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Dalu D, Ridolfo AL, Ruggieri L, Cona MS, Riva A, De Francesco D, Tricella C, Fasola C, Ferrario S, Gambaro A, Lombardi Stocchetti B, Smiroldo V, Rebecchi G, Piva S, Carrozzo G, Antinori S, La Verde N. Hospital-Based Influenza and Pneumococcal Vaccination for Cancer Patients on Active Treatment and Their Family Members during the COVID-19 Pandemic in Italy: A Single-Center Experience. Vaccines (Basel) 2024; 12:642. [PMID: 38932371 PMCID: PMC11209258 DOI: 10.3390/vaccines12060642] [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: 04/27/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
In patients with cancer, tumor- and treatment-induced immunosuppression are responsible for a four-fold increase in morbidity and mortality caused by influenza and invasive Streptococcus pneumoniae infections compared to the general population. The main oncology societies strongly recommend vaccination in patients with cancer to prevent these infections. However, vaccine hesitancy is a main concern in this population. The aim of this study was to assess the feasibility of in-hospital vaccination for patients under anticancer treatment and their family members (FMs) against influenza and pneumococcal infections during the COVID-19 pandemic in order to increase vaccine coverage. This was a single-center, prospective, observational study conducted at the Department of Oncology of Luigi Sacco University Hospital (Milan, Italy) between October 2020 and April 2021. The main primary outcome was the incidence of influenza-like illness (ILI) and pneumococcal infections. The main secondary outcome was safety. A total of 341 subjects were enrolled, including 194 patients with cancer and 147 FMs. The incidence of ILI was higher among patients than among FMs (9% vs. 2.7%, OR 3.92, p = 0.02). Moreover, two subjects were diagnosed with pneumococcal pneumonia. The most frequent vaccine-related AEs were pain in the injection site (31%) and fatigue (8.7%). In conclusion, this hospital-based vaccination strategy was feasible during the COVID-19 pandemic, representing a potential model to maximize vaccine coverage during a public health emergency.
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Affiliation(s)
- Davide Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
| | - Lorenzo Ruggieri
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Maria Silvia Cona
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Agostino Riva
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, 20157 Milan, Italy
| | | | - Chiara Tricella
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Cinzia Fasola
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Sabrina Ferrario
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Anna Gambaro
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Benedetta Lombardi Stocchetti
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Valeria Smiroldo
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Gaia Rebecchi
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
| | - Sheila Piva
- Department of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy;
| | - Giorgia Carrozzo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.L.R.); (A.R.); (G.C.); (S.A.)
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBIC, University of Milan, 20157 Milan, Italy
| | - Nicla La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (D.D.); (M.S.C.); (C.T.); (C.F.); (S.F.); (A.G.); (B.L.S.); (V.S.); (G.R.); (N.L.V.)
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2
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Hendy DA, Pena ES, Ontiveros‐Padilla L, Dixon TA, Middleton DD, Williamson GL, Lukesh NR, Simpson SR, Stiepel RT, Islam MJ, Carlock MA, Ross TM, Bachelder EM, Ainslie KM. Immunogenicity of an adjuvanted broadly active influenza vaccine in immunocompromised and diverse populations. Bioeng Transl Med 2024; 9:e10634. [PMID: 38435811 PMCID: PMC10905549 DOI: 10.1002/btm2.10634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024] Open
Abstract
Influenza virus outbreaks are a major burden worldwide each year. Current vaccination strategies are inadequate due to antigenic drift/shift of the virus and the elicitation of low immune responses. The use of computationally optimized broadly reactive antigen (COBRA) hemagglutinin (HA) immunogens subvert the constantly mutating viruses; however, they are poorly immunogenic on their own. To increase the immunogenicity of subunit vaccines such as this, adjuvants can be delivered with the vaccine. For example, agonists of the stimulator of interferon genes (STING) have proven efficacy as vaccine adjuvants. However, their use in high-risk populations most vulnerable to influenza virus infection has not been closely examined. Here, we utilize a vaccine platform consisting of acetalated dextran microparticles loaded with COBRA HA and the STING agonist cyclic GMP-AMP. We examine the immunogenicity of this platform in mouse models of obesity, aging, and chemotherapy-induced immunosuppression. Further, we examine vaccine efficacy in collaborative cross mice, a genetically diverse population that mimics human genetic heterogeneity. Overall, this vaccine platform had variable efficacy in these populations supporting work to better tailor adjuvants to specific populations.
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Affiliation(s)
- Dylan A. Hendy
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Erik S. Pena
- Joint Department of Biomedical EngineeringUniversity of North Carolina at Chapel Hill and North Carolina State UniversityChapel HillNorth CarolinaUSA
| | - Luis Ontiveros‐Padilla
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Timothy A. Dixon
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Denzel D. Middleton
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Grace L. Williamson
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Nicole Rose Lukesh
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sean R. Simpson
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Rebeca T. Stiepel
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Md Jahirul Islam
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Ted M. Ross
- Florida Research and Innovation CenterPort St. LucieFloridaUSA
- Center for Vaccines and ImmunologyUniversity of GeorgiaAthensGeorgiaUSA
- Department of Infectious DiseasesUniversity of GeorgiaAthensGeorgiaUSA
| | - Eric M. Bachelder
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kristy M. Ainslie
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Joint Department of Biomedical EngineeringUniversity of North Carolina at Chapel Hill and North Carolina State UniversityChapel HillNorth CarolinaUSA
- Department of Microbiology and Immunology, UNC School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
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3
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Mubarak S, Alsmadi O, Tbakhi A, Ata OA, Hassan A, AlGhawrie H. Impact of the SARS-CoV-2 pandemic on the overall respiratory viruses' transmission in a cancer care setting. Immun Inflamm Dis 2023; 11:e1073. [PMID: 38018583 PMCID: PMC10664391 DOI: 10.1002/iid3.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/27/2023] [Accepted: 10/25/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE The emergence of the COVID-19 pandemic raised questions about the interaction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. The objective of this study is to validate the impact of the SARS-CoV-2 pandemic and its interventional measures on the respiratory viruses' transmission/infection rates. METHODS A retrospective chart review was conducted for cancer patients who underwent laboratory-confirmed respiratory virus polymerase chain reaction (PCR) testing from January 2018 to June 2022. COVID-19 PCR tests from March 2020 to June 2022 were also included. Joinpoint regression analysis was applied to evaluate trends in respiratory virus rates. Statistical analysis was performed using Statistical Package for Social Science software. RESULTS A total of 6298 respiratory virus PCRs and 40,000 COVID-19 PCRs were performed. Data showed a significant decrease in respiratory viruses' positive cases, total respiratory tests, and respiratory viruses' activity during the pandemic period compared with the pre-pandemic period (p = .0209, .026, and .028, respectively). The joinpoint regression analysis showed a significant decrease of 13.85% in the tested positive cases of respiratory viruses between the years 2018 and 2022. Monthly, the analysis indicated a significant decrease in the positive cases by 13.46% from December 2019 to May 2021. Weekly analysis following lockdown initiation showed a reduction in respiratory virus cases. CONCLUSION This study provides valuable insights into the interplay between COVID-19 and other respiratory viruses, suggesting that the measures taken for COVID-19 were effective in reducing the spread of viral respiratory infections, aiding future infection control strategies to protect vulnerable populations, including cancer patients, from seasonal respiratory infections.
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Affiliation(s)
- Sawsan Mubarak
- Infection Control ProgramKing Hussein Cancer CenterAmmanJordan
| | - Osama Alsmadi
- Department of Cell Therapy & Applied GenomicsKing Hussein Cancer CenterAmmanJordan
| | - Abdelghani Tbakhi
- Department of Cell Therapy & Applied GenomicsKing Hussein Cancer CenterAmmanJordan
| | - Osama Abu Ata
- Department of Internal MedicineKing Hussein Cancer CenterAmmanJordan
| | - Ala'a Hassan
- Department of Cell Therapy & Applied GenomicsKing Hussein Cancer CenterAmmanJordan
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4
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Ivanov N, Krastev B, Miteva DG, Batselova H, Alexandrova R, Velikova T. Effectiveness and safety of COVID-19 vaccines in patients with oncological diseases: State-of-the-art. World J Clin Oncol 2023; 14:343-356. [PMID: 37771630 PMCID: PMC10523189 DOI: 10.5306/wjco.v14.i9.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/06/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023] Open
Abstract
Although the coronavirus disease 2019 (COVID-19) pandemic was declared to be no longer “a public health emergency of international concern” with its wide range of clinical manifestations and late complications, severe acute respiratory syndrome coronavirus 2 infection proved to be a serious threat, especially to the elderly and patients with comorbidities. Patients with oncologic diseases are vulnerable to severe infection and death. Indeed, patients with oncohematological diseases have a higher risk of severe COVID-19 and impaired post-vaccination immunity. Unfortunately, cancer patients are usually excluded from vaccine trials and investigations of post-vaccinal immune responses and the effectiveness of the vaccines. We aimed to elucidate to what extent patients with cancer are at increased risk of developing severe COVID-19 and what is their overall case fatality rate. We also present the current concept and evidence on the effectiveness and safety of COVID-19 vaccines, including boosters, in oncology patients. In conclusion, despite the considerably higher mortality in the cancer patient group than the general population, countries with high vaccination rates have demonstrated trends toward improved survival of cancer patients early and late in the pandemic.
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Affiliation(s)
- Nedelcho Ivanov
- Department of Clinical Immunology with Stem Cell Bank, University Hospital Alexanrovska, Sofia 1431, Bulgaria
| | - Boris Krastev
- Medical Center Nadezhda, Medical Center Nadezhda, Sofia 1407, Bulgaria
| | | | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University, Plovdiv, University Hospital St. George, Plovdiv 6000, Bulgaria
| | - Radostina Alexandrova
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia 1000, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
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5
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Low ZY, Wong KH, Wen Yip AJ, Choo WS. The convergent evolution of influenza A virus: Implications, therapeutic strategies and what we need to know. CURRENT RESEARCH IN MICROBIAL SCIENCES 2023; 5:100202. [PMID: 37700857 PMCID: PMC10493511 DOI: 10.1016/j.crmicr.2023.100202] [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: 09/14/2023] Open
Abstract
Influenza virus infection, more commonly known as the 'cold flu', is an etiological agent that gives rise to recurrent annual flu and many pandemics. Dated back to the 1918- Spanish Flu, the influenza infection has caused the loss of many human lives and significantly impacted the economy and daily lives. Influenza virus can be classified into four different genera: influenza A-D, with the former two, influenza A and B, relevant to humans. The capacity of antigenic drift and shift in Influenza A has given rise to many novel variants, rendering vaccines and antiviral therapies useless. In light of the emergence of a novel betacoronavirus, the SARS-CoV-2, unravelling the underpinning mechanisms that support the recurrent influenza epidemics and pandemics is essential. Given the symptom similarities between influenza and covid infection, it is crucial to reiterate what we know about the influenza infection. This review aims to describe the origin and evolution of influenza infection. Apart from that, the risk factors entail the implication of co-infections, especially regarding the COVID-19 pandemic is further discussed. In addition, antiviral strategies, including the potential of drug repositioning, are discussed in this context. The diagnostic approach is also critically discussed in an effort to understand better and prepare for upcoming variants and potential influenza pandemics in the future. Lastly, this review encapsulates the challenges in curbing the influenza spread and provides insights for future directions in influenza management.
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Affiliation(s)
- Zheng Yao Low
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ka Heng Wong
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ashley Jia Wen Yip
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Wee Sim Choo
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
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6
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Jeong NY, Kim CJ, Park SM, Kim YJ, Lee J, Choi NK. Active surveillance for adverse events of influenza vaccine safety in elderly cancer patients using self-controlled tree-temporal scan statistic analysis. Sci Rep 2023; 13:13346. [PMID: 37587127 PMCID: PMC10432531 DOI: 10.1038/s41598-023-40091-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
Both cancer patients and the elderly are at high risk of developing flu complications, so influenza vaccination is recommended. We aimed to evaluate potential adverse events (AEs) following influenza vaccination in elderly cancer patients using the self-controlled tree-temporal scan statistic method. From a large linked database of Korea Disease Control and Prevention Agency vaccination data and the National Health Insurance Service claims data, we identified cancer patients aged over 65 who received flu vaccines during the 2016/2017 and 2017/2018 seasons. We included all the outcomes occurring on 1-84 days post-vaccination and evaluated all temporal risk windows, which started 1-28 days and ended 2-42 days. Patients who were diagnosed with the same disease during a year prior to vaccination were excluded. We used the hierarchy of ICD-10 to identify statistically significant clustering. This study included 431,276 doses of flu vaccine. We detected signals for 1 set: other dorsopathies on 1-15 days (attributable risk 16.5 per 100,000, P = 0.017). Dorsopathy is a known AE of influenza vaccine. No statistically significant clusters were found when analyzed by flu season. Therefore, influenza vaccination is more recommended for elderly patients with cancer and weakened immune systems.
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Affiliation(s)
- Na-Young Jeong
- Department of Health Convergence, College of Science & Industry Convergence, Ewha Womans University, Seoul, Korea
| | - Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul National University College of Medicine, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science & Industry Convergence, Ewha Womans University, Seoul, Korea.
- Graduate School of Industrial Pharmaceutical Science, College of Pharmacy, Ewha Womans University, Seoul, Korea.
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7
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Felip E, Pradenas E, Romeo M, Marfil S, Trinité B, Urrea V, Hernández A, Ballana E, Cucurull M, Mateu L, Massanella M, Clotet B, Morán T, Blanco J. Impact of chemotherapy and/or immunotherapy on neutralizing antibody response to SARS-CoV-2 mRNA-1237 vaccine in patients with solid tumors. Mol Oncol 2023; 17:686-694. [PMID: 36495129 PMCID: PMC9877816 DOI: 10.1002/1878-0261.13359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/02/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with solid tumors have been a risk group since the beginning of the SARS-CoV-2 pandemic due to more significant complications, hospitalizations or deaths. The immunosuppressive state of cancer treatments or the tumor itself could influence the development of post-vaccination antibodies. This study prospectively analyzed 89 patients under chemotherapy and/or immunotherapy, who received two doses of the mRNA-1237 vaccine, and were compared with a group of 26 non-cancer individuals. Information on adverse events and neutralizing antibodies against the ancestral strain of SARS-CoV-2 (WH1) have been analyzed. Local reactions accounted for 65%, while systemic reactions accounted for 46% of oncologic individuals/cancer patients. Regarding the response to vaccination, 6.7% of cancer patients developed low neutralizing antibody levels. Lower levels of neutralizing antibodies between cancer and non-cancer groups were significant in individuals without previous SARS-CoV-2 infection, but not in previously infected individuals. We also observed that patients receiving chemotherapy or chemoimmunotherapy have significantly lower levels of neutralizing antibodies than non-cancer individuals. In conclusion, our study confirms the importance of prioritizing cancer patients receiving anticancer treatment in SARS-CoV-2 vaccination programs.
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Affiliation(s)
- Eudald Felip
- IrsiCaixa AIDS Research InstituteBadalonaSpain
- Medical Oncology Department, Catalan Institute of Oncology – BadalonaBadalona Applied Research Group in Oncology (B‐ARGO)Spain
| | | | - Margarita Romeo
- Medical Oncology Department, Catalan Institute of Oncology – BadalonaBadalona Applied Research Group in Oncology (B‐ARGO)Spain
| | | | | | | | - Ainhoa Hernández
- Medical Oncology Department, Catalan Institute of Oncology – BadalonaBadalona Applied Research Group in Oncology (B‐ARGO)Spain
| | - Ester Ballana
- IrsiCaixa AIDS Research InstituteBadalonaSpain
- Germans Trias i Pujol Research Institute (IGTP)BadalonaSpain
- CIBER Infectious Diseases (CIBERINFEC), Carlos III Institute of Health (ISCIII)MadridSpain
| | - Marc Cucurull
- Medical Oncology Department, Catalan Institute of Oncology – BadalonaBadalona Applied Research Group in Oncology (B‐ARGO)Spain
| | - Lourdes Mateu
- Infectious Diseases DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
- Fundació Lluita contra les InfeccionsHospital Universitari Germans Trias i PujolBadalonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Carlos III Institute of Health (ISCIII)MadridSpain
- University of Vic–Central University of Catalonia (UVic‐UCC)Spain
| | - Marta Massanella
- IrsiCaixa AIDS Research InstituteBadalonaSpain
- CIBER Infectious Diseases (CIBERINFEC), Carlos III Institute of Health (ISCIII)MadridSpain
- University of Vic–Central University of Catalonia (UVic‐UCC)Spain
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research InstituteBadalonaSpain
- CIBER Infectious Diseases (CIBERINFEC), Carlos III Institute of Health (ISCIII)MadridSpain
- University of Vic–Central University of Catalonia (UVic‐UCC)Spain
| | - Teresa Morán
- Medical Oncology Department, Catalan Institute of Oncology – BadalonaBadalona Applied Research Group in Oncology (B‐ARGO)Spain
| | - Julià Blanco
- IrsiCaixa AIDS Research InstituteBadalonaSpain
- Germans Trias i Pujol Research Institute (IGTP)BadalonaSpain
- CIBER Infectious Diseases (CIBERINFEC), Carlos III Institute of Health (ISCIII)MadridSpain
- University of Vic–Central University of Catalonia (UVic‐UCC)Spain
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8
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Li H, Cai D, Jiang D, Li X, Liao X, Liu D, Liu Z, Zhu P, Yin G, Ming J, Peng M, Chen M, Ling N, Lan Y, Zhang D, Hu P, Ren H. Risk of waning humoral responses after inactivated or subunit recombinant SARS-CoV-2 vaccination in patients with chronic diseases: Findings from a prospective observational study in China. J Med Virol 2023; 95:e28434. [PMID: 36571260 PMCID: PMC9880742 DOI: 10.1002/jmv.28434] [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: 07/01/2022] [Revised: 10/30/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
Heterogeneity of antibody responses has been reported in SARS-CoV-2 vaccination recipients with underlying diseases. We investigated the impact of the presence of comorbidities on the humoral response to SARS-CoV-2 vaccination in patients with chronic disease (PWCD) and assessed the effect of the number of comorbidities on the humoral response to vaccination. In this study, neutralizing antibodies (NAbs) and IgG antibodies against the receptor-binding domain (RBD-IgG) were monitored following a full-course vaccination. In total, 1400 PWCD (82.7%, inactivated vaccines; 17.3%, subunit recombinant vaccine) and 245 healthy controls (65.7% inactivated vaccines, 34.3% subunit recombinant vaccine) vaccinated with inactivated or subunit recombinant SARS-CoV-2 vaccines, were included. The seroconversion and antibody levels of the NAbs and RBD-IgG were different in the PWCD group compared with those in the control group. Chronic hepatitis B (odds ratio [OR]: 0.65; 95% confidence interval [CI]: 0.46-0.93), cancer (OR: 0.65; 95% CI: 0.42-0.99), and diabetes (OR: 0.50; 95% CI: 0.28-0.89) were associated with lower seroconversion of NAbs. Chronic kidney disease (OR: 0.29; 95% CI: 0.11-0.76), cancer (OR: 0.38; 95% CI: 0.23-0.62), and diabetes (OR: 0.37; 95% CI: 0.20-0.69) were associated with lower seroconversion of RBD-IgG. Only the presence of autoimmune disease showed significantly lower NAbs and RBD-IgG titers. Patients with most types of chronic diseases showed similar responses to the controls, but humoral responses were still significantly associated with the presence of ≥2 coexisting diseases. Our study suggested that humoral responses following SARS-CoV-2 vaccination are impaired in patients with certain chronic diseases.
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Affiliation(s)
- Hu Li
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Dachuan Cai
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Depeng Jiang
- Department of Respiratory and Critical Care MedicineThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xingsheng Li
- Department of GerontologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiaohui Liao
- Department of NephrologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Dongfang Liu
- Department of EndocrinologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zuojin Liu
- Department of Hepatobiliary SurgeryThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Peng Zhu
- Department of Gastroenterological SurgeryThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Guobing Yin
- Department of Breast and Thyroid SurgeryThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jia Ming
- Department of Breast and Thyroid SurgeryThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Mingli Peng
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Min Chen
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Ning Ling
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Yinghua Lan
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Dazhi Zhang
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Peng Hu
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Hong Ren
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated HospitalChongqing Medical UniversityChongqingChina
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9
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Mai AS, Lee ARYB, Tay RYK, Shapiro L, Thakkar A, Halmos B, Grinshpun A, Herishanu Y, Benjamini O, Tadmor T, Shroff RT, LaFleur BJ, Bhattacharya D, Peng S, Tey J, Lee SC, Chai LYA, Soon YY, Sundar R, Lee MX. Booster doses of COVID-19 vaccines for patients with haematological and solid cancer: a systematic review and individual patient data meta-analysis. Eur J Cancer 2022; 172:65-75. [PMID: 35753213 PMCID: PMC9163022 DOI: 10.1016/j.ejca.2022.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Patients with cancer have an increased risk of severe disease and mortality from COVID-19, as the disease and antineoplastic therapy cause reduced vaccine immunogenicity. Booster doses have been proposed to enhance protection, and efficacy data are emerging from several studies. OBJECTIVE To evaluate the proportion of COVID-19 primary vaccination non-responders with cancer who seroconvert after a booster dose. METHODS PubMed, EMBASE, CENTRAL and medRxiv were searched from 1st January 2021 to 10th March 2022. Quality was assessed using the Joanna Briggs Institute Critical Appraisal checklist. RESULTS After the eligibility assessment, 22 studies were included in this systematic review and 17 for meta-analysis of seroconversion in non-responders, pooling a total of 849 patients with haematological cancer and 82 patients with solid cancer. Haematological cancer non-responders exhibited lower seroconversion at 44% (95% CI 36-53%) than solid cancer at 80% (95% CI 69-87%). Individual patient data meta-analysis found the odds of having a meaningful rise in antibody titres to be significantly associated with increased duration between the second and third dose (OR 1.02, 95% CI 1.00-1.03, P ≤ 0.05), age of patient (OR 0.960, 95% CI 0.934-0.987, P ≤ 0.05) and cancer type. With patients with haematological cancer as a reference, patients with lung cancer had 16.8 times the odds of achieving a meaningful increase in antibody titres (OR 16.8, 95% CI 2.95-318, P ≤ 0.05) and gastrointestinal cancer patients had 25.4 times the odds of achieving a meaningful increase in antibody titres (OR 25.4, 95% CI 5.26-492.21, P ≤ 0.05). CONCLUSIONS administration of a COVID-19 vaccine booster dose is effective in improving seroconversion and antibody levels. Patients with haematological cancer consistently demonstrate poorer response to booster vaccines than patients with solid cancer.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ryan Yong Kiat Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lauren Shapiro
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Astha Thakkar
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Yair Herishanu
- Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ohad Benjamini
- Hematology Division, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Rachna T Shroff
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | | | - Deepta Bhattacharya
- BIO5 Institute, University of Arizona, Tucson, AZ, USA; Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Siyu Peng
- Department of Medicine, National University Health System, Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Synthetic Biology for Clinical and Technological Innovation, National University of Singapore, Singapore; National University Cancer Institute, Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Singapore Gastric Cancer Consortium, Singapore.
| | - Matilda Xinwei Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
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10
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The Protective Effects of Influenza Vaccination in Elderly Patients with Breast Cancer in Taiwan: A Real-World Evidence-Based Study. Vaccines (Basel) 2022; 10:vaccines10071144. [PMID: 35891308 PMCID: PMC9320514 DOI: 10.3390/vaccines10071144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 02/04/2023] Open
Abstract
In elderly patients with newly diagnosed breast cancer, clarity is lacking regarding the effects of influenza vaccines, particularly on clinical outcomes. This study conducted two nationwide, population-based, and propensity score-matched cohorts to estimate and compare the protective effects of influenza vaccine in elderly women and elderly patients with breast cancer. Data were derived from the National Health Insurance Research Database and Cancer Registry Database. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. Adjusted odds ratios (aORs) were used to estimate the relative risks, and stratified analyses in the breast cancer cohort were performed to further evaluate elderly breast cancer patients undergoing a variety of adjuvant therapies. The GEE analysis showed that the aORs of death and hospitalization, including for influenza and pneumonia, respiratory diseases, respiratory failure, and heart disease, did not significantly decrease in vaccinated elderly patients with newly diagnosed breast cancer. Conversely, the aORs of all influenza-related clinical outcomes were significantly decreased in elderly women. No protective effects of influenza vaccination were found in the elderly patients with a newly diagnosed breast cancer. More studies focusing on identifying strategies to improve the real-world effectiveness of influenza vaccination to the immunocompromised are needed. Our clinical outcomes will be valuable for future public health policy establishment and shared decision making for influenza vaccine use in elderly patients with newly diagnosed breast cancer. According to our findings, regular influenza vaccine administration for elderly patients with newly diagnosed breast cancer may be reconsidered, with potential contraindications for vaccination. On the other hand, implementing the vaccination of close contacts of patients with breast cancer may be a more important strategy for enhancing protection of those fragile patients.
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11
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Bemben NM, Berg ML. Efficacy of inactivated vaccines in patients treated with immunosuppressive drug therapy. Pharmacotherapy 2022; 42:334-342. [PMID: 35146780 PMCID: PMC9088666 DOI: 10.1002/phar.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Nina M. Bemben
- Wolters Kluwer Clinical Effectiveness Chicago Illinois USA
| | - Melody L. Berg
- American Society of Health‐System Pharmacists Bethesda Maryland USA
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12
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Notarte KI, Ver AT, Velasco JV, Pastrana A, Catahay JA, Salvagno GL, Yap EPH, Martinez-Sobrido L, B Torrelles J, Lippi G, Henry BM. Effects of age, sex, serostatus, and underlying comorbidities on humoral response post-SARS-CoV-2 Pfizer-BioNTech mRNA vaccination: a systematic review. Crit Rev Clin Lab Sci 2022; 59:373-390. [PMID: 35220860 PMCID: PMC8935447 DOI: 10.1080/10408363.2022.2038539] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the advent of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, several vaccines have been developed to mitigate its spread and prevent adverse consequences of the Coronavirus Disease 2019 (COVID-19). The mRNA technology is an unprecedented vaccine, usually given in two doses to prevent SARS-CoV-2 infections. Despite effectiveness and safety, inter-individual immune response heterogeneity has been observed in recipients of mRNA-based vaccines. As a novel disease, the specific immune response mechanism responsible for warding off COVID-19 remains unclear at this point. However, significant evidence suggests that humoral response plays a crucial role in affording immunoprotection and preventing debilitating sequelae from COVID-19. As such, this paper focused on the possible effects of age, sex, serostatus, and comorbidities on humoral response (i.e. total antibodies, IgG, and/or IgA) of different populations post-mRNA-based Pfizer-BioNTech vaccination. A systematic search of literature was performed through PubMed, Cochrane CENTRAL, Google Scholar, Science Direct, medRxiv, and Research Square. Studies were included if they reported humoral response to COVID-19 mRNA vaccines. A total of 32 studies were identified and reviewed, and the percent differences of means of reported antibody levels were calculated for comparison. Findings revealed that older individuals, male sex, seronegativity, and those with more comorbidities mounted less humoral immune response. Given these findings, several recommendations were proposed regarding the current vaccination practices. These include giving additional doses of vaccination for immunocompromised and elderly populations. Another recommendation is conducting clinical trials in giving a combined scheme of mRNA vaccines, protein vaccines, and vector-based vaccines.
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Affiliation(s)
- Kin Israel Notarte
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | | | - Adriel Pastrana
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | | | - Gian Luca Salvagno
- Service of Laboratory Medicine, Pederzoli Hospital, Peschiera del Garda, Italy.,Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Eric Peng Huat Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Luis Martinez-Sobrido
- Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Jordi B Torrelles
- Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Brandon Michael Henry
- Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA.,Division of Nephrology and Hypertension, Clinical Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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13
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Shmueli ES, Itay A, Margalit O, Berger R, Halperin S, Jurkowicz M, Levin EG, Levy I, Olmer L, Regev-Yochay G, Lustig Y, Rahav G. Efficacy and safety of BNT162b2 vaccination in patients with solid cancer receiving anticancer therapy - a single centre prospective study. Eur J Cancer 2021; 157:124-131. [PMID: 34508994 PMCID: PMC8424105 DOI: 10.1016/j.ejca.2021.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
AIM Patients with cancer are at an increased risk for severe coronavirus disease of 2019, thus data on the safety and efficacy of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines are essential. We conducted this prospective study of patients with cancer vaccinated with BNT162b2 and monitored for antibody response and safety. The aim was to evaluate the rate of seropositivity and define predictors for non-reactive immune response. Furthermore, we evaluated the frequency and the severity of adverse events. METHODS The study included patients with solid tumours undergoing anticancer treatment and immunocompetent health-care workers serving as controls. Serum titres of the receptor-binding domain (RBD) immunoglobulin G (IgG) and neutralising antibodies were measured 2-4 weeks after each vaccine dose. RESULTS The analysis included 129 patients, of which 70.5% patients were metastatic. Patients were treated with chemotherapy (55%), immunotherapy (34.1%), biological agents (24.8%), hormonal treatment (8.5%) and radiotherapy (4.6%), that were given either alone or in combinations. The seropositivity rate among patients with cancer and controls was 32.4% versus 59.8% (p < 0.0001) after the first dose and 84.1% versus 98.9% (p < 0.0001) after the second dose, respectively. Median RBD-IgG titre was lower among patients than controls (p < 0.0001). Patients who were seronegative after the second dose had significantly more comorbidities than that with patients with seropositivity (77.8% vs 41.1%, respectively, p = 0.0042). CONCLUSION Adequate antibody response after BNT162b2 vaccination was achieved after two doses but not after one dose, in patients with cancer vaccinated during anticancer therapy.
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Affiliation(s)
- Einat S Shmueli
- Department of Oncology, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel.
| | - Amit Itay
- Department of Oncology, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel
| | - Ofer Margalit
- Department of Oncology, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel
| | - Raanan Berger
- Department of Oncology, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel
| | - Sharon Halperin
- Department of Oncology, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
| | - Menucha Jurkowicz
- Department of Oncology, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
| | - Einav G Levin
- Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel; The Infectious Diseases Unit, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
| | - Itzchak Levy
- Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel; The Infectious Diseases Unit, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
| | - Liraz Olmer
- Bio-statistical and Bio-mathematical Unit, The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
| | - Gili Regev-Yochay
- Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel; The Infectious Diseases Unit, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel; The Infectious Diseases Unit, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel-Aviv University, P.O.B 39040 Ramat Aviv Tel Aviv Israel; The Infectious Diseases Unit, Sheba Medical Center, Derech Sheba 2, Tel-Hashomer, Ramat Gan, Israel
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14
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Ligumsky H, Safadi E, Etan T, Vaknin N, Waller M, Croll A, Nikolaevski-Berlin A, Greenberg I, Halperin T, Wasserman A, Galazan L, Arber N, Wolf I. Immunogenicity and Safety of the BNT162b2 mRNA COVID-19 Vaccine Among Actively Treated Cancer Patients. J Natl Cancer Inst 2021; 114:203-209. [PMID: 34453830 PMCID: PMC8499747 DOI: 10.1093/jnci/djab174] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/06/2021] [Accepted: 08/26/2021] [Indexed: 01/13/2023] Open
Abstract
Background Activity and safety of the SARS-CoV-2 BNT162b2 vaccine in actively treated patients with solid tumors is currently unknown. Methods We conducted a retrospective study of 326 patients with solid tumors treated with anticancer medications to determine the proportion of cancer patients with immunogenicity against SARS-CoV-2 following 2 doses of the BNT162b2 vaccine. The control group comprised 164 vaccinated healthy adults. Anti-SARS-CoV-2 S immunoglobulin G antibodies were measured using a level greater than 50 AU/mL as a cutoff for seropositivity. Information on adverse effects was collected using a questionnaire. All statistical tests were 2-sided. Results Most patients (205, 62.9%) were treated with chemotherapy either alone or with additional therapy; 55 (16.9%) were treated with immune checkpoint inhibitors and 38 (11.7%) with targeted therapy alone; 28 (8.6%) received other combinations. The vaccine was well tolerated, and no severe side effects were reported. Among patients with cancer, 39 (11.9%) were seronegative compared with 5 (3.0%) of the control group (P = .001). Median immunoglobulin G titers were statistically significantly lower among patients with cancer compared with control (931 AU/mL vs 2817 AU/mL, P = .003). Seronegativity proportions were higher in the chemotherapy-treated group (n = 19; 18.8%) compared with the immune checkpoint inhibitor–treated patients (n = 5; 9.1%) and with those treated with targeted therapy (n = 1; 2.6%) (P = .02). Titers were also statistically significantly different among treatment types (P = .002). Conclusions The BNT162b2 vaccine is safe and effective in actively treated patients with cancer. The relatively lower antibody titers and lower proportion of seropositive patients, especially among chemotherapy-treated patients, call for continuing the use of personal protective measures in these patients, even following vaccination.
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Affiliation(s)
- Hagai Ligumsky
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esraa Safadi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Etan
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Vaknin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Manuel Waller
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Assaf Croll
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Inbal Greenberg
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Halperin
- Human immunodeficiency virus lab, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Asaf Wasserman
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lior Galazan
- The Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadir Arber
- The Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Massarweh A, Eliakim-Raz N, Stemmer A, Levy-Barda A, Yust-Katz S, Zer A, Benouaich-Amiel A, Ben-Zvi H, Moskovits N, Brenner B, Bishara J, Yahav D, Tadmor B, Zaks T, Stemmer SM. Evaluation of Seropositivity Following BNT162b2 Messenger RNA Vaccination for SARS-CoV-2 in Patients Undergoing Treatment for Cancer. JAMA Oncol 2021; 7:1133-1140. [PMID: 34047765 PMCID: PMC8164144 DOI: 10.1001/jamaoncol.2021.2155] [Citation(s) in RCA: 193] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
Importance Patients with cancer undergoing treatment are at high risk of COVID-19 following SARS-CoV-2 infection; however, their ability to produce an adequate antibody response to messenger RNA SARS-CoV-2 vaccines is unclear. Objective To evaluate rates of antispike (anti-S) antibody response to a BNT162b2 vaccine in patients with cancer who are undergoing systemic treatment vs healthy controls. Design, Setting, and Participants This prospective cohort study included 102 adult patients with solid tumors undergoing active intravenous anticancer treatment and 78 controls who received the second dose of the BNT162b2 vaccine at least 12 days before enrollment. The controls were taken from a convenience sample of the patients' family/caregivers who accompanied them to treatment. The study was conducted between February 22, 2021, and March 15, 2021 at Davidoff Cancer Center at Beilinson Hospital (Petah Tikva, Israel). Interventions Blood samples were drawn from the study participants. Serum samples were analyzed and the titers of the IgG antibodies against SARS-CoV-2 spike receptor-binding domain were determined using a commercially available immunoassay. Seropositivity was defined as 50 or greater AU/mL. Main Outcomes and Measures The primary outcome was the rate of seropositivity. Secondary outcomes included comparisons of IgG titers and identifying factors that were associated with seropositivity using univariate/multivariable analyses. Results The analysis included 180 participants, which comprised 102 patients with cancer (median [interquartile range (IQR)] age, 66 [56-72] years; 58 men [57%]) and 78 healthy controls (median [IQR] age, 62 [49-70] years; 25 men [32%]). The most common tumor type was gastrointestinal (29 [28%]). In the patient group, 92 (90%) were seropositive for SARS-CoV 2 antispike IgG antibodies after the second vaccine dose, whereas in the control group, all were seropositive. The median IgG titer in the patients with cancer was significantly lower than that in the controls (1931 [IQR, 509-4386] AU/mL vs 7160 [IQR, 3129-11 241] AU/mL; P < .001). In a multivariable analysis, the only variable that was significantly associated with lower IgG titers was treatment with chemotherapy plus immunotherapy (β, -3.5; 95% CI, -5.6 to -1.5). Conclusions and Relevance In this cohort study of patients with cancer who were receiving active systemic therapy, 90% of patients exhibited adequate antibody response to the BNT162b2 vaccine, although their antibody titers were significantly lower than those of healthy controls. Further research into the clinical relevance of lower titers and their durability is required. Nonetheless, the data support vaccinating patients with cancer as a high priority, even during therapy.
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Affiliation(s)
- Amir Massarweh
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Stemmer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adva Levy-Barda
- Biobank, Department of Pathology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Shlomit Yust-Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Oncology Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Alona Zer
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Neta Moskovits
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Tadmor
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tal Zaks
- Moderna, Cambridge, Massachusetts
| | - Salomon M. Stemmer
- Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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王 珞, 徐 燕, 张 路, 范 俊, 潘 瑞, 王 京, 王 孟. [COVID-19 Vaccination for Cancer Patients: Progress and Preliminary Recommendations]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:377-383. [PMID: 34024060 PMCID: PMC8246390 DOI: 10.3779/j.issn.1009-3419.2021.101.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 01/14/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) has had a serious impact on global health. COVID-19 vaccines may be one of the most effective measure to end the pandemic. High infection risk and higher serious incident and mortality rates have been shown in cancer patients with COVID-19. Therefore, cancer patients should be the priority group for COVID-19 prevention. Until now, data of COVID-19 vaccination for cancer patients is lacking. We review the interim data of safety and immune-efficacy of COVID-19 vaccination in cancer patients based on the latest studies. Due to the complicated immune systems of cancer patients caused by the malignancy and anticancer treatments, we proposed preliminary specific COVID-19 vaccination recommendations for cancer patients with different anticancer treatments and at different stages of the disease. Preventing COVID-19 with vaccinations for cancer patients is crucial, and we call for more large-scale clinical trials and real-world studies, for further COVID-19 vaccination recommendations development.
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Affiliation(s)
- 珞 王
- 100730 北京,中国医学科学院,北京协和医学院,北京协和医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - 燕 徐
- 100730 北京,中国医学科学院,北京协和医学院,北京协和医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - 路 张
- 100730 北京,中国医学科学院,北京协和医学院,北京协和医院血液内科Department of Hematopathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - 俊平 范
- 100730 北京,中国医学科学院,北京协和医学院,北京协和医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - 瑞丽 潘
- 100730 北京,中国医学科学院,北京协和医学院,北京协和医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - 京岚 王
- 100730 北京,中国医学科学院,北京协和医学院,北京协和医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - 孟昭 王
- 100730 北京,中国医学科学院,北京协和医学院,北京协和医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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17
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Barrière J, Chamorey E, Adjtoutah Z, Castelnau O, Mahamat A, Marco S, Petit E, Leysalle A, Raimondi V, Carles M. Impaired immunogenicity of BNT162b2 anti-SARS-CoV-2 vaccine in patients treated for solid tumors. Ann Oncol 2021; 32:1053-1055. [PMID: 33932508 PMCID: PMC8080507 DOI: 10.1016/j.annonc.2021.04.019] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/11/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Barrière
- Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France.
| | - E Chamorey
- Department of Biostatistics and Epidemiology, Centre Antoine Lacassagne, Nice, France
| | - Z Adjtoutah
- Department of Biology, Cerballiance, Cagnes-sur-Mer, France
| | - O Castelnau
- Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France
| | - A Mahamat
- Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France
| | - S Marco
- Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France
| | - E Petit
- Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France
| | - A Leysalle
- Department of Radiation Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France
| | - V Raimondi
- Department of Biology, Cerballiance, Cagnes-sur-Mer, France
| | - M Carles
- Department of Infectious Disease, Centre Hospitalo-Universitaire de Nice, Nice, France
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18
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Barrière J, Audigier-Valette C, Borchiellini D, Hoch B, Castelnau O, Francois E, Gastaud L, Skaf R, Berdah JF, Marie W, Lescaut W, Peyrade F, Cluzeau T, Cassuto O, Carles M. [We must respect the anti-SARS-CoV-2 vaccine schedule without delay in cancer patients under treatment]. Bull Cancer 2021; 108:341-342. [PMID: 33741139 PMCID: PMC7934697 DOI: 10.1016/j.bulcan.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jérôme Barrière
- Polyclinique Saint-Jean, département d'oncologie médicale, 92, avenue Dr Maurice Donat, 06800 Cagnes-sur-Mer, France.
| | - Clarisse Audigier-Valette
- Centre hospitalier Toulon Sainte-Musse, département de pneumo-oncologie, 54, rue Henri-Sainte-Claire-Deville, 83056 Toulon, France
| | - Delphine Borchiellini
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Benjamin Hoch
- Centre Azuréen de cancérologie, département d'oncologie médicale, 1, place Docteur-Jean-Luc Broquerie, 06250 Mougins, France
| | - Olivier Castelnau
- Institut Arnault Tzanck, département de pneumo-oncologie, 116, rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Eric Francois
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Lauris Gastaud
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Richard Skaf
- Polyclinique Saint-George, département d'oncologie médicale, 2, avenue De Rimiez, 06100 Nice, France
| | - Jean-François Berdah
- Hôpital privé Toulon-Hyères, Sainte-Marguerite, département d'oncologie médicale, avenue Alexis-Godillot, 83400 Hyères, France
| | - Wislez Marie
- Hôpital Cochin, université de Paris, unité d'oncologie thoracique, service de pneumologie, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Willy Lescaut
- Centre hospitalier Princesse-Grace, département d'oncologie médicale, avenue Pasteur, 98000 Monaco
| | - Frédéric Peyrade
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Thomas Cluzeau
- CHU de Nice, hôpital Archet 1, département d'hématologie clinique, 151, route Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - Ophélie Cassuto
- Polyclinique Saint-George, département d'oncologie médicale, 2, avenue De Rimiez, 06100 Nice, France
| | - Michel Carles
- CHU de Nice, hôpital Archet 1, département d'infectiologie, 151, route Saint-Antoine-de-Ginestière, 06200 Nice, France
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19
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Hwang JK, Zhang T, Wang AZ, Li Z. COVID-19 vaccines for patients with cancer: benefits likely outweigh risks. J Hematol Oncol 2021; 14:38. [PMID: 33640005 PMCID: PMC7910769 DOI: 10.1186/s13045-021-01046-w] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/07/2021] [Indexed: 02/08/2023] Open
Abstract
Less than a year since the start of the COVID-19 pandemic, ten vaccines against SARS-CoV-2 have been approved for at least limited use, with over sixty others in clinical trials. This swift achievement has generated excitement and arrives at a time of great need, as the number of COVID-19 cases worldwide continues to rapidly increase. Two vaccines are currently approved for full use, both built on mRNA and lipid nanotechnology platforms, a success story of mRNA technology 20 years in the making. For patients with cancer, questions arise around the safety and efficacy of these vaccines in the setting of immune alterations engendered by their malignancy and/or therapies. We summarize the current data on leading COVID-19 vaccine candidates and vaccination of patients undergoing immunomodulatory cancer treatments. Most current cancer therapeutics should not prevent the generation of protective immunity. We call for more research in this area and recommend that the majority of patients with cancer receive COVID vaccinations when possible.
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Affiliation(s)
| | - Tian Zhang
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, DUMC Box 103861, Durham, NC, 27710, USA.
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.
| | - Andrew Z Wang
- Department of Radiation Oncology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Zihai Li
- Pelotonia Institute for Immuno-Oncology, The OH State University Comprehensive Cancer Center - James, Columbus, OH, USA
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20
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Abstract
Less than a year since the start of the COVID-19 pandemic, ten vaccines against SARS-CoV-2 have been approved for at least limited use, with over sixty others in clinical trials. This swift achievement has generated excitement and arrives at a time of great need, as the number of COVID-19 cases worldwide continues to rapidly increase. Two vaccines are currently approved for full use, both built on mRNA and lipid nanotechnology platforms, a success story of mRNA technology 20 years in the making. For patients with cancer, questions arise around the safety and efficacy of these vaccines in the setting of immune alterations engendered by their malignancy and/or therapies. We summarize the current data on leading COVID-19 vaccine candidates and vaccination of patients undergoing immunomodulatory cancer treatments. Most current cancer therapeutics should not prevent the generation of protective immunity. We call for more research in this area and recommend that the majority of patients with cancer receive COVID vaccinations when possible.
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21
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Barrière J, Gal J, Hoch B, Cassuto O, Leysalle A, Chamorey E, Borchiellini D. Acceptance of SARS-CoV-2 vaccination among French patients with cancer: a cross-sectional survey. Ann Oncol 2021; 32:673-674. [PMID: 33529740 PMCID: PMC7846886 DOI: 10.1016/j.annonc.2021.01.066] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/23/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- J Barrière
- Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France.
| | - J Gal
- Department of Biostatistics and Epidemiology, Centre Antoine Lacassagne, Nice, France
| | - B Hoch
- Department of Medical Oncology, Centre Azuréen de Cancérologie, Mougins, France
| | - O Cassuto
- Department of Medical Oncology, Clinique Saint George, Nice, France
| | - A Leysalle
- Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France
| | - E Chamorey
- Department of Biostatistics and Epidemiology, Centre Antoine Lacassagne, Nice, France
| | - D Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
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22
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Laws HJ, Baumann U, Bogdan C, Burchard G, Christopeit M, Hecht J, Heininger U, Hilgendorf I, Kern W, Kling K, Kobbe G, Külper W, Lehrnbecher T, Meisel R, Simon A, Ullmann A, de Wit M, Zepp F. Impfen bei Immundefizienz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:588-644. [PMID: 32350583 PMCID: PMC7223132 DOI: 10.1007/s00103-020-03123-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hans-Jürgen Laws
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität FAU Erlangen-Nürnberg, Erlangen, Deutschland
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
| | - Gerd Burchard
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland
| | - Maximilian Christopeit
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrich Heininger
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Kern
- Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Kerstin Kling
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland.
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wiebe Külper
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maike de Wit
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Onkologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - Fred Zepp
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Deutschland
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23
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Ayoola A, Sukumaran S, Jain K, Kumar R, Gordon D, Honda-Okubo Y, Quinn S, Roy A, Vatandoust S, Koczwara B, Kichenadasse G, Richards A, Mead K, Karapetis C. Efficacy of influenza vaccine (Fluvax) in cancer patients on treatment: a prospective single arm, open-label study. Support Care Cancer 2020; 28:5411-5417. [PMID: 32144585 DOI: 10.1007/s00520-020-05384-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Influenza virus infection has significant morbidity and mortality in patients with medical co-morbidities who are also immunosuppressed. The efficacy of the seasonal influenza vaccine has not been well studied in patients receiving chemotherapy. We assessed the efficacy of seasonal influenza vaccine in patients with non-haematological malignancy on active treatment (chemotherapy and targeted therapy). METHODS A prospective single arm, open label study with 53 patients with non-haematological cancers recruited during the 2011 and 2012 influenza seasons. Participants had one dose of 2011/2012 trivalent vaccine containing strains A/California/7/2009(H1N1), A/Perth/16/2009 (H3N2) and B/Brisbane/60/2008 (Fluvax) prior to or in-between treatment cycles. Haemagglutination inhibition antibody (HIA) titres in serum were measured at baseline 3, 6 and 24 weeks. Primary endpoint: seroconversion rate (SCR) at 3 weeks. Secondary endpoints: late SCR at 6 weeks. rate of sustained sero-protection titres (SPR) at 24 weeks. Seroconversion was defined as postvaccination ≥ 4-fold increase in HIA titre and sero-protection defined as a HIA ≥ 1:40. RESULTS The SCR at 3 weeks were 35%, 30% and 22.5% to the H1N1, H3N2 and B/Bris strains, respectively. There were no new cases of late SC at 6 weeks or 24 weeks. The SPR at 3 weeks were 72.5%, 65% and 40%, respectively, to H1N1, H3N2 and B/Bris. The SPR at 24 weeks to H1N1, H3N2 and B/Bris were 40%, 52.5% and 17.5%, respectively. CONCLUSIONS Patients on various solid tumour treatments achieve sero-protection rate congruent with the general population. The sero-protection HIA titres were not sustained at 24 weeks postvaccination.
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Affiliation(s)
- A Ayoola
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia.
| | - S Sukumaran
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - K Jain
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - R Kumar
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - D Gordon
- Department of Microbiology and Infectious Diseases, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - Y Honda-Okubo
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - S Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, 3122, Australia
| | - A Roy
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - S Vatandoust
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - B Koczwara
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - G Kichenadasse
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - A Richards
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - K Mead
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - C Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
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24
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Rieger CT, Liss B, Mellinghoff S, Buchheidt D, Cornely OA, Egerer G, Heinz WJ, Hentrich M, Maschmeyer G, Mayer K, Sandherr M, Silling G, Ullmann A, Vehreschild MJGT, von Lilienfeld-Toal M, Wolf HH, Lehners N. Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors-Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol 2019; 29:1354-1365. [PMID: 29688266 PMCID: PMC6005139 DOI: 10.1093/annonc/mdy117] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Infectious complications are a significant cause of morbidity and mortality in patients with malignancies specifically when receiving anticancer treatments. Prevention of infection through vaccines is an important aspect of clinical care of cancer patients. Immunocompromising effects of the underlying disease as well as of antineoplastic therapies need to be considered when devising vaccination strategies. This guideline provides clinical recommendations on vaccine use in cancer patients including autologous stem cell transplant recipients, while allogeneic stem cell transplantation is subject of a separate guideline. The document was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) by reviewing currently available data and applying evidence-based medicine criteria.
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Affiliation(s)
- C T Rieger
- Hematology and Oncology Germering, Lehrpraxis der Ludwig-Maximilians-Universität, University of Munich, Munich.
| | - B Liss
- Department of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal
| | - S Mellinghoff
- Department I of Internal Medicine, University Hospital Cologne, Cologne; CECAD Cluster of Excellence, University of Cologne, Cologne
| | - D Buchheidt
- Department of Internal Medicine - Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Heidelberg
| | - O A Cornely
- Department I of Internal Medicine, University Hospital Cologne, Cologne; CECAD Cluster of Excellence, University of Cologne, Cologne; Clinical Trials Center Cologne, ZKS Köln, University Hospital of Cologne, Cologne
| | - G Egerer
- Department of Hematology, University Hospital Heidelberg, Heidelberg
| | - W J Heinz
- Department of Internal Medicine II - Hematology and Oncology, University of Würzburg, Würzburg
| | - M Hentrich
- Department of Hematology and Oncology, Rotkreuzklinikum München, Munich
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam
| | - K Mayer
- Department of Hematology and Oncology, University Hospital Bonn, Bonn
| | | | - G Silling
- Department of Hematology and Oncology, University of Aachen, Aachen
| | - A Ullmann
- Department of Internal Medicine II - Hematology and Oncology, University of Würzburg, Würzburg
| | - M J G T Vehreschild
- Department of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal
| | - M von Lilienfeld-Toal
- Department of Hematology and Oncology, Internal Medicine II, University Hospital Jena, Jena
| | - H H Wolf
- Department of Hematology and Oncology, University Hospital Halle, Halle
| | - N Lehners
- Department of Hematology, University Hospital Heidelberg, Heidelberg; Max-Eder-Group Experimental Therapies for Hematologic Malignancies, German Cancer Research Center (DKFZ), Heidelberg, Germany
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25
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Blanchette PS, Chung H, Pritchard KI, Earle CC, Campitelli MA, Buchan SA, Schwartz KL, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson DC, Richardson SE, Rosella LC, Simor A, Smieja M, Zahariadis G, Campigotto A, Kwong JC. Influenza Vaccine Effectiveness Among Patients With Cancer: A Population-Based Study Using Health Administrative and Laboratory Testing Data From Ontario, Canada. J Clin Oncol 2019; 37:2795-2804. [PMID: 31465264 DOI: 10.1200/jco.19.00354] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer. PATIENTS AND METHODS We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time. RESULTS We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies (P = .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer. CONCLUSION Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
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Affiliation(s)
- Phillip S Blanchette
- University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,ICES London and Toronto, Ontario, Canada
| | | | | | - Craig C Earle
- ICES London and Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Sarah A Buchan
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Katz
- University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Allison J McGeer
- University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Ontario, Canada
| | - James D McNally
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Susan E Richardson
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | | | | | - Aaron Campigotto
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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26
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[Before seasonal influenza, vaccination of cancer patients and healthcare givers]. Bull Cancer 2019; 106:94-96. [PMID: 30711198 DOI: 10.1016/j.bulcan.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 11/21/2022]
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Influenza vaccination in adult patients with solid tumours treated with chemotherapy. Eur J Cancer 2017; 76:134-143. [PMID: 28324748 DOI: 10.1016/j.ejca.2017.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 01/04/2023]
Abstract
Patients with solid tumours receiving chemotherapy are at risk for influenza complications. Yearly influenza vaccination is recommended to patients treated with chemotherapy. However, adherence to vaccination is low, most likely due to lack of data on efficacy, optimal timing and safety of vaccination. There is scarce evidence for the effectiveness of the influenza vaccine in adult patients with solid tumours and chemotherapy on reduction of pneumonia, decreased mortality and fewer interruptions of oncological treatment. A review of 20 non-randomised serological studies in adult patients with different cancer types and chemotherapy provides insight in general trends of response to vaccination. Overall, the magnitude of the antibody response after influenza vaccination (i.e. seroconversion) can be lower than in healthy controls, but the majority of patients with solid tumours is able to mount a timely, protective immunological response (i.e. seroprotection) regardless of chemotherapy schedule, similar to healthy controls. Small sample sizes, patient heterogeneity and lack of comparable study designs limit more specific recommendations related to cancer type and optimal timing of vaccination. The inactivated influenza vaccine is safe to administer to immunosuppressed patients; side-effects are similar to those in healthy individuals. Although vaccination before start of chemotherapy is preferred to ensure optimal protection in adults with solid tumours, also vaccination during chemotherapy can reduce influenza-related complications considering the overall trends in serological response. Given the increased morbidity and mortality of influenza, influenza vaccination should be advocated as an inexpensive and safe preventive measure in patients with solid tumours receiving chemotherapy.
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Wumkes ML, van der Velden AMT, de Bruin E, Meerveld-Eggink A, Koopmans MPG, Rimmelzwaan GF, Rijkers GT, Biesma DH. Microarray profile of the humoral immune response to influenza vaccination in breast cancer patients treated with chemotherapy. Vaccine 2017; 35:1299-1305. [PMID: 28169075 DOI: 10.1016/j.vaccine.2017.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients treated with chemotherapy have an impaired response to influenza virus vaccination compared to healthy controls. Little is known about the broadness of the antibody response in these patients. METHODS Breast cancer patients on FEC (5-fluorouracil, epirubicin and cyclophosphamide) chemotherapy regimens were vaccinated with influenza virus vaccine. Sera were obtained before and three weeks after vaccination. In addition to the determination of virus-specific antibody titres by hemagglutination inhibition assay, the broadness of the response was assessed by the use of a protein microarray and baseline titres were compared with an age-matched reference group. RESULTS We included 38 breast cancer patients and found a wide variety in serum antibody response after vaccination. Patients with a history of influenza vaccination had higher pre-vaccination titres, which were comparable to the reference group. Increasing number of cycles of chemotherapy did not have a negative effect on influenza array antibody levels, nor on the HI antibody response. CONCLUSIONS Overall there was a broad serum antibody response to the influenza virus vaccine in patients treated with chemotherapy for breast cancer.
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Affiliation(s)
- M L Wumkes
- Department of Internal Medicine, Tergooi Hilversum/Blaricum, PO Box 10016, 1201 DA Hilversum, The Netherlands; Department of Internal Medicine, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - A M T van der Velden
- Department of Internal Medicine, Tergooi Hilversum/Blaricum, PO Box 10016, 1201 DA Hilversum, The Netherlands.
| | - E de Bruin
- Laboratory for Infectious Diseases and Screening, Centre for Infectious Disease Control (CIDC), National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands; Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - A Meerveld-Eggink
- Department of Medical Oncology, Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, The Netherlands; Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands.
| | - M P G Koopmans
- Laboratory for Infectious Diseases and Screening, Centre for Infectious Disease Control (CIDC), National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands; Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - G F Rimmelzwaan
- Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - G T Rijkers
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands; Science Department, University College Roosevelt, PO Box 94, 4330 AB Middelburg, The Netherlands.
| | - D H Biesma
- Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands; Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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29
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Keam B, Kim MK, Choi Y, Choi SJ, Choe PG, Lee KH, Kim TM, Kim TY, Oh DY, Kim DW, Im SA, Kim NJ, Heo DS, Park WB, Oh MD. Optimal timing of influenza vaccination during 3-week cytotoxic chemotherapy cycles. Cancer 2016; 123:841-848. [DOI: 10.1002/cncr.30468] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Bhumsuk Keam
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Min-Kyung Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Yunhee Choi
- Medical Research Collaborating Center; Seoul National University Hospital; Seoul Republic of Korea
| | - Su-Jin Choi
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Do-Youn Oh
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Dong-Wan Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
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30
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Dulek DE, Halasa NB. Timing isn't everything: Influenza vaccination in cancer patients. Cancer 2016; 123:731-733. [DOI: 10.1002/cncr.30467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel E. Dulek
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
- Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee
| | - Natasha B. Halasa
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
- Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee
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31
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Wiedermann U, Sitte HH, Burgmann H, Eser A, Falb P, Holzmann H, Kitchen M, Köller M, Kollaritsch H, Kundi M, Lassmann H, Mutz I, Pickl WF, Riedl E, Sibilia M, Thalhammer F, Tucek B, Zenz W, Zwiauer K. [Guidelines for vaccination of immunocompromised individuals]. Wien Klin Wochenschr 2016; 128 Suppl 4:337-76. [PMID: 27457874 DOI: 10.1007/s00508-016-1033-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 12/14/2022]
Abstract
Immunosuppression of various origins is associated with an increased risk of infection; therefore the prevention of infectious diseases by vaccination is especially important in immunocompromised patients. However, the response to vaccinations is often reduced in these risk groups and the application of live vaccines is contraindicated during immunosuppression.In the following expert statement, recommendations for vaccination were created on the basis of current evidence and theoretical/immunological considerations. A first, general part elaborates on efficacy and safety of vaccinations during immunosuppression, modes of action of immunosuppressive medications and recommended time intervals between immunosuppressive treatments and vaccinations. A core piece of this part is a graduation of immunosuppression into three stages, i. e. no relevant immunosuppression, mild to moderate and severe immunosuppression and the assignment of various medications (including biologicals) to one of those stages; this is followed by an overview of possible and necessary vaccinations in each of those stages.The second part gives detailed vaccination guidelines for common diseases and therapies associated with immunosuppression. Primary immune deficiencies, chronic kidney disease, diabetes mellitus, solid and hematological tumors, hematopoetic stem cell transplantation, transplantation of solid organs, aspenia, rheumatological-, gastroenterologic-, dermatologic-, neurologic diseases, biologicals during pregnancy and HIV infection are dealt with.These vaccination guidelines, compiled for the first time in Austria, aim to be of practical help for physicians to facilitate and improve vaccination coverage in immunocompromised patients and their household members and contact persons.
