A survey of infectious diseases and vaccination uptake in long‐term hematopoietic stem cell transplant survivors in Australia

Abstract

Background This cross‐sectional survey aimed to establish the prevalence of infectious diseases and vaccination uptake in long‐term allogeneic hematopoietic stem cell transplants (HSCT) survivors in New South Wales, in order to reduce long‐term post‐HSCT morbidity and mortality and enhance long‐term care. Patients and methods Hematopoietic stem cell transplants survivors aged over 18 years and transplanted between 2000‐2012 in New South Wales (NSW) were eligible to participate. Survivors self‐completed the Sydney Post BMT Study survey, FACT‐BMT (V4), Chronic Graft versus Host Disease (cGVHD) Activity Assessment Self Report, Lee Chronic GvHD Symptom Scale, DASS21, Post Traumatic Growth Inventory, and the Fear of Recurrence Scale. Results Of the 583 HSCT survivors contacted, 441 (78%) completed the survey. Respondents included 250 (57%) males and median age was 54 years (range 19‐79 years). The median age at the time of transplant was 49 years (Range: 17‐71), the median time since HSCT was 5 years (Range: 1‐14) and 69% had cGVHD. Collectively, 41.7% of survivors reported a vaccine preventable disease (VPD) with the most common being influenza‐like‐illness (38.4%), varicella zoster/shingles (27.9%), pap smear abnormalities (9.8%), pneumococcal disease (5.1%), and varicella zoster (chicken pox) (4.6%). Only 31.8% had received the full post‐HSCT vaccination schedule, and the majority (69.8%) of these had received the vaccines via their General Practitioner. cGVHD was not found to be a significant factor on multivariate analysis for those who were vaccinated. There was a trend toward lower vaccination rates in patients in a lower income strata. Conclusions Vaccinating post‐HSCT survivors to prevent infections and their consequences have an established role in post‐HSCT care. Improving rates of post‐HSCT vaccination should be a major priority for BMT units.

Prevalence of COVID-19-related risk factors and risk of severe influenza outcomes in cancer survivors: A matched cohort study using linked English electronic health records data

“…To our knowledge, this is the first large cohort study using prospectively collected data to quantify the relative risk of severe influenza outcomes in different groups of cancer survivors compared to the general population, including stratification by time since diagnosis. The few previous studies in this area have reported high rates of influenza amongst cancer survivors, consistent with our findings, but have lacked a cancer-free comparison group [18] , [19] , [20] , [21] . Hermann et al.…”

“…Other studies have investigated vulnerability to influenza infection of any severity; two studies using administrative claims data in South Korea found a high rate of claims for influenza amongst both breast cancer survivors and survivors of childhood cancers [ 19 , 20 ]. Similarly, Australian survey data found that a large proportion (38%) of hematopoietic stem cell transplant survivors had influenza-like illnesses in the time (median 5 years) since their transplant suggesting potentially high vulnerability to infection, but there was no control group or information on severity of infection [21] .…”

Respiratory Viruses Cause Late Morbidity in Recipients of Hematopoietic Stem Cell Transplantation

“…As treatment for CRVI is limited, prevention is key. Vaccine uptake among HSCT recipients can be low and the incidence of self-reported vaccine-preventable diseases high [38]. Annual vaccination against influenza for HSCT recipients and their close contacts, creating a "protective cocoon," is an important strategy to mitigate the risk that this virus poses, including bacterial and fungal coinfection, hospitalization, and mortality [39].…”

Prevalence of COVID-19-related risk factors and risk of severe influenza outcomes in cancer survivors: a matched cohort study using linked English electronic health records data

“…The few previous studies in this area have reported high rates of influenza among cancer survivors, consistent with our findings, but have lacked a cancer-free comparison group. 18-21 Hermann et al investigated outcomes among patients with a history of cancer presenting with influenza, and found no difference in mortality according to haematological or non-haematological cancer type, or activity of the cancer. 18 Our results showed considerably higher risks of hospitalisation or death among haematological cancer survivors, which could be consistent with the findings in Hermann et al if haematological cancer survivors are at increased risk of infection, but not mortality once infected, compared to non-haematological cancer survivors.…”

“…19,20 Similarly, Australian survey data found that a large proportion (38%) of hematopoietic stem cell transplant survivors had had influenza-like illnesses in the time (median 5 years) since their transplant suggesting potentially high vulnerability to infection, but there was no control group or information on severity of infection. 21…”