Clinical Effectiveness of Influenza Vaccination After Allogeneic Hematopoietic Stem Cell Transplantation: A Cross-sectional, Prospective, Observational Study

Abstract

This study shows that influenza vaccination may have a clinical benefit in allo-HSCT recipients with virologicallly confirmed RVI, in terms of lower influenza RVI prevalence, LRTD progression and hospital admission.

The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation

“…Of note, our current policy also translated into an increased influenza vaccination rate (from 3% to 27%) which has also surely played a role in reducing influenza prevalence, influenza LRTD progression and hospital admission. 9 Of note, this study confirms the value of ISI score in predicting mortality in several CARV type. 43 The ISI was developed by investigators from the MD Anderson Cancer Center to predict LRTD progression and mortality in allo-HCT with RSV.…”

“…The seasonality of CARV infections in allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients mirrors the incidence of infection in the community. 9 However, CARV infections in immunocompromised patients, in particular recipients of allo-HCT, are more severe than in the general population, showing long viral shedding, higher rates of progression from the upper (URTD) to the lower respiratory tract disease (LRTD) and higher mortality rates, irrespective of the CARV type. [10][11][12] In these patients, StCP focused on influenza and RSV seems suboptimal since this strategy led to significant mortality rates after any CARV LRTD ranging from 6% to 83%.…”

Respiratory Virus Infections of the Stem Cell Transplant Recipient and the Hematologic Malignancy Patient

“…7 In a 5-year prospective observational study, allogeneic HCT recipients who received trivalent inactivated influenza vaccination had a significantly lower prevalence of virologically confirmed influenza infection (36% of vaccinated compared with 51% of nonvaccinated recipients; odds ratio [OR] 0.39), a decreased risk for progression to LRTI (OR 0.12) and a lower likelihood of influenza-related hospitalization compared with the nonvaccinated state. 29 All individuals greater than 6 months of age without contraindication, including HCT recipients and HM patients, should receive the influenza vaccination annually. Vaccination at less than 6 months post-transplant has been demonstrated to result in poor immune response, 86 and 2 doses of the influenza vaccine does not confer superior immunity compared with 1 dose.…”

The effect of timing on community acquired respiratory virus infection mortality during the first year after allogeneic hematopoietic stem cell transplantation: a prospective epidemiological survey

“…Understanding the epidemiology and timing of respiratory virus infections (RVI) after allