Istanbul, Turkey
| | - Deniz Tugcu
- Department of Pediatric Hematology-Oncology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Aysegul Unuvar
- Department of Pediatric Hematology-Oncology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Zeynep Karakas
- Department of Pediatric Hematology-Oncology, Istanbul University School of Medicine, Istanbul, Turkey
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Attina’ G, Triarico S, Romano A, Maurizi P, Mastrangelo S, Ruggiero A. Role of Partial Splenectomy in Hematologic Childhood Disorders. Pathogens 2021; 10:1436. [PMID: 34832592 PMCID: PMC8620563 DOI: 10.3390/pathogens10111436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
The spleen is a secondary lymphoid organ that belongs to the reticular-endothelial system, directly connected to blood circulation. The spleen is greatly involved in the immune response, especially against capsulated bacteria. Splenectomy plays a fundamental role in the treatment of numerous pediatric hematologic disorders. Taking into account all the possible complications (especially infections) linked to this procedure, alternatives to total splenectomy have been sought. Partial splenectomy has been proposed as a treatment that allows the reduction of infectious risk. This approach has proven safe and feasible in most patients, but multicentric and prospective studies are necessary to more accurately define the indications for performing partial splenectomy. However, vaccinations and antibiotic prophylaxis remain fundamental for preventing serious infections, even in the case of partial splenectomy. We review anatomical and functional properties of the spleen, with a focus on medical or surgical indications to splenectomy, aiming to give practical educational information to patients and their families after splenectomy. Furthermore, we discuss the feasibility of partial splenectomy in children with hematologic diseases who require splenectomy.
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Affiliation(s)
| | | | | | | | | | - Antonio Ruggiero
- Pediatric Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.A.); (S.T.); (A.R.); (P.M.); (S.M.)
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7
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Yilmazbas P, Susam Sen H, Ocak S. Revaccination in Pediatric Oncology Patients: One Center Experience. Eurasian J Med 2021; 53:5-8. [PMID: 33716522 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] [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.
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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
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8
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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.
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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
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Zhang L, Thornton CP, Ruble K, Cooper SL. Post-Chemotherapy Titer Status and Need for Revaccination After Treatment for Childhood Cancer. Clin Pediatr (Phila) 2020; 59:606-613. [PMID: 32423345 DOI: 10.1177/0009922820915884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives. To evaluate the strategy of checking vaccine titers after completion of chemotherapy. Study Design. Retrospective review of pediatric oncology patients who completed chemotherapy. Demographics, post-chemotherapy titers, and absolute lymphocyte counts (ALCs) were analyzed. Results. Ninety patients met inclusion criteria, and 87% of patients had at least one titer checked. Comparing patients <7 years and those ≥7 years at diagnosis, there was no difference in incidence of negative titers except mumps; those <7 years old were more likely to have negative titers (58% vs 20%, P = .003). Comparing those <13 years old to ≥13 years old, there was no difference in negative titers except mumps (45% vs 19%, P = .02) and tetanus (44% vs 0%, P = .002). No patient maintained all protective titers after completion of chemotherapy. Time to ALC recovery was not predictive of positive titers. Conclusion. Checking titers after chemotherapy is not recommended. Providers should assume loss of immunity.
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Affiliation(s)
- Lindy Zhang
- Johns Hopkins University, Baltimore, MD, USA.,National Institutes of Health, Bethesda, MD, USA
| | - Clifton P Thornton
- Johns Hopkins University, Baltimore, MD, USA.,Herman & Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA
| | - Kathy Ruble
- Johns Hopkins University, Baltimore, MD, USA
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Ruggiero A, Romano A, Attinà G. Facing the COVID-19 outbreak in children with cancer. Drugs Context 2020; 9:dic-2020-4-12. [PMID: 32435268 PMCID: PMC7224358 DOI: 10.7573/dic.2020-4-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 01/21/2023] Open
Abstract
Europe is now the epicenter of the COVID-19 outbreak. Many concerns have arisen about the management and treatment of children with cancer while researchers are wondering how to deal with this devastating pandemic. In view of the epidemiological and clinical characteristics of the COVID-19 outbreak, it is fundamental to stress that the behavior and hygiene rules adopted by children with cancer must be respected and implemented in order to continue to safeguard their health for the current pandemic.
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Affiliation(s)
- Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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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.
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Mikulska M, Cesaro S, de Lavallade H, Di Blasi R, Einarsdottir S, Gallo G, Rieger C, Engelhard D, Lehrnbecher T, Ljungman P, Cordonnier C. Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7). THE LANCET. INFECTIOUS DISEASES 2019; 19:e188-e199. [PMID: 30744964 DOI: 10.1016/s1473-3099(18)30601-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/21/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
Patients with haematological malignancies are at high risk of infection because of various mechanisms of humoral and cell-mediated immune deficiencies, which mainly depend on underlying disease and specific therapies. Some of these infections are vaccine preventable. However, these malignancies are different from each other, and the treatment approaches are diverse and rapidly evolving, so it is difficult to have a common programme for vaccination in a haematology ward. Additionally, because of insufficient training about the topic, vaccination is an area often neglected by haematologists, and influenced by cultural differences, even among health-care workers, in compliance to vaccines. Several issues are encountered when addressing vaccination in haematology: the small size of the cohorts that makes it difficult to show the clinical benefits of vaccination, the subsequent need to rely on biological parameters, their clinical pertinence not being established in immunocompromised patients, scarcity of clarity on the optimal timing of vaccination in complex treatment schedules, and the scarcity of data on long-term protection in patients receiving treatments. Moreover, the risk of vaccine-induced disease with live-attenuated vaccines strongly limits their use. Here we summarise guidelines for patients without transplantations, and address the issue by the haematological group-myeloid and lymphoid-of diseases, with a special consideration for children with acute leukaemia.
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Affiliation(s)
- Malgorzata Mikulska
- University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Hugues de Lavallade
- Deparment of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Roberta Di Blasi
- Haematology Department, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Créteil, France
| | - Sigrun Einarsdottir
- Section of Hematology, Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Giuseppe Gallo
- Pediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Christina Rieger
- Department of Hematology Oncology, University of Munich, Germering, Germany
| | - Dan Engelhard
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Ein-Kerem Jerusalem, Israel
| | - Thomas Lehrnbecher
- Paediatric Haematology and Oncology Department, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Per Ljungman
- Department of Cellular Therapy and Allogenenic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden
| | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Créteil, France; University Paris-Est Créteil, Créteil, France.
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Han JH, Harmoney KM, Dokmeci E, Torrez J, Chavez CM, Cordova de Ortega L, Kuttesch JF, Muller M, Winter SS. Dynamic re-immunization of off-treatment childhood cancer survivors: An implementation feasibility study. PLoS One 2018; 13:e0191804. [PMID: 29389976 PMCID: PMC5794110 DOI: 10.1371/journal.pone.0191804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/11/2018] [Indexed: 12/20/2022] Open
Abstract
There are no universally approved re-vaccination guidelines for non-transplant pediatric cancer survivors. We hypothesized that by utilizing a response-based re-vaccination schedule, we could tailor vaccine schedules in off-treatment cancer survivors. Pre-vaccination antibody levels were obtained in 7 patients at an average of 20 days after the end of treatment date. In those without protective antibody levels, we administered vaccines 3 months after completion of treatment. Revaccinating patients 3 months after the end of treatment date resulted in protective antibody levels for most vaccines. We showed, on a preliminary basis, that vaccinating non-transplanted pediatric cancer survivors can be dynamically implemented in children with recovering immune function.
