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Guo X, Han Q, Wang Y, Zhang R, Huang Y, Guo B. Influenza Vaccine Hesitancy among Cancer Survivors in China: A Multicenter Survey. Vaccines (Basel) 2024; 12:639. [PMID: 38932368 PMCID: PMC11209103 DOI: 10.3390/vaccines12060639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Cancer survivors are at higher risk of developing severe complications from influenza due to their compromised immune systems. Despite their increased vulnerability to influenza and the availability of vaccines, vaccine hesitancy among cancer survivors remains a significant public health concern in China. METHODS A multicenter, cross-sectional study was conducted among cancer survivors in China from January to December 2023. A total of 500 participants were recruited from the oncology departments of five tertiary hospitals. A structured, self-administered questionnaire was used to collect data on socio-demographic characteristics, cancer-related information, medical history, lifestyle factors, and influenza vaccine hesitancy. Univariate and multivariate logistic regression analyses were performed to identify factors associated with influenza vaccine hesitancy. RESULTS The response rate was 97.0% (485/500). Among all participants, 204 (42.06%) reported vaccine hesitancy. The results of multiple logistic regression showed that the longer the end of anti-cancer treatment, without a history of adverse vaccine reactions, and the level of family support played a protective role in vaccine hesitancy. Current rehabilitation status, frequent colds, not being informed by doctors about vaccination, exercising, lack of community vaccination education programs, and concerns about vaccine safety were risk factors that increase vaccine hesitancy. CONCLUSIONS A high proportion of cancer survivors in our study reported influenza vaccine hesitancy. Addressing concerns about vaccine safety, improving access to vaccination services, and enhancing doctor-patient communication are crucial for increasing influenza vaccine uptake in this vulnerable population.
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Affiliation(s)
- Xin Guo
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Qi Han
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Yuqin Wang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Rui Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China (R.Z.)
| | - Yuenan Huang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Botang Guo
- Department of Medical Psychology, Harbin Medical University, Baojian Road 158, Harbin 150078, China
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen 518001, China
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Sabatino DC, Campbell P, Santamala J. Assessment of adherence to routine vaccination schedules in oncology patients. J Oncol Pharm Pract 2023:10781552231208434. [PMID: 37847582 DOI: 10.1177/10781552231208434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Patients diagnosed with cancer are at an increased risk of infection. Vaccines remain one of the most critical public health strategies in limiting infectious diseases, with a heightened importance in cancer patients. Data across the general US population indicates that vaccine adherence rates are suboptimal across all adult vaccine schedules. This study aims to define vaccine adherence rates within the oncology population. METHODS This retrospective cohort study includes adult patients with a new cancer diagnosis. Vaccine administrations for COVID-19 (SARS-CoV-2), influenza, pneumococcal, tetanus/diphtheria/pertussis (TDaP), herpes zoster (RZV), human papillomavirus (HPV), and hepatitis B (hepB) were assessed. The primary outcome was complete vaccine adherence. RESULTS Two hundred and eighty-three oncology patients were included. The median age at diagnosis was 63 years old, and most subjects were females (60%). The two most common malignancies were gastrointestinal and breast cancer at 26.5% and 15.2%, respectively. Suboptimal vaccine adherence rates were observed across the entire oncology population. Complete adherence was observed in only 1.4% of patients. Vaccine specific adherence rates were as follows, SARS-CoV-2: 38.9%; influenza: 11.4%; pneumococcal: 12.7%; TDaP: 13.1%; RZV: 3.5%; HPV: 0%; and hepB: 34%. Among the vaccine schedules assessed, SARS-CoV-2 vaccination rates were the highest with 38.9% of patients being fully adherent and 73% receiving at least one dose. CONCLUSION Lower vaccine adherence rates were observed in oncology patients compared to currently published rates. Providers and pharmacists can play a role in assessing and counseling patients on the importance of vaccine adherence before chemotherapy is initiated and after a remission is obtained.
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Affiliation(s)
- David C Sabatino
- Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Peter Campbell
- Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Jennifer Santamala
- Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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Vaid A, Rastogi N, Doherty TM, San Martin P, Chugh Y. Review of the unmet medical need for vaccination in adults with immunocompromising conditions: An Indian perspective. Hum Vaccin Immunother 2023; 19:2224186. [PMID: 37402477 DOI: 10.1080/21645515.2023.2224186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
Immunocompromised (IC) populations are at increased risk of vaccine-preventable diseases (VPDs). In India, the concern of VPDs in IC populations is particularly acute due to the prevalence of crowded living situations, poor sanitation and variable access to healthcare services. We present a narrative review of IC-related disease and economic burden, risk of VPDs and vaccination guidelines, based on global and India-specific literature (2000-2022). IC conditions considered were cancer, diabetes mellitus, chronic kidney disease, respiratory disorders, disorders treated with immunosuppressive therapy, and human immune deficiency virus (HIV). The burden of IC populations in India is comparable to the global population, except for cancer and HIV, which have lower prevalence compared with the global average. Regional and socioeconomic inequalities exist in IC prevalence; VPDs add to the burden of IC conditions, especially in lower income strata. Adult vaccination programs could improve health and reduce the economic impact of VPDs in IC populations.
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Affiliation(s)
- Ashok Vaid
- Medical Oncology and Hematology, Medanta Cancer Institute, Gurugram, India
| | - Neha Rastogi
- Pediatric Hematology, Oncology and BMT, Medanta Cancer Institute, Gurugram, India
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Retnakumar SV, Chauvin C, Bayry J. The implication of anti-PD-1 therapy in cancer patients for the vaccination against viral and other infectious diseases. Pharmacol Ther 2023; 245:108399. [PMID: 37001736 DOI: 10.1016/j.pharmthera.2023.108399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
The phenomenon of 'T cell exhaustion', a state of T cell dysfunction observed during chronic infections and cancers, has been a major obstacle in mounting appropriate immune responses against infectious agents or tumor antigens. The exhausted T cells are characterized by poor effector functions mainly due to the overexpression of inhibitory receptors such as programmed cell death protein 1 (PD-1), cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), T cell immunoglobulin and mucin-domain containing 3 (TIM3), lymphocyte activation gene 3 (LAG3), and T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), commonly referred to as immune checkpoint (ICP) molecules. ICP blockade, especially of PD-1 that can potentially reverse T cell exhaustion and thereby re-stimulate the impaired immune system, is widely used in clinics as a promising therapeutic strategy for various cancers and is more recently being investigated in infectious diseases as well. In fact, cancer patients represent a population of immunocompromised individuals who are more susceptible to infections and associated complications, and thus the need for protective vaccinations against these diseases is of prime importance in this category. When it comes to vaccinating anti-PD-1-treated cancer patients against infectious diseases including COVID-19 and influenza, a special focus should be brought on the revived immune cells, which could be dynamically affected by the antigenic stimulation. However, since cancer patients are not generally included in clinical trials for designing vaccines against infectious diseases, the possible interaction between vaccine immune responses and ICP therapy is largely unexplored. Mechanistically, the reversal of T cell exhaustion by ICP in an otherwise immunocompromised population could be beneficial for the vaccine's efficacy, helping the immune system to mount a robust immune response. Nevertheless, patients with cancer undergoing anti-PD-1 blockade are known to experience immune-related adverse effects (irAEs). The risk of increasing the irAEs due to the overstimulation of the immune system during vaccination is a major concern. Therefore, while routine vaccination is indispensable for the protection of cancer patients, the impact of PD-1 blockade on vaccine responses against infectious agents requires careful consideration to avoid undesirable adverse effects that could impair the efficacy of anti-cancer treatment.
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Short-Term Safety and Psychosocial Impact of the BNT162b2 mRNA COVID-19 Vaccine in Cancer Patients-An Italian Single-Center Experience. Biomedicines 2023; 11:biomedicines11010165. [PMID: 36672673 PMCID: PMC9855735 DOI: 10.3390/biomedicines11010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Safety data regarding BNT162b2 in cancer patients (CPs) are scarce. Herein we report the side effects (SEs), the adverse events (AEs), and the patient-reported outcomes (PROs) following BNT162b2 administration in CPs treated at the San Luigi Gonzaga University Hospital. All CPs who agreed to participate in our vaccination campaign received BNT162b2 and were included in the descriptive analysis. An anonymous questionnaire investigating the occurrence of SEs/AEs and PROs was administered to the study population 21 days after the first dose. Pearson's chi-squared test was used to estimate the risk of experiencing SEs/AEs according to selected variables. A total of 997 patients were included in the study: 62.0% had stage IV cancer, and 68.8% were receiving an active treatment, of whom 15.9% were receiving immunotherapy. SEs/AEs were recorded in 37.1% of cases after the first dose and in 48.5% of cases after the second dose. The most common SEs were muscle pain/local rash (27.9% and 28%, after the first and second dose, respectively). Patients older than 70 years showed lower risk of SEs/AEs, while women showed a higher risk. Before receiving the vaccine, 18.2% of patients felt fearful and/or insecure about the vaccination. After the first dose, 57.5% of patients changed their feelings positively. Our data support the short-term safety of BNT162b2 in CPs, regardless of disease stage and concurrent treatments. Overall, the vaccination showed a positive impact on quality of life.
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Kiderlen TR, Trostdorf K, Delmastro N, Salomon A, Scholz CW, Späth-Schwalbe E, Mansmann V, Roll S, Reinwald M, de Wit M. Controlled non-randomised before-after study evaluating the impact of a focused recommendation card on vaccination rates of oncological patients-The Easy Vaccination in Oncology (EVO) strategy. Eur J Cancer Care (Engl) 2022; 31:e13725. [PMID: 36221170 DOI: 10.1111/ecc.13725] [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: 02/18/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE By implementing a focused must-have vaccination strategy (Easy Vaccination in Oncology [EVO]), we aimed to increase rates for high-impact vaccinations (Streptococcus pneumoniae, influenza, herpes zoster and hepatitis B) in the at-risk population of oncological patients. METHODS In this German multicentre interventional non-randomised controlled two-arm open trial with repeated cross-sectional data collection, we evaluated the EVO strategy as an easy to implement approach. Vaccination rates were assessed in the outpatient setting and re-assessed after 3 months. A generalised linear mixed model (GLMM) was used to assess the primary endpoint (Streptococcus pneumoniae vaccination rates according to recommendations), taking clustering within clinics into account. RESULTS Vaccination rates substantially increased in the intervention group; Streptococcus pneumoniae +21.5% (+16.7% according to recommendations), influenza +12.2%, herpes zoster +13.3% (+13.6% age group 50+), and hepatitis B +11%. Vaccination rates in the control group tended to decrease or increase only moderately (-5.8% [-3.8%], +7.4%, +2.1% [1.4%], and -1.7%, respectively). GLMM showed significant effect of the intervention (OR 7.50, 95% CI 2.18-25.80, p = 0.001). CONCLUSION This easy-to-implement and resource-saving approach has the potential to increase vaccination rates in oncological patients and to have a considerable impact protecting oncological patients from preventable infectious diseases. CLINICAL TRIAL REGISTRATION The study was registered at the German Resister for Clinical Studies (DRKS) under DRKS00020118.
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Affiliation(s)
- Til R Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Katrin Trostdorf
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
| | - Nicola Delmastro
- Department of Cardiology, Vivantes Hospital Neukoelln, Berlin, Germany
| | - Arne Salomon
- Department of Pulmonology and Infectious Diseases, Vivantes Hospital Neukoelln, Berlin, Germany
| | - Christian W Scholz
- Department of Hematology and Oncology, Vivantes Hospital am Urban, Berlin, Germany
| | - Ernst Späth-Schwalbe
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Spandau, Berlin, Germany
| | - Veit Mansmann
- Department of Hematology, Oncology and Palliative Care, Vivantes Humboldt Hospital, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mark Reinwald
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Maike de Wit
- Department of Hematology, Oncology and Palliative Care, Vivantes Hospital Neukoelln, Berlin, Germany
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Einarsson J. Vaccination considerations for patients receiving cancer therapy. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:751-752. [PMID: 36241417 PMCID: PMC9833152 DOI: 10.46747/cfp.6810751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- James Einarsson
- Family physician at Cornelia Court Family Medicine in Smiths Falls, Ont, and practises emergency medicine at the Smiths Falls site of the Perth and Smiths Falls District Hospital
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8
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Mekkawi R, Elkattan BA, Shablak A, Bakr M, Yassin MA, Omar NE. COVID-19 Vaccination in Cancer Patients: A Review Article. Cancer Control 2022; 29:10732748221106266. [PMID: 36066031 PMCID: PMC9459453 DOI: 10.1177/10732748221106266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus 2. Adults with cancer are immunocompromised due to several causes including cancer itself and immunosuppressive therapy. Thus, cancer patients are more susceptible to develop COVID-19 infection. As COVID-19 vaccines became available, patients with cancer would benefit from receiving the vaccine. This article aims to review the recent evidences and recommendations about COVID-19 vaccination in cancer patients.Current guidelines recommend that patients with cancer should have the priority to receive the vaccine given their immunocompromised state. The timing of administration varies depending on cancer type and treatment. Generally, the vaccine should be given before starting the chemotherapy if possible or in between chemotherapy cycles and away from nadir phase. For other cancer treatments, it is recommended to give the vaccine when there is evidence of blood count recovery. In general, induction therapy and treatment for newly diagnosed patients should not be delayed for the vaccination purpose. It is noteworthy to mention that cancer patients especially those with hematologic malignancies might have absented or attenuated response to the vaccine due to their pathophysiological status.On the other hand, the current vaccine guidelines have been criticized for lacking evidence on some important topics that need to be addressed. Firstly, some vaccines have been granted an emergency use authorization, prior to the usual comprehensive safety and efficacy evaluation process. Secondly, specific populations including cancer patients were excluded from the approval trials for safety reasons. Finally, some recommendations regarding the COVID-19 vaccines are extrapolated from other vaccines studies. Further studies are required to fill these gaps and observational studies that include cancer patients are warranted to have a better understanding of the safety and efficacy of the vaccines in cancer patients.
