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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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Martire B, Azzari C, Badolato R, Canessa C, Cirillo E, Gallo V, Graziani S, Lorenzini T, Milito C, Panza R, Moschese V. Vaccination in immunocompromised host: Recommendations of Italian Primary Immunodeficiency Network Centers (IPINET). Vaccine 2018; 36:3541-3554. [PMID: 29426658 DOI: 10.1016/j.vaccine.2018.01.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/29/2017] [Accepted: 01/24/2018] [Indexed: 12/13/2022]
Abstract
Infectious complications are a major cause of morbidity and mortality in patients with primary or secondary immunodeficiency. Prevention of infectious diseases by vaccines is among the most effective healthcare measures mainly for these subjects. However immunocompromised people vary in their degree of immunosuppression and susceptibility to infection and, therefore, represent a heterogeneous population with regard to immunization. To date there is no well- established evidence for use of vaccines in immunodeficient patients, and indications are not clearly defined even in high-quality reviews and in most of the guidelines prepared to provide recommendations for the active vaccination of immunocompromised hosts. The aim of this document is to issue recommendations based on published literature and the collective experience of the Italian primary immunodeficiency centers, about how and when vaccines can be used in immunocompromised patients, in order to facilitate physician decisions and to ensure the best immune protection with the lowest risk to the health of the patient.
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Affiliation(s)
- Baldassarre Martire
- Paediatric Hematology Oncology Unit, "Policlinico-Giovanni XXII" Hospital, University of Bari, Italy.
| | - Chiara Azzari
- Pediatric Immunology Unit "Anna Meyer" Hospital University of Florence, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Clementina Canessa
- Pediatric Immunology Unit "Anna Meyer" Hospital University of Florence, Italy
| | - Emilia Cirillo
- Department of Translational Medical Sciences, Pediatric section, Federico II University, Naples, Italy
| | - Vera Gallo
- Department of Translational Medical Sciences, Pediatric section, Federico II University, Naples, Italy
| | - Simona Graziani
- Paediatric Allergology and Immunology Unit, Policlinico Tor Vergata, University of Rome Tor, Vergata, Italy
| | - Tiziana Lorenzini
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Italy
| | - Raffaella Panza
- Paediatric Hematology Oncology Unit, "Policlinico-Giovanni XXII" Hospital, University of Bari, Italy
| | - Viviana Moschese
- Paediatric Allergology and Immunology Unit, Policlinico Tor Vergata, University of Rome Tor, Vergata, Italy
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The accelerated hepatitis B virus vaccination schedule among hemodialysis patients, does it work? A randomized controlled trial. J Nephrol 2017; 30:803-809. [DOI: 10.1007/s40620-017-0443-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/08/2017] [Indexed: 01/06/2023]
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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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Abstract
In summary, immunizations in special populations require understanding the underlying disease and how it might affect the immune system's ability to mount an antibody response to vaccines or predispose certain patient populations to developing certain serious infections. There is still a great need for research on the optimal timing of vaccines after transplants, how to assess protection and development of a protective antibody response after immunization, and whether certain groups (eg, HIV) need to be revaccinated after a certain amount of time if their antibody levels decline. In addition, there are limited data on efficacy of the newer vaccines in these special patient populations, which also requires further investigation.
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Affiliation(s)
- Michael A Miller
- Department of Pediatric Infectious Diseases and Immunology, University of Florida, Jacksonville, 32209, USA
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Vaccinations in children with cancer. Vaccine 2010; 28:3278-84. [PMID: 20226246 DOI: 10.1016/j.vaccine.2010.02.096] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 02/22/2010] [Accepted: 02/23/2010] [Indexed: 11/20/2022]
Abstract
Children with cancer may be immunocompromised as a result of their primary underlying disease and/or the use of prolonged and intensive chemotherapy administered with or without irradiation. The damage to the immune system varies with the age of the patient, the type of cancer, and the intensity of the chemotherapy used to treat it. This review analyses the data regarding the immunogenicity, efficacy, safety and tolerability of the vaccines usually recommended in the first years of life in order to help pediatricians choose the best immunisation programme against vaccine-preventable disease in children with cancer receiving standard-dose chemotherapy. Areas for future research are highlighted because new data are required to be able to draw up evidence-based recommendations that will ensure adequate protection against infectious diseases in such high-risk children.
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