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Affiliation(s)
- Jennifer H. Han
- Department of Pediatrics, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
- * E-mail: (JHH); (KMH)
| | - Kathryn M. Harmoney
- Department of Pediatrics, Division of Hematology/Oncology, University of Iowa Stead Family Children’s Hospital, 200 Hawkins Drive, Iowa City, Iowa, United States of America
- * E-mail: (JHH); (KMH)
| | - Elif Dokmeci
- Department of Pediatrics, Division of Allergy/Immunology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Jacqueline Torrez
- Department of Pediatrics, Division of Hematology/Oncology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Cathy M. Chavez
- Department of Pediatrics, Division of Hematology/Oncology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Loretta Cordova de Ortega
- Department of Pediatrics, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - John F. Kuttesch
- Department of Pediatrics, Division of Hematology/Oncology, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Martha Muller
- Department of Pediatrics, Division of Infectious Diseases, The University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Stuart S. Winter
- Cancer and Blood Disorders Program, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, Minnesota, United States of America
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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.
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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
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Wiedermann U, Garner-Spitzer E, Wagner A. Primary vaccine failure to routine vaccines: Why and what to do? Hum Vaccin Immunother 2016; 12:239-43. [PMID: 26836329 PMCID: PMC4962729 DOI: 10.1080/21645515.2015.1093263] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
There are 2 major factors responsible for vaccine failures, the first is vaccine-related such as failures in vaccine attenuation, vaccination regimes or administration. The other is host-related, of which host genetics, immune status, age, health or nutritional status can be associated with primary or secondary vaccine failures. The first describes the inability to respond to primary vaccination, the latter is characterized by a loss of protection after initial effectiveness. Our studies concentrate on the evaluation of immunological characteristics responsible for primary vaccine failures in different (risk) populations for which the underlying mechanisms are currently unknown. Here we summarise current knowledge and findings from our studies. About 2–10% of healthy individuals fail to mount antibody levels to routine vaccines. Comparing the immune responses to different vaccines in non-responder and high-responder vaccinees revealed that hypo-responsiveness is antigen/vaccine-specific at the humoral but not at the cellular level. We found that T-regulatory as well as B-regulatory cells and the production of IL-10 are involved in non/hypo-responsiveness. Non-responsiveness increases with age and in particular vaccination to a novel vaccine in persons > 65 years is associated with a high low/non-responder rate, indicating that vaccine schedules and doses (at least for primary vaccination) should be adapted according to age. In light of the growing number of allergic but also obese people, our current studies concentrate on these risk groups to reveal whether different vaccination approaches are necessary for optimal protection compared to healthy individuals. These studies are in line with the significant paradigm shift taking place in many fields of medical research and care, and will extend the concept of personalised medicine into the field of vaccinology.
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Affiliation(s)
- Ursula Wiedermann
- a Institute of Specific Prophylaxis and Tropical Medicine; Medical University Vienna ; Vienna , Austria
| | - Erika Garner-Spitzer
- a Institute of Specific Prophylaxis and Tropical Medicine; Medical University Vienna ; Vienna , Austria
| | - Angelika Wagner
- a Institute of Specific Prophylaxis and Tropical Medicine; Medical University Vienna ; Vienna , Austria
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Esposito S, Prada E, Lelii M, Castellazzi L. Immunization of children with secondary immunodeficiency. Hum Vaccin Immunother 2015; 11:2564-70. [PMID: 26176360 DOI: 10.1080/21645515.2015.1039208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The main causes of secondary immunodeficiency at a pediatric age include infectious diseases (mainly HIV infection), malignancies, haematopoietic stem cell or solid organ transplantation and autoimmune diseases. Children with secondary immunodeficiency have an increased risk of severe infectious diseases that could be prevented by adequate vaccination coverage, but vaccines administration can be associated with reduced immune response and an increased risk of adverse reactions. The immunogenicity of inactivated and recombinant vaccines is comparable to that of healthy children at the moment of vaccination, but it undergoes a progressive decline over time, and in the absence of a booster, the patients remain at risk of developing vaccine-preventable infections. However, the administration of live attenuated viral vaccines is controversial because of the risk of the activation of vaccine viruses. A specific immunization program should be administered according to the clinical and immunological status of each of these conditions to ensure a sustained immune response without any risks to the patients' health.
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Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
| | - Elisabetta Prada
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
| | - Mara Lelii
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
| | - Luca Castellazzi
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
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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.
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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
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