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Kinslow CJ, Wang Y, Liu Y, Zuev KM, Chaudhary KR, Wang TJC, Donalek C, Amori M, Cheng SK. Influenza activity and regional mortality for non-small cell lung cancer. Sci Rep 2023; 13:21674. [PMID: 38065996 PMCID: PMC10709588 DOI: 10.1038/s41598-023-47173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in patients with cancer remains largely unknown. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015. Influenza-like illness (ILI) activity, provided by the Outpatient Influenza-like Illness Surveillance Network of the Center of Disease for Control and Prevention, was merged with the SEER dataset on the state-month level. Regional monthly mortality rates were compared during low versus high flu months in this ecological cohort study. 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1049 state-months (5.1%) had high flu activity. Monthly mortality rates during low and high flu months were 0.041 (95% CI 0.041-0.042) and 0.051 (95% CI 0.050-0.053), respectively (RR 1.24 [95% CI 1.21-1.27]). The association between ILI activity and mortality was observed at the individual state level and in all clinical and regional subgroups. Increased regional influenza activity is associated with higher mortality rates for patients with NSCLC. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related lung cancer deaths in the U.S.
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Affiliation(s)
- Connor J Kinslow
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Yuankun Wang
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Yi Liu
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Konstantin M Zuev
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
- California Institute of Technology, 1200 E. California Blvd., Pasadena, CA, 91125, USA
| | - Kunal R Chaudhary
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Ciro Donalek
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Michael Amori
- Virtualitics Inc, 225 S. Lake Avenue Suite 120, Pasadena, CA, 91101, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
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Abreu RB, Kirchenbaum GA, Clutter EF, Sautto GA, Ross TM. Preexisting subtype immunodominance shapes memory B cell recall response to influenza vaccination. JCI Insight 2020; 5:132155. [PMID: 31794433 DOI: 10.1172/jci.insight.132155] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
Influenza is a highly contagious viral pathogen with more than 200,000 cases reported in the United States during the 2017-2018 season. Annual vaccination is recommended by the World Health Organization, with the goal to reduce influenza severity and transmission. Currently available vaccines are about 60% effective, and vaccine effectiveness varies from season to season, as well as between different influenza subtypes within a single season. Immunological imprinting from early-life influenza infection can prominently shape the immune response to subsequent infections. Here, the impact of preexisting B cell memory in the response to quadrivalent influenza vaccine was assessed using blood samples collected from healthy subjects (18-85 years old) prior to and 21-28 days following influenza vaccination. Influenza vaccination increased both HA-specific antibodies and memory B cell frequency. Despite no apparent differences in antigenicity between vaccine components, most individuals were biased toward one of the vaccine strains. Specifically, responses to H3N2 were reduced in magnitude relative to the other vaccine components. Overall, this study unveils a potentially new mechanism underlying differential vaccine effectiveness against distinct influenza subtypes.
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Affiliation(s)
| | | | | | | | - Ted M Ross
- Center for Vaccines and Immunology and.,Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
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Andrew MK, Bowles SK, Pawelec G, Haynes L, Kuchel GA, McNeil SA, McElhaney JE. Influenza Vaccination in Older Adults: Recent Innovations and Practical Applications. Drugs Aging 2019; 36:29-37. [PMID: 30411283 DOI: 10.1007/s40266-018-0597-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Influenza can lead to serious illness, particularly for older adults. In addition to short-term morbidity and mortality during the acute infection, recovery can be prolonged and often incomplete. This may lead to persistent declines in health and function, including catastrophic disability, which has dramatic implications for the well-being and support needs of older adults and their caregivers. All of this means that prevention of infection and effective treatment when illness has occurred are of paramount importance. In this narrative review, we discuss the effectiveness of influenza vaccines for the prevention of influenza illness and serious outcomes in older adults. We review evidence of vaccine effectiveness for older adults in comparison with younger age groups, and also highlight the importance of frailty as a determinant of vaccine effectiveness. We then turn our attention to the question of why older and frailer individuals have poorer vaccine responses, and consider changes in immune function and inflammatory responses. This sets the stage for a discussion of newer influenza vaccine products that have been developed with the aim of enhancing vaccine effectiveness in older adults. We review the available evidence on vaccine efficacy, effectiveness and cost benefits, consider the potential place of these innovations in clinical geriatric practice, and discuss international advisory committee recommendations on influenza vaccination in older adults. Finally, we highlight the importance of influenza prevention to support healthy aging, along with the need to improve vaccine coverage rates using available vaccine products, and to spur development of better influenza vaccines for older adults in the near future.