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Affiliation(s)
| | | | - Alaaeldin Shablak
- Department of Medical Oncology,
National Center for Cancer Care and Research, Hamad Medical
Corporation, Doha, Qatar
| | - Mohammad Bakr
- Department of Clinical Hematology,
National Center for Cancer Care and Research, Hamad Medical
Corporation, Doha, Qatar
| | - Mohamed A. Yassin
- Department of Clinical Hematology,
National Center for Cancer Care and Research, Hamad Medical
Corporation, Doha, Qatar
| | - Nabil E. Omar
- Department of Pharmacy, National
Center for Cancer Care and Research, Hamad Medical
Corporation, Doha, Qatar,Nabil Elhadi Omar, National Centre for
Cancer Care and Research – Hamad Medical Corporation, College of Pharmacy, Qatar
University, P.O. : 3050, Doha, Qatar.
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Draliuk R, Shadmi E, Preis M, Dagan E. Association between PCV13 pneumococcal vaccination and risk of hospital admissions due to pneumonia or sepsis among patients with haematological malignancies: a single-centre retrospective cohort study in Israel. BMJ Open 2022; 12:e056986. [PMID: 35428637 PMCID: PMC9013985 DOI: 10.1136/bmjopen-2021-056986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Patients with haematological malignancies receiving immunosuppressive therapy are at highest risk of invasive pneumococcal disease. Our goal was to investigate whether vaccination of haematological patients with pneumococcal 13-valent conjugated vaccine (PCV13) prior to therapy initiation is associated with decreased hospital admissions due to pneumonia or sepsis within 12 months. DESIGN AND SETTING A longitudinal retrospective cohort study was conducted at the haematology unit of Carmel Medical Center, Israel. PARTICIPANTS Information on adult patients (>18 years) who were diagnosed between 1 January 2009 and 30 December 2019 with haematological malignancies and received immunosuppressive therapy was retrieved from the electronic health records. Patients with haematological malignancies who received the PCV13 vaccination during or after initiation of the immunosuppressive therapy were excluded from the study. OUTCOME MEASURES A multivariate logistic regression model was performed to determine whether PCV13 vaccination is associated with fewer hospital admissions due to pneumonia or sepsis. RESULTS The cohort included 616 patients, of which 418 (67%) patients were not vaccinated and 198 (33%) were vaccinated. Within 12 months, 15.1% (n=63) of non-vaccinated patients compared with only 7.1% (n=14) of the vaccinated patients were hospitalised due to pneumonia or sepsis. The logistic regression analysis demonstrated that receiving PCV13 vaccination is associated with 45% (OR=0.45, 95% CI: 0.246 to 0.839, p=0.012) reduced odds of being hospitalised due to pneumonia or sepsis in patients with haematological malignancies receiving immunosuppressive therapy. CONCLUSION This is the first observational study to demonstrate the association between PCV13 vaccination and hospital admissions in patients with haematological malignancies receiving immunosuppressive therapy. Patients receiving PCV13 vaccination before immunosuppressive therapy initiation had significantly reduced odds of hospitalisation due to pneumonia or sepsis compared with non-PCV13-vaccinated patients.
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Affiliation(s)
- Regina Draliuk
- Department of Nursing, University of Haifa, Haifa, Israel
- Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Efrat Shadmi
- Department of Nursing, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Meir Preis
- Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Efrat Dagan
- Department of Nursing, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
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Echavarria I, Carrión Galindo JR, Corral J, Diz Taín MP, Henao Carrasco F, Iranzo González-Cruz V, Mielgo-Rubio X, Quintanar T, Rivas Corredor C, Pérez Segura P. SEOM clinical guidelines for the prophylaxis of infectious diseases in cancer patients (2021). Clin Transl Oncol 2022; 24:724-732. [PMID: 35230619 PMCID: PMC8886704 DOI: 10.1007/s12094-022-02800-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/14/2022]
Abstract
Infections are still a major cause of morbi-mortality in patients with cancer. Some of these infections are preventable through specific measures, such as vaccination or prophylaxis. This guideline aims to summarize the evidence and recommendations for the prevention of infections in cancer patients, devoting special attention to the most prevalent preventable infectious disease. All the evidences will be graded according to The Infectious Diseases Society of America grading system.