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Affiliation(s)
- Ursula Wiedermann
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich.
| | - Harald H Sitte
- Institut für Pharmakologie, Medizinische Universität Wien, Wien, Österreich
| | - Heinz Burgmann
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Eser
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien, Österreich
| | - Petra Falb
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | | | - Maria Kitchen
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Marcus Köller
- Sozialmedizinisches Zentrum Sophienspital, Wien, Österreich
| | - Herwig Kollaritsch
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich
| | - Michael Kundi
- Institut für Umwelthygiene, Medizinische Universität Wien, Wien, Österreich
| | - Hans Lassmann
- Abteilung für Neuroimmunologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Winfried F Pickl
- Institut für Immunologie, Medizinische Universität Wien, Wien, Österreich
| | - Elisabeth Riedl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Maria Sibilia
- Institut für Krebsforschung, Medizinische Universität Wien, Wien, Österreich
| | - Florian Thalhammer
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Barbara Tucek
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | - Werner Zenz
- Klinische Abteilung für allgemeine Pädiatrie, Medizinische Universität Graz, Graz, Österreich
| | - Karl Zwiauer
- Klinische Abteilung für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
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32
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Loubet P, Loulergue P, Galtier F, Launay O. Seasonal influenza vaccination of high-risk adults. Expert Rev Vaccines 2016; 15:1507-1518. [PMID: 27169689 DOI: 10.1080/14760584.2016.1188696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Adults at a high risk of severe influenza, because of their age and/or underlying health disorders, should receive seasonal influenza vaccination in order to reduce the incidence of severe illness and premature death. However, because current influenza vaccines are perceived to have suboptimal efficacy, vaccine coverage is below the recommended level in this population. Areas covered: This review examines, for each high-risk group, available data on influenza infection, vaccine efficacy and safety, and vaccine coverage. We conducted a literature search in the PubMed database to identify randomized controlled trials, observational studies and reviews published from 2000 through 2015 on both seasonal and pandemic influenza. Only studies published in English were considered. While the topic of this review is seasonal influenza, data on pandemics are included when relevant. Expert Commentary: Current seasonal influenza vaccines are only moderately protective, and vaccines eliciting broader and more durable immunity are therefore needed. Research on the use of higher doses, adjuvants, and a universal influenza vaccine is ongoing. Influenza vaccine coverage needs to be increased. Vaccination of contacts of high-risk individuals, including healthcare workers, should be encouraged.
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Affiliation(s)
- Paul Loubet
- a Inserm, CIC 1417 , Paris , France.,b Department of Infectious Diseases , Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Broca Hôtel-Dieu hospital, CIC Cochin Pasteur , Paris , France
| | - Pierre Loulergue
- a Inserm, CIC 1417 , Paris , France.,b Department of Infectious Diseases , Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Broca Hôtel-Dieu hospital, CIC Cochin Pasteur , Paris , France.,c Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC) , Paris , France
| | - Florence Galtier
- c Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC) , Paris , France.,d CHRU de Montpellier, CIC 1411, Hôpital Saint-Eloi , Montpellier , France
| | - Odile Launay
- a Inserm, CIC 1417 , Paris , France.,b Department of Infectious Diseases , Assistance Publique-Hôpitaux de Paris (AP-HP), Cochin Broca Hôtel-Dieu hospital, CIC Cochin Pasteur , Paris , France.,c Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC) , Paris , France.,e Université Paris Descartes, Sorbonne Paris Cité , Paris , France
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33
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Specks U. Opponent's comments. Nephrol Dial Transplant 2015; 30:1081-2. [PMID: 26109682 DOI: 10.1093/ndt/gfv216a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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34
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Antiviral prophylaxis in patients with solid tumours and haematological malignancies--update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol 2015; 94:1441-50. [PMID: 26193852 PMCID: PMC4525190 DOI: 10.1007/s00277-015-2447-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/06/2015] [Indexed: 01/17/2023]
Abstract
Reactivation of viral infections is common in patients with solid tumour or haematological malignancy. Incidence and severity depend on the extent of cellular immunosuppression. Antiviral prophylaxis may be effective to prevent viral reactivation. In 2006, the Infectious Diseases Working Party of German Society for Hematology and Medical Oncology (DGHO) published guidelines for antiviral prophylaxis in these patient populations. Here, we present an update of these guidelines for patients with solid and haematological malignancies undergoing antineoplastic treatment but not allogeneic stem cell transplantation. Relevant literature for reactivation of different viruses (herpes simplex virus (HSV), varicella zoster virus (VZV), hepatitis B virus (HBV) and respiratory viruses) is discussed to provide evidence-based recommendations for clinicians taking care of this patient population. We recommend a risk-adapted approach with (val)acyclovir against HSV and VZV in patients treated with alemtuzumab, bortezomib or purine analogues. Seasonal vaccination against influenza is recommended for all patients with solid or haematological malignancies regardless of antineoplastic therapy. Hepatitis B screening is recommended in lymphoproliferative disorders, acute leukaemia, and breast cancer, and during treatment with monoclonal anti-B-cell antibodies, anthracyclines, steroids and in autologous stem cell transplantation. In those with a history of hepatitis B prophylactic lamivudine, entecavir or nucleotide analogues as adefovir are recommended to prevent reactivation.
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35
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Ariza-Heredia EJ, Chemaly RF. Practical review of immunizations in adult patients with cancer. Hum Vaccin Immunother 2015; 11:2606-14. [PMID: 26110220 PMCID: PMC4685676 DOI: 10.1080/21645515.2015.1062189] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/28/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022] Open
Abstract
Compared with the general population, patients with cancer in general are more susceptible to vaccine-preventable infections, either by an increased risk due to the malignancy itself or immunosuppressive treatment. The goal of immunizations in these patients is therefore to provide protection against these infections, and to decrease the number of vulnerable patients who can disseminate these organisms. The proper timing of immunization with cancer treatment is key to achieving better vaccine protection. As the oncology field continues to advance, leading to better quality of life and longer survival, immunization and other aspects of preventive medicine ought to move to the frontline in the care of these patients. Herein, we review the vaccines most clinically relevant to patients with cancer, as well as special cases including vaccines after splenectomy, travel immunization and recommendations for family members.
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Affiliation(s)
- Ella J Ariza-Heredia
- Department of Infectious Diseases; Infection Control and Employee Health; The University of Texas; MD Anderson Cancer Center; Houston, TX USA
| | - Roy F Chemaly
- Department of Infectious Diseases; Infection Control and Employee Health; The University of Texas; MD Anderson Cancer Center; Houston, TX USA
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36
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Berglund A, Willén L, Grödeberg L, Skattum L, Hagberg H, Pauksens K. The response to vaccination against influenza A(H1N1) 2009, seasonal influenza and Streptococcus pneumoniae in adult outpatients with ongoing treatment for cancer with and without rituximab. Acta Oncol 2014; 53:1212-20. [PMID: 24865118 DOI: 10.3109/0284186x.2014.914243] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED It is debated whether cancer patients treated with chemotherapy can mount an adequate response to vaccination. MATERIAL AND METHODS Ninety-six adult outpatients with cancer, who were undergoing chemotherapy and/or monoclonal antibody, tyrosine kinase inhibitor, irradiation or corticosteroid treatments, were studied. Two doses of the pandemic influenza A(H1N1)/09 AS03-adjuvanted split virion vaccine, one dose of the seasonal influenza vaccine and one dose of the 23-valent pneumococcal polysaccharide vaccine were given. Serum haemagglutination inhibition (HI) assays were used to determine antibody titres against the influenza strains. For the pneumococcal vaccine 14 different serotype-specific anti-capsular antibodies were measured by bead assay xMAP(®). RESULTS Patients treated with rituximab did not respond to vaccination. For patients without rituximab treatment 4% had putatively protective antibodies before vaccination (HI ≥ 40) to the pandemic-like strain A/California7/2009HINI. After the first and second dose of vaccine, seroprotection rates (SPR) were 62% and 87%, and seroconversion rates (SCR) 62% and 84%, respectively. Before seasonal flu vaccination SPR against influenza A/Brisbane/59/2007H1N1 and A/Uruguay/10/2007H3N2 were 19% and 17%, respectively. After vaccination, SPR were 70% and 59% and SCR 42% and 50%, respectively. For the pneumococcal vaccine protective antibodies were found to 40% of the 14 strains before and to 68% after vaccination. The mean response to pneumococcal vaccination was to 44% of the 14 serotypes. A response to at least 50% of the 14 serotypes was found in 49% of the patients. No serious adverse events were reported. CONCLUSION A substantial number of adult cancer patients with ongoing chemotherapy treatment could mount an adequate serological response to influenza and pneumococcal vaccination without severe adverse events. Thus, vaccination should be recommended. Adjuvanted vaccines may improve the vaccine response among this patient group. Patients recently treated with rituximab do not respond to vaccination.
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Affiliation(s)
- Ake Berglund
- Department of Radiology, Oncology, and Radiation Science, Uppsala University , Uppsala , Sweden
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Pedrazzoli P, Baldanti F, Donatelli I, Castrucci MR, Puglisi F, Silvestris N, Cinieri S. Vaccination for seasonal influenza in patients with cancer: recommendations of the Italian Society of Medical Oncology (AIOM). Ann Oncol 2014; 25:1243-7. [PMID: 24618150 PMCID: PMC7109906 DOI: 10.1093/annonc/mdu114] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Influenza virus causes annual epidemics in the winter–spring season with significant morbidity in the general population and important mortality in high-risk groups, including cancer patients. Opinions on the suitability of patients with malignancies not undergoing active treatment and in different phases of antineoplastic therapy, to receive influenza vaccination, vary considerably among oncologists, sometimes even within one center. Methods We reviewed available data, including recommendations by national health authorities, on impact of influenza in patients with cancer and their capacity to mount protective immunological responses to vaccination, thus allowing, on behalf of Italian Association of Medical Oncology, to make suitable recommendations for the prevention and treatment of seasonal influenza. Results and discussion Patients with cancer often have disease- or treatment-related immunosuppression, and as a consequence, they may have a suboptimal serologic response to influenza vaccination. The protective effect of the different preparations of influenza vaccines in patients with cancer has not been widely investigated, especially in adult patients harboring solid tumors. The optimal timing for administration of influenza vaccines in patients receiving chemotherapy is also not clearly defined. However, since vaccination is the most effective method, along with antiviral drugs in selected patients, for preventing influenza infection, it has to be recommended for cancer patients. Implementing vaccination of close contacts of oncology patients would be an additional tool for enhancing protection in fragile patient populations.