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Affiliation(s)
- Melissa K Andrew
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, Canada. .,Canadian Center for Vaccinology, Halifax, NS, Canada.
| | - Susan K Bowles
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS, Canada.,Canadian Center for Vaccinology, Halifax, NS, Canada.,Department of Pharmacy, Nova Scotia Health Authority, Central Zone, Halifax, NS, Canada
| | - Graham Pawelec
- Second Department of Internal Medicine, University of Tübingen, Tübingen, Germany.,Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Laura Haynes
- Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - George A Kuchel
- Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Halifax, NS, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, NS, Canada
| | - Janet E McElhaney
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada
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Lee JKH, Lam GKL, Shin T, Kim J, Krishnan A, Greenberg DP, Chit A. Efficacy and effectiveness of high-dose versus standard-dose influenza vaccination for older adults: a systematic review and meta-analysis. Expert Rev Vaccines 2018; 17:435-443. [PMID: 29715054 DOI: 10.1080/14760584.2018.1471989] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Influenza is responsible for a significant disease burden annually, especially in older adults. This study reviews the relative vaccine efficacy or effectiveness (rVE) of high-dose inactivated trivalent influenza vaccine (HD-IIV3) compared to standard-dose influenza vaccines (SD-IIV3) in adults ≥65 against influenza-associated outcomes to inform evidence-based decision-making to shift clinical practice and standard of care in this population. METHODS A systematic review was conducted for studies assessing the rVE of HD-IIV3 against probable/laboratory-confirmed influenza-like illness (ILI), hospital admissions, and death in adults ≥65. Results from individual seasons were meta-analyzed and a random-effects model was used to estimate pooled rVEs. RESULTS After screening 992 studies, seven studies were meta-analyzed. HD-IIV3 demonstrated better protection against ILI compared to SD-IIV3 (rVE = 19.5%; 95% CI: 8.6-29.0%). HD-IIV3 was also more effective at preventing hospital admissions from all-causes (rVE = 9.1%; 95% CI: 2.4-15.3%), as well as from influenza (rVE = 17.8%; 95% CI: 8.1-26.5%), pneumonia (rVE = 24.3%, 95% CI: 13.9-33.4%), and cardiorespiratory events (rVE = 18.2%; 95% CI: 6.8-28.1%). rVE against post-influenza mortality was 22.2% (95% CI: -18.2-48.8%) and 2.5% (95% CI: -5.2-9.5%) against all-cause mortality. CONCLUSIONS Available evidence suggests HD-IIV3 is more effective than SD-IIV3 at reducing the clinical outcomes associated with influenza infection in older adults and should be considered for routine use in the 65+ population.
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Affiliation(s)
- Jason K H Lee
- a Leslie Dan School of Pharmacy , University of Toronto , Toronto , Canada
- b Sanofi Pasteur , Toronto , Canada
| | - Gary K L Lam
- a Leslie Dan School of Pharmacy , University of Toronto , Toronto , Canada
- b Sanofi Pasteur , Toronto , Canada
| | - Thomas Shin
- b Sanofi Pasteur , Toronto , Canada
- c Department of Mathematics and Statistics , York University , Toronto , Canada
| | - Jiyeon Kim
- a Leslie Dan School of Pharmacy , University of Toronto , Toronto , Canada
- b Sanofi Pasteur , Toronto , Canada
| | - Anish Krishnan
- a Leslie Dan School of Pharmacy , University of Toronto , Toronto , Canada
- b Sanofi Pasteur , Toronto , Canada
| | - David P Greenberg
- d Sanofi Pasteur , Swiftwater , PA , USA
- e Department of Pediatrics , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Ayman Chit
- a Leslie Dan School of Pharmacy , University of Toronto , Toronto , Canada
- d Sanofi Pasteur , Swiftwater , PA , USA
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