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Affiliation(s)
- Isabel Echavarria
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CIBERONC, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain
| | | | - Jesús Corral
- Department of Medical Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | | | | | - Vega Iranzo González-Cruz
- Department of Medical Oncology, Hospital General Universitario de Valencia, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Valencia, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Teresa Quintanar
- Department of Medical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Pedro Pérez Segura
- Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
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Vaccination against Cancer or Infectious Agents during Checkpoint Inhibitor Therapy. Vaccines (Basel) 2021; 9:vaccines9121396. [PMID: 34960142 PMCID: PMC8706349 DOI: 10.3390/vaccines9121396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 12/19/2022] Open
Abstract
The use of immune checkpoint inhibitors (ICI) has substantially increased the overall survival of cancer patients and has revolutionized the therapeutic situation in oncology. However, not all patients and cancer types respond to ICI, or become resistant over time. Combining ICIs with therapeutic cancer vaccines is a promising option as vaccination may help to overcome resistance to immunotherapies while immunotherapies may increase immune responses to the particular cancer vaccine by reinvigorating exhausted T cells. Thus, it would be possible to reprogram a response with appropriate vaccines, using a particular cancer antigen and a corresponding ICI. Target populations include currently untreatable cancer patients or those who receive treatment regimens with high risk of serious side effects. In addition, with the increased use of ICI in clinical practice, questions arise regarding safety and efficacy of administration of conventional vaccines, such as influenza or COVID-19 vaccines, during active ICI treatment. This review discusses the main principles of prophylactic and therapeutic cancer vaccines, the potential impact on combining therapeutic cancer vaccines with ICI, and briefly summarizes the current knowledge of safety and effectiveness of influenza and COVID-19 vaccines in ICI-treated patients.
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12
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Choudhury SM, Ma X, Dang W, Li Y, Zheng H. Recent Development of Ruminant Vaccine Against Viral Diseases. Front Vet Sci 2021; 8:697194. [PMID: 34805327 PMCID: PMC8595237 DOI: 10.3389/fvets.2021.697194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/04/2021] [Indexed: 01/21/2023] Open
Abstract
Pathogens of viral origin produce a large variety of infectious diseases in livestock. It is essential to establish the best practices in animal care and an efficient way to stop and prevent infectious diseases that impact animal husbandry. So far, the greatest way to combat the disease is to adopt a vaccine policy. In the fight against infectious diseases, vaccines are very popular. Vaccination's fundamental concept is to utilize particular antigens, either endogenous or exogenous to induce immunity against the antigens or cells. In light of how past emerging and reemerging infectious diseases and pandemics were handled, examining the vaccination methods and technological platforms utilized for the animals may provide some useful insights. New vaccine manufacturing methods have evolved because of developments in technology and medicine and our broad knowledge of immunology, molecular biology, microbiology, and biochemistry, among other basic science disciplines. Genetic engineering, proteomics, and other advanced technologies have aided in implementing novel vaccine theories, resulting in the discovery of new ruminant vaccines and the improvement of existing ones. Subunit vaccines, recombinant vaccines, DNA vaccines, and vectored vaccines are increasingly gaining scientific and public attention as the next generation of vaccines and are being seen as viable replacements to conventional vaccines. The current review looks at the effects and implications of recent ruminant vaccine advances in terms of evolving microbiology, immunology, and molecular biology.
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Affiliation(s)
- Sk Mohiuddin Choudhury
- State Key Laboratory of Veterinary Etiological Biology, National Foot and Mouth Disease Reference Laboratory, Key Laboratory of Animal Virology of Ministry of Agriculture, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - XuSheng Ma
- State Key Laboratory of Veterinary Etiological Biology, National Foot and Mouth Disease Reference Laboratory, Key Laboratory of Animal Virology of Ministry of Agriculture, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Wen Dang
- State Key Laboratory of Veterinary Etiological Biology, National Foot and Mouth Disease Reference Laboratory, Key Laboratory of Animal Virology of Ministry of Agriculture, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - YuanYuan Li
- Gansu Agricultural University, Lanzhou, China
| | - HaiXue Zheng
- State Key Laboratory of Veterinary Etiological Biology, National Foot and Mouth Disease Reference Laboratory, Key Laboratory of Animal Virology of Ministry of Agriculture, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
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13
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Seasonal influenza vaccination among cancer patients during the COVID-19 pandemic in Poland. Contemp Oncol (Pozn) 2021; 25:168-173. [PMID: 34729036 PMCID: PMC8547183 DOI: 10.5114/wo.2021.109417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction In the era of the COVID-19 pandemic overlapping with the influenza season, the number of infections with the abovementioned viruses may result in overload in the healthcare system, difficulties in the diagnosis of respiratory diseases, poorer access to appropriate therapy, and increased mortality. Aim of the study The aim of this study was to analyze the influence of the COVID-19 pandemic on the decision to be vaccinated against seasonal influenza in cancer patients. Material and methods An anonymous survey prepared by the authors was made available to patients at the Chemotherapy Department at the Greater Poland Cancer Center. The survey covered 236 respondents, both female (67.4%, n = 159) and male (32.6%, n =77). A 0–10 point numerical scale was used to assess the fear of coronavirus infection and the influenza. Data were collected from June 8 to September 30, 2020. The survey included 25 questions. The patients were informed by physicians about the voluntary and anonymous nature of the survey, to which they gave their oral consent. IBM SPSS Statistics 26 was used for the analysis. Results The vast majority of patients (69.5%, n = 164) have never been vaccinated against influenza and 30.5% (n = 72) have been vaccinated at least once in the past. In the face of the COVID-19 pandemic, almost ¼ of the patients (24.6%, n = 58) stated that they wanted to be vaccinated against influenza. Only 33.5% (n = 79) of the respondents believed that the influenza vaccine was effective. Conclusions Action is needed to increase the percentage of cancer patients who will be regularly vaccinated against the influenza. The COVID-19 pandemic may raise the interest of cancer patients in influenza vaccination.
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Mukherji R, Marshall JL. Lessons Learned in Managing Patients with Colorectal Cancer During the COVID-19 Pandemic. Curr Treat Options Oncol 2021; 22:93. [PMID: 34424418 PMCID: PMC8381863 DOI: 10.1007/s11864-021-00888-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT The COVID-19 pandemic forced us to rapidly and dramatically shift our medical priorities and decision making. With little literature or experience to rely on, the initial priority was to minimize patient exposure to the hospital and to others. It remains unclear whether cancer patients are at higher risk of infection or serious complications, or if it is our traditional therapies that place them to be at higher risk. By far, the greatest negative impact was on screening. Routine colonoscopies were considered elective, and as a result, delays in diagnosis will be felt for years to come. The most positive changes were the incorporation of tele-visits, increased use of oral therapies, alterations in treatment schedules of both chemotherapy and radiation, and an increased emphasis on neoadjuvant therapy. These too will be felt for years to come. The colorectal cancer medical community has responded collaboratively and effectively to maintain treatment and to optimize outcomes for our patients during the COVID-19 pandemic.
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Affiliation(s)
- Reetu Mukherji
- Department of Hematology and Oncology, Georgetown University Medical Center, Washington, DC, 20057, USA
| | - John L Marshall
- Department of Hematology and Oncology, Georgetown University Medical Center, Washington, DC, 20057, USA.
- Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road, Washington, DC, 20057, USA.
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15
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So ACP, McGrath H, Ting J, Srikandarajah K, Germanou S, Moss C, Russell B, Monroy-Iglesias M, Dolly S, Irshad S, Van Hemelrijck M, Enting D. COVID-19 Vaccine Safety in Cancer Patients: A Single Centre Experience. Cancers (Basel) 2021; 13:3573. [PMID: 34298785 PMCID: PMC8304256 DOI: 10.3390/cancers13143573] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 12/23/2022] Open
Abstract
Emergency approval of vaccines against COVID-19 provides an opportunity for us to return to pre-pandemic oncology care. However, safety data in cancer patients is lacking due to their exclusion from most phase III trials. We included all patients aged less than 65 years who received a COVID-19 vaccine from 8 December 2020 to 28 February 2021 at our London tertiary oncology centre. Solicited and unsolicited vaccine-related adverse events (VRAEs) were collected using telephone or face-to-face consultation. Within the study period, 373 patients received their first dose of vaccine: Pfizer/BioNTech (75.1%), Oxford/AstraZeneca (23.6%), Moderna (0.3%), and unknown (1.1%). Median follow-up was 25 days (5-85). Median age was 56 years (19-65). Of the patients, 94.9% had a solid malignancy and 76.7% were stage 3-4. The most common cancers were breast (34.0%), lung (13.4%), colorectal (10.2%), and gynaecological (10.2%). Of the patients, 88.5% were receiving anti-cancer treatment (36.2% parenteral chemotherapy and 15.3% immunotherapy), 76.1% developed any grade VRAE of which 2.1% were grade 3. No grade 4/5 or anaphylaxis were observed. The most common VRAEs within 7 days post-vaccination were sore arm (61.7%), fatigue (18.2%), and headaches (12.1%). Most common grade 3 VRAE was fatigue (1.1%). Our results demonstrate that COVID-19 vaccines in oncology patients have mild reactogenicity.
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Affiliation(s)
- Alfred Chung Pui So
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Harriet McGrath
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Jonathan Ting
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Krishnie Srikandarajah
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Styliani Germanou
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Charlotte Moss
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Beth Russell
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Maria Monroy-Iglesias
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Saoirse Dolly
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Sheeba Irshad
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.M.); (B.R.); (M.M.-I.); (M.V.H.)
| | - Deborah Enting
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK; (H.M.); (J.T.); (K.S.); (S.G.); (S.D.); (S.I.)
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16
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Indini A, Tourlaki A, Grossi F, Gambini D, Brambilla L. COVID-19 Vaccination in Patients with Classic Kaposi's Sarcoma. Vaccines (Basel) 2021; 9:632. [PMID: 34200648 PMCID: PMC8228949 DOI: 10.3390/vaccines9060632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 01/10/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) has represented an overwhelming challenge for worldwide health systems. Patients with cancer are considered at higher risk for severe COVID-19 and increased mortality in case of infection. Although data on the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in patients with cancer are limited, there is enough evidence supporting anti-infective vaccination in general in patients with active cancer, or with history of previous malignancy. Subjects with classic Kaposi's sarcoma (KS) represent a small subset of cancer patients, which should be considered at heightened risk for infections due to several factors including age, and impaired immune function status. Several cases of human herpesviruses reactivation among critically ill COVID-19 patients have been described. Moreover, in case of severe infection and treatment with immunomodulating agents, patients with CKS are exposed at significant risk of viral reactivation and disease progression. Considering the baseline clinical risk factors of patients with CKS, and the complex interplay of the two viral agents, SARS-CoV-2 vaccination should be strongly recommended among patients with KS. KS represents an interesting field to study the interactions among chronic viral infections, SARS-CoV-2 and the host's immune system. Prospective observational studies are needed to provide more insights on vaccine activity and safety among patients with cancer, optimal vaccine schedules, potential interactions with antineoplastic therapies, and other comorbidities including chronic viral infections.
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Affiliation(s)
- Alice Indini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Athanasia Tourlaki
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.T.); (L.B.)
| | - Francesco Grossi
- Medical Oncology Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, 21100 Varese, Italy;
| | - Donatella Gambini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Lucia Brambilla
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.T.); (L.B.)
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Sandor AM, Sturdivant MS, Ting JPY. Influenza Virus and SARS-CoV-2 Vaccines. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2021; 206:2509-2520. [PMID: 34021048 PMCID: PMC8722349 DOI: 10.4049/jimmunol.2001287] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/29/2021] [Indexed: 12/13/2022]
Abstract
Seasonal influenza and the current COVID-19 pandemic represent looming global health challenges. Efficacious and safe vaccines remain the frontline tools for mitigating both influenza virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced diseases. This review will discuss the existing strategies for influenza vaccines and how these strategies have informed SARS-CoV-2 vaccines. It will also discuss new vaccine platforms and potential challenges for both viruses.
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Affiliation(s)
- Adam M Sandor
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC; and
| | - Michael S Sturdivant
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Biological and Biomedical Sciences Program, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jenny P Y Ting
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC;
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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18
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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 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.
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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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19
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Dwipayana IDAP, Sutarini IDAAD. Covid-19 Vaccination Options for Immunosuppressed Cancer Patients. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i12021.1-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Currently, many COVID-19 vaccine candidates are being developed to end the pandemic; however, immunosuppressed cancer patients have been excluded from the participating criteria. It is important that they are able to examine their options for achieving immunity against COVID-19. Purpose: This review aims to discuss the available options that can be taken to vaccinate immunosuppressed cancer patients when no vaccine is being developed for their safety. Method: A literature study was conducted using Google Scholar, DOAJ, and GARUDA Library on November 2, 2020, focusing on articles examining vaccination guidelines for immunosuppressed cancer patients. Results: The search found 200 articles, which were curated to obtain 13 articles that satisfied all inclusion criteria. These consist of four guidelines, five reviews, and four research articles. Based on the literature, immunosuppressed cancer patients have the option to use the vaccines currently under development, with precautions set for live attenuated and potentially infectious vaccines. Vaccination timing also needs to be adjusted so as to fall at a certain time before or after the immunosuppressive condition. Moreover, a more complete COVID-19 immunity can be achieved through a synergy between individual vaccination and the construction of herd immunity. Conclusion: Most of the vaccines currently under development may be safe for cancer patients, being mindful of several considerations. Here, herd immunity can serve as a complement to individual immunity.