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Affiliation(s)
- P Pedrazzoli
- Division of Medical Oncology, Department of Hemato-oncology
| | - F Baldanti
- Molecular Virology Unit, Virology, Department of Microbiology, IRCCS Policlinico 'San Matteo' Foundation, Pavia
| | - I Donatelli
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome
| | - M R Castrucci
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome
| | - F Puglisi
- Department of Oncology, University Hospital of Udine, Udine
| | - N Silvestris
- Division of Medical Oncology, 'Giovanni Paolo II' Cancer Institute, Bari
| | - S Cinieri
- Medical Oncology Division and Breast Unit, Sen. Antonio Perrino Hospital, Brindisi, Italy
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Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2013; 58:e44-100. [PMID: 24311479 DOI: 10.1093/cid/cit684] [Citation(s) in RCA: 543] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
An international panel of experts prepared an evidenced-based guideline for vaccination of immunocompromised adults and children. These guidelines are intended for use by primary care and subspecialty providers who care for immunocompromised patients. Evidence was often limited. Areas that warrant future investigation are highlighted.
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Affiliation(s)
- Lorry G Rubin
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York of the North Shore-LIJ Health System, New Hyde Park
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39
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Serum antibody response to influenza virus vaccination during chemotherapy treatment in adult patients with solid tumours. Vaccine 2013; 31:6177-84. [DOI: 10.1016/j.vaccine.2013.10.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/27/2013] [Accepted: 10/16/2013] [Indexed: 11/23/2022]
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40
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Pham VL, Nakayama M, Itoh Y, Ishigaki H, Kitano M, Arikata M, Ishida H, Kitagawa N, Shichinohe S, Okamatsu M, Sakoda Y, Tsuchiya H, Nakamura S, Kida H, Ogasawara K. Pathogenicity of pandemic H1N1 influenza A virus in immunocompromised cynomolgus macaques. PLoS One 2013; 8:e75910. [PMID: 24086663 PMCID: PMC3781065 DOI: 10.1371/journal.pone.0075910] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/20/2013] [Indexed: 01/20/2023] Open
Abstract
Pandemic (H1N1) 2009 influenza virus spread throughout the world since most people did not have immunity against the virus. In the post pandemic phase when many humans might possess immunity against the pandemic virus, one of the concerns is infection in immunocompromised people. Therefore, we used an immunosuppressed macaque model to examine pathogenicity of the pandemic (H1N1) 2009 virus under an immunocompromised condition. The virus in nasal samples of immunosuppressed macaques infected with the pandemic (H1N1) 2009 virus was detected longer after infection than was the virus in nasal samples of immunocompetent macaques. As expected, not only virus amounts but also virus propagation sites in the immunosuppressed macaques were larger than those in lungs of the immunocompetent macaques when they were infected with the pandemic virus. Immunosuppressed macaques possessed low levels of immune cells producing cytokines and chemokines, but levels of inflammatory cytokines/chemokine interleukin (IL)-6, IL-18, and monocyte chemotactic protein (MCP)-1 in lungs of the immunosuppressed macaques were higher than those in lungs of the immunocompetent macaques, though the differences were not statistically significant. Therefore, under an immunosuppressive condition, the pandemic influenza (H1N1) 2009 virus might cause more severe morbidity with high cytokine/chemokine production by the host innate immune system than that seen in macaques under the immunocompetent condition.
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Affiliation(s)
- Van Loi Pham
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Misako Nakayama
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Yasushi Itoh
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
- * E-mail:
| | - Hirohito Ishigaki
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Mitsutaka Kitano
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Masahiko Arikata
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Hideaki Ishida
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Naoko Kitagawa
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Shintaro Shichinohe
- Laboratory of Microbiology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Masatoshi Okamatsu
- Laboratory of Microbiology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshihiro Sakoda
- Laboratory of Microbiology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Hideaki Tsuchiya
- Research Center for Animal Life Science, Shiga University of Medical Science, Otsu, Japan
| | - Shinichiro Nakamura
- Research Center for Animal Life Science, Shiga University of Medical Science, Otsu, Japan
| | - Hiroshi Kida
- Laboratory of Microbiology, Department of Disease Control, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
- Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Kazumasa Ogasawara
- Division of Pathology and Disease Regulation, Department of Pathology, Shiga University of Medical Science, Otsu, Japan
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Abstract
Vaccination of immunocompromised patients is challenging both regarding efficacy and safety. True efficacy data are lacking so existing recommendations are based on immune responses and safety data. Inactivated vaccines can generally be used without risk but the patients who are most at risk for infectious morbidity and mortality as a result of their severely immunosuppressed state are also those least likely to respond to vaccination. However, vaccination against pneumococci, Haemophilus influenzae and influenza are generally recommended. Live vaccines must be used with care because the risk for vaccine-associated disease exists.
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Affiliation(s)
- Per Ljungman
- Department of Haematology, Karolinska University Hospital, Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
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42
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Kersun LS, Reilly AF, Coffin SE, Sullivan KE. Protecting pediatric oncology patients from influenza. Oncologist 2013; 18:204-11. [PMID: 23370325 PMCID: PMC3579605 DOI: 10.1634/theoncologist.2012-0401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/10/2013] [Indexed: 01/14/2023] Open
Abstract
Influenza is a common respiratory pathogen. Its severity can be unpredictable, but people with chronic illness are at increased risk of severe infection, complications, and death from influenza. This review examines evidence to support various strategies to protect pediatric oncology patients from influenza-related morbidity. Influenza vaccination should be considered standard. Additional evidence-supported measures include antiviral treatment, antiviral prophylaxis, cohorting of patients, and hospital infection control measures. Data from other high-risk populations support the vaccination of family members, double-dose or high-dose vaccination, and the use of barrier methods. These measures have the potential to optimize patient outcomes because there will be fewer treatment interruptions for acute illness. These strategies can also protect patients from prolonged hospitalizations and morbidity related to influenza.
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Affiliation(s)
| | | | | | - Kathleen E. Sullivan
- Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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43
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Vaccination of immunocompromised hosts. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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44
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Pandemic whole-virion, Vero-cell-derived, adjuvant-free influenza A H1N1 vaccine in patients with solid tumors and hematologic malignancies receiving concurrent anticancer treatment: Immunogenicity, tolerability, and acceptability during the pandemic situation. Vaccine 2012; 30:6864-70. [DOI: 10.1016/j.vaccine.2012.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 08/27/2012] [Accepted: 09/04/2012] [Indexed: 12/23/2022]
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45
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Hottinger AF, George ACC, Bel M, Favet L, Combescure C, Meier S, Grillet S, Posfay-Barbe K, Kaiser L, Siegrist CA, Dietrich PY. A prospective study of the factors shaping antibody responses to the AS03-adjuvanted influenza A/H1N1 vaccine in cancer outpatients. Oncologist 2012; 17:436-45. [PMID: 22357731 DOI: 10.1634/theoncologist.2011-0342] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To identify the determinants of antibody responses to adjuvanted influenza A/H1N1/09 vaccines in a cohort of cancer outpatients. PATIENTS AND METHODS Patients with cancer and controls were enrolled in a prospective single-center field study. Two doses of AS03-adjuvanted pandemic influenza vaccine were administered to patients and one dose was administered to controls. Antibody responses were measured using hemagglutination inhibition and confirmed by microneutralization. Geometric mean titers (GMTs) and seroprotection rates (defined as GMTs ≥40) were compared. RESULTS Immunizations were safe and well tolerated in 197 cancer patients (lymphoma, 57; glioma, 26; lung or head and neck, 37; gastrointestinal, 41; breast, 36) and 138 controls. Similar seroprotection rates (82.3% versus 87%) and GMTs (336.9 versus 329.9) were achieved after two doses of adjuvanted vaccine in cancer patients and one dose in controls. Univariate analyses identified older age, prior immunization against seasonal influenza, lymphoma, CD4 count, active chemotherapy, and rituximab and steroid treatments as being associated with weaker antibody responses. However, only age and chemotherapy plus rituximab remained independent determinants of vaccine responses in multivariate analyses. CONCLUSIONS Two doses of AS03-adjuvanted influenza vaccine elicited potent antibody responses in most cancer patients despite ongoing chemotherapy, with the exception of rituximab-induced B-cell depletion. Oncology patients treated in an outpatient setting benefit from preventive vaccination against influenza with adjuvanted vaccines.
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Affiliation(s)
- Andreas F Hottinger
- Center of Oncology, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 4, Switzerland
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Proietti E, Moschella F, Capone I, Belardelli F. Exploitation of the propulsive force of chemotherapy for improving the response to cancer immunotherapy. Mol Oncol 2011; 6:1-14. [PMID: 22177803 DOI: 10.1016/j.molonc.2011.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/11/2011] [Indexed: 12/19/2022] Open
Abstract
Since the early clinical studies of cancer immunotherapy, the question arose as to whether it was possible to combine it with standard cancer treatments, mostly chemotherapy. The answer, now, is past history. The combined use of immunotherapy and chemotherapy is not only possible but, in certain cases, can be advantageous, depending on the drug, the dose and the combination modalities. In order to find the best synergisms between the two treatments and to turn weak immunotherapeutic interventions into potent anticancer instruments, it is mandatory to understand the complex mechanisms responsible for the positive interactions between chemotherapy and immunotherapy. In this article, we review the current knowledge on mechanisms involved in the immunostimulating activity of chemotherapy and summarize the main studies in both mouse models and patients aimed at exploiting such mechanisms for enhancing the response to cancer immunotherapy.
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Affiliation(s)
- Enrico Proietti
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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