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20
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McGinnis JM, Jones R, Hillis C, Kokus H, Thomas H, Thomas J, Alyafi M, Bernard L, Eiriksson LR, Elit LM, Hirte H, Jimenez W, Reade CJ, Kumar Tyagi N, Helpman L. A pneumococcal pneumonia and influenza vaccination quality improvement program for women receiving chemotherapy for gynecologic cancers at a major tertiary cancer Centre. Gynecol Oncol 2021; 161:236-243. [PMID: 33526258 DOI: 10.1016/j.ygyno.2021.01.014] [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: 11/25/2020] [Accepted: 01/13/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE International guidelines recommend pneumococcal pneumonia and influenza vaccination for all patients with solid organ malignancies prior to initiating chemotherapy. Baseline vaccination rates (March 2019) for pneumococcal pneumonia and influenza at our tertiary cancer centre were 8% and 40%, respectively. The aim of this study was to increase the number of gynecologic chemotherapy patients receiving pneumococcal and influenza vaccinations to 80% by March 2020. METHODS We performed an interrupted time series study using structured quality improvement methodology. Three interventions were introduced to address vaccination barriers: an in-house vaccination program, a staff education campaign, and a patient care bundle (pre-printed prescription, information brochure, vaccine record booklet). Process and outcome data were collected by patient survey and pharmacy audit and analyzed on statistical process control charts. RESULTS We identified 195 eligible patients. Pneumococcal and influenza vaccination rates rose significantly from 5% to a monthly mean of 61% and from 36% to a monthly mean of 67%, respectively. The 80% target was reached for both vaccines during one or more months of study. The in-house vaccination and staff education programs were major contributors to the improvement, whereas the information brochure and record booklet were minor contributors. CONCLUSIONS Three interventions to promote pneumococcal and influenza vaccination among chemotherapy patients resulted in significantly improved vaccination rates. Lessons learned about promoting vaccine uptake may be generalizable to different populations and vaccine types. In response to the global COVID-19 pandemic, initiatives to expand the program to all chemotherapy patients at our centre are underway.
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Affiliation(s)
- Justin M McGinnis
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada.
| | - Rebecca Jones
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christopher Hillis
- Department of Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Heather Kokus
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Heidi Thomas
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jason Thomas
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mohammad Alyafi
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Laurence Bernard
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Lua R Eiriksson
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Lorraine M Elit
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Hal Hirte
- Department of Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Waldo Jimenez
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Clare J Reade
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Nidhi Kumar Tyagi
- Department of Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
| | - Limor Helpman
- Division of Gynecologic Oncology, McMaster University, Juravinski Hospital & Cancer Centre, Hamilton, ON, Canada
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21
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Pimple S, Mishra G. Need more evidence for establishing standard vaccination practices among patients with cancer. CANCER RESEARCH, STATISTICS, AND TREATMENT 2021. [DOI: 10.4103/crst.crst_280_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Arreola-Rodríguez A, Negrete-Najar JP, Soto-Perez-de-Celis E, Navarrete-Reyes AP. Vaccination in older adults with cancer and older cancer survivors. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vaccination is one of the most effective means of preventing infections and should be widely promoted, especially in immunocompromised patients, such as older adults with cancer and older cancer survivors. However, adherence is low, which is due in part to lack of awareness, fear of side effects, hesitancy to vaccinate and rejection of vaccination, especially for COVID-19. The objective of this paper is to clarify current indications for vaccination in these populations and underscore its importance.
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23
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McMasters M, Blair BM, Lazarus HM, Alonso CD. Casting a wider protective net: Anti-infective vaccine strategies for patients with hematologic malignancy and blood and marrow transplantation. Blood Rev 2020; 47:100779. [PMID: 33223246 DOI: 10.1016/j.blre.2020.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
Patients who have hematologic malignancies are at high risk for infections but vaccinations may be effective prophylaxis. The increased infection risk derives from immune defects secondary to malignancy, the classic example being CLL, and chemotherapies and immunotherapy used to treat the malignancies. Therapy of hematologic malignancies is being revolutionized by introduction of novel targeted agents and immunomodulatory medications, improving the survival of patients. At the same time those agents uniquely change the infection risk and response to immunizations. This review will summarize current vaccine recommendations for patients with hematologic malignancies including patients who undergo hematopoietic cell transplant.
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Affiliation(s)
- Malgorzata McMasters
- Division of Hematologic Malignancy and Bone Marrow Transplant, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - Barbra M Blair
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Carolyn D Alonso
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA.
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24
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Casciani F, Trudeau MT, Vollmer CM. Perioperative Immunization for Splenectomy and the Surgeon's Responsibility: A Review. JAMA Surg 2020; 155:1068-1077. [PMID: 32936229 DOI: 10.1001/jamasurg.2020.1463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Patients who have had splenectomy have a lifelong risk of overwhelming postsplenectomy infection (OPSI), a condition associated with high mortality rates. Surgeons must be aware of the rationale of vaccination in the case of splenectomy, to provide appropriate immunization in the perioperative time. Observations English-language articles published from January 1, 1990, to December 31, 2019, were retrieved from MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases. Randomized clinical trials as well as systematic reviews and observational studies were considered. Asplenia yields an impairment of both innate and adaptive immunity, thus increasing the risk of severe encapsulated bacterial infections. Current epidemiology of OPSI ranges from 0.1% to 8.5% but is hard to ascertain because of ongoing shifts in patients' baseline conditions and vaccine penetration. Despite the lack of randomized clinical trials, immunization appears to be effective in reducing OPSI incidence. Unfortunately, vaccination coverage is still suboptimal, with a great variability in vaccination rates being reported across institutions and time frames. Notably, current guidelines do not advocate any particular health care qualification responsible for vaccine prescription or administration. Given the dearth of high-level basic science or clinical evidence, the optimal vaccination timing and the need for booster doses are not yet well established. Although almost all guidelines indicate to not administer vaccines within 14 days before and after surgery, most data suggest that immunization might be effective even in the immediate perioperative time, thus placing the surgeon in a primary position for vaccine delivery. Furthermore, revaccination schedules are the target of ongoing debates, since a vaccine-driven hyporesponsiveness has been postulated. Conclusions and Relevance In patients who have undergone splenectomy, OPSI might be effectively prevented by proper immunization. Surgeons have the primary responsibility for achieving adequate, initial immunization in the setting of both planned and urgent splenectomy.
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Affiliation(s)
- Fabio Casciani
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Maxwell T Trudeau
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Charles M Vollmer
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
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25
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Indini A, Rijavec E, Ghidini M, Bareggi C, Cattaneo M, Galassi B, Gambini D, Grossi F. Coronavirus infection and immune system: An insight of COVID-19 in cancer patients. Crit Rev Oncol Hematol 2020; 153:103059. [PMID: 32711241 PMCID: PMC7347348 DOI: 10.1016/j.critrevonc.2020.103059] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus respiratory illness (COVID-19) is a public health emergency of global concern. Patients with cancer are at high risk of infections, due to an overall immunocompromised status. However, this connection is not straightforward for coronavirus (CoV) infection, in which the host immune response is the main driver of tissue damage. We performed a thorough review of data on CoV pathogenesis and morbidity rate in cancer patients, through the analysis of the previous CoV pandemics. Considering the interaction between CoV and the host immune system, cancer patients receiving immunotherapy might be more at risk for an aberrant immune response in case of infection, and might therefore deserve additional precautions. The limited available data do not allow us to provide practical indications for the management of cancer patients in this critical situation. Efforts should be made to prospectively collect data, to identify effective interventions to guide treatment decision.
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Affiliation(s)
- Alice Indini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Erika Rijavec
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Claudia Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Monica Cattaneo
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Barbara Galassi
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Donatella Gambini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
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26
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Pozdeyev N, Patel A, Pottinger PS, Leu M, Payne TH. Adherence to Recommended Post-Splenectomy Immunizations to Reduce the Risk of Sepsis: The University of Washington Experience. Am J Med Qual 2020; 35:405-410. [DOI: 10.1177/1062860619897289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Immunizations against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b are recommended for patients undergoing splenectomy to decrease the risk of developing overwhelming infections. The authors sought to determine adherence to these recommendations by providers at UW Medicine. Regional immunization records for patients who underwent splenectomy between October 2015 and January 2019 were analyzed to measure compliance with immunization guidelines from the US Centers for Disease Control and Prevention (CDC). Among 253 patients who underwent splenectomy, 38 (15%) received all 7 immunizations against S pneumoniae, N meningitidis, and H influenzae type b recommended by the CDC; 95% of patients received at least 1 pneumococcal vaccine; 26% percent of patients did not receive MenB-4C vaccine. Many patients (3% to 10%) received redundant immunizations not in accordance with CDC recommendations. Development of state and national immunization registries and systems to improve adherence with post-splenectomy immunization guidelines may reduce risk for life-threatening infections.
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27
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Monier A, Puyade M, Hernanz MPG, Bouchaert P, Leleu X, Tourani JM, Roblot F, Rammaert B. Observational study of vaccination in cancer patients: How can vaccine coverage be improved? Med Mal Infect 2019; 50:263-268. [PMID: 31848105 DOI: 10.1016/j.medmal.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 03/04/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chemotherapy increases the risk of infections, often severe, and some of them are vaccine-preventable infections. We aimed to assess vaccination coverage and associated factors in oncology and hematology patients. METHODS Consecutive adult patients followed in a French university hospital for hematological malignancy or solid cancer voluntarily completed an anonymous questionnaire in September and October 2016. It included questions on underlying disease, chemotherapy, flu, and pneumococcal vaccination uptakes, and attitudes toward vaccination. Factors associated with vaccination uptake were assessed by multivariate logistic regression. RESULTS The response rate was 41.9% (N=671) among 1,600 questionnaires distributed; 232 patients had underlying hematological malignancy and 439 had solid cancer. Half of the patients were aged over 65 years. Chemotherapy was ongoing or discontinued for less than one year in 74.7% of patients. In patients aged <65 years undergoing chemotherapy, flu vaccination rate was 19.9% whereas patients aged >65 years had coverage of 47%. Pneumococcal vaccine uptake was 7.3%. However, 64.7% of patients were favorable to vaccination. Vaccine uptake was associated with age >65 years (OR 4.5 [2.9-7.0]), information about vaccination delivered by the family physician (OR 12.9 [5.5-30.1]), follow-up in hematology unit (OR 2.0 [1.3-3.1]), and positive opinion about vaccination (OR 2.0 [1.3-3.1]). CONCLUSION Despite specific recommendations regarding immunocompromised patients, anti-pneumococcal and flu vaccinations were rarely conducted, even in elderly patients. Targeted information campaigns to family physicians, oncologists, and patients should be implemented to improve vaccine coverage in patients with underlying malignancies.
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Affiliation(s)
- A Monier
- Faculté de médecine et pharmacie, University of Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France
| | - M Puyade
- Service de médecine interne, CHU de Poitiers, Poitiers, France
| | - M P Gallego Hernanz
- Service d'hématologie et thérapie cellulaire, CHU de Poitiers, Poitiers, France
| | - P Bouchaert
- Service d'oncologie médicale, CHU de Poitiers, Poitiers, France
| | - X Leleu
- Service d'hématologie et thérapie cellulaire, CHU de Poitiers, Poitiers, France; Inserm CIC 1402, Poitiers, France
| | - J M Tourani
- Service d'oncologie médicale, CHU de Poitiers, Poitiers, France
| | - F Roblot
- Faculté de médecine et pharmacie, University of Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France
| | - B Rammaert
- Faculté de médecine et pharmacie, University of Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France.
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Gwynn ME, DeRemer DL, Saunders KM, Parikh J, Bollag RJ, Clemmons AB. Immune-mediated adverse events following influenza vaccine in cancer patients receiving immune checkpoint inhibitors. J Oncol Pharm Pract 2019; 26:647-654. [PMID: 31474214 DOI: 10.1177/1078155219868758] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The emergence of immune checkpoint inhibitors has transformed treatment paradigms for various malignancies. Patients with cancer are at increased risk of complications and hospitalizations from influenza; therefore, it is recommended that they receive inactivated influenza vaccination. However, efficacy and safety of inactivated influenza vaccination in patients receiving immune checkpoint inhibitors is uncertain. The objective of this prospective case series was to evaluate the incidence of immune-mediated adverse events (imAEs) following inactivated influenza vaccination in patients receiving immune checkpoint inhibitors. Changes in cytokine and chemokine levels were also evaluated. METHODS Patients receiving immune checkpoint inhibitors during the 2017-2018 influenza season were eligible for study participation. Peripheral blood samples were collected prior to administration of inactivated influenza vaccine and two post-vaccination time points. Evaluation of new or worsening imAEs occurred via patient questionnaire and review of medical records for 60 days following inactivated influenza vaccination. Baseline imAEs were evaluated from review of medical records for 60 days prior to inactivated influenza vaccination. Serum cytokines and chemokines were measured using a multiplex Luminex assay. RESULTS Twenty-four patients were enrolled in this study. Seven patients experienced any grade imAE (one patient having 2) within 60 days following inactivated influenza vaccination. The majority were Grades 1-2, including rash (n = 3), hypothyroidism, myalgia, and colitis (n = 1 each). Two patients experienced severe imAEs (grade 3 nephritis and grade 4 diabetes). No significant changes (p > 0.05) in serum cytokine or chemokine concentrations were observed. CONCLUSIONS Although small, our study suggests that inactivated influenza vaccine may be safely administered to patients receiving immune checkpoint inhibitors. The majority of imAEs following inactivated influenza vaccination were Grades 1-2 and did not require changes in immune checkpoint inhibitor therapy.
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Affiliation(s)
- Morgan E Gwynn
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - David L DeRemer
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Katherine M Saunders
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.,Georgia Cancer Center, Augusta, GA, USA
| | - Jigarkumar Parikh
- Georgia Cancer Center, Augusta, GA, USA.,Department of Hematology/Oncology, Augusta University, Augusta, GA, USA
| | - Roni J Bollag
- Department of Pathology, Augusta University, Augusta, GA, USA
| | - Amber B Clemmons
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.,Georgia Cancer Center, Augusta, GA, USA.,Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, USA
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Bianchi FP, Rizzo LA, De Nitto S, Stefanizzi P, Tafuri S. Influenza vaccination coverage among splenectomized patients: an Italian study on the role of active recall in the vaccination compliance. Hum Vaccin Immunother 2019; 15:2644-2649. [PMID: 31063019 PMCID: PMC6930075 DOI: 10.1080/21645515.2019.1599678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/04/2019] [Accepted: 03/14/2019] [Indexed: 11/07/2022] Open
Abstract
Patients with anatomical or functional hypo-/a-splenia have a 10- to 50-fold higher risk of developing severe infectious diseases than does the general population. Thus, it is recommended to adhere to a specific vaccination schedule, including receiving influenza vaccine. During 2014, Bari Policlinico General Hospital approved a specific protocol to ensure that vaccines are actively offered to all splenectomized patients during their hospitalizations. The aim of this study is to evaluate the efficacy of this active recall protocol for performing influenza vaccination in the years following splenectomy among patients still involved in a specific vaccination program carried out by the hospital's Hygiene department. From May 2014 to October 2016, 96 patients were involved in the vaccination program of the Hygiene department. In November 2017, 46/96 (48%) of patients received a specific invitation by phone to receive the annual influenza vaccine (intervention group), while 50/96 (52%) did not receive any such invitation (control group). At the end of the 2017 influenza season, 73/96 (76%; 95%CI = 66-84%) of patients reported having received the influenza vaccine; no differences were observed in the extent of vaccine coverage between the groups (intervention group = 80% vs. control group = 72%; p = 0.33). Older age, more recent splenectomy, hemo-lymphopathy and receiving the previous years' doses of influenza vaccine are associated with receiving influenza vaccination during the 2017 season. These data indicate how effective communication at the time of the vaccine counseling results in good adherence to the vaccination program even after several years. Indeed, vaccination should be an opportunity not only limited to the administration of the vaccine but also for providing patient care.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Letizia Alessia Rizzo
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Sara De Nitto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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Ariza‐Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin 2018; 68:340-355. [PMID: 29985544 PMCID: PMC7162018 DOI: 10.3322/caac.21462] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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Alvarado AR, Udobi K, Berry S, Assmann J, McDonald T, Winfield RD. An opportunity for improvement in trauma care: 8-week booster vaccination adherence among patients after trauma splenectomy. Surgery 2017; 163:415-418. [PMID: 29203286 DOI: 10.1016/j.surg.2017.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/06/2017] [Accepted: 09/28/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Splenectomies are common after abdominal trauma, and measures must be taken to prevent infection, namely, the administration of available conjugate vaccinations against encapsulated organisms. While initial immunization is frequently completed prior to discharge, the Advisory Council on Immunization Practices recommends administration of an 8-week vaccination booster against S. pneumoniae, and compliance with this practice is unknown. We hypothesized that patients undergoing splenectomy for trauma would not routinely receive the recommended immunization and subsequent booster. METHODS All trauma admissions at our center who required splenectomy secondary to trauma between 2010 and 2015 were included. Demographic and injury data, splenectomy dates, immunization documentation, subsequent boosters received, and outcomes were collected from the medical record. RESULTS Of the 9,965 patients observed, 44 patients underwent splenectomy, with 31 patients meeting inclusion/exclusion criteria. Two patients received subsequent boosters during office or hospital visits; however, no patient received any booster within Advisory Council on Immunization Practices' recommended timeframe with median time to subsequent boosters of 22 months. Seven patients have had a subsequent admission for infection or sepsis, with one presenting with S. pneumoniae meningitis. None of the patients subsequently admitted for infection or sepsis had received boosters. CONCLUSION While trauma patients at our institution receive recommended immunizations after splenectomy prior to discharge, they receive boosters at a suboptimal rate and beyond the advised timeframe. We speculate that this phenomenon is widespread in the American trauma population. These data suggest a need for improved patient and provider education and coordination with primary care practitioners to ensure ideal defense against infectious complications.
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Affiliation(s)
- Aaron R Alvarado
- Trauma/Critical Care Division, University of Kansas Medical Center, Kansas City, KS
| | - Kahdi Udobi
- Trauma/Critical Care Division, University of Kansas Medical Center, Kansas City, KS
| | - Stepheny Berry
- Trauma/Critical Care Division, University of Kansas Medical Center, Kansas City, KS
| | - Jaynell Assmann
- Trauma/Critical Care Division, University of Kansas Medical Center, Kansas City, KS
| | - Tracy McDonald
- Trauma/Critical Care Division, University of Kansas Medical Center, Kansas City, KS
| | - Robert D Winfield
- Trauma/Critical Care Division, University of Kansas Medical Center, Kansas City, KS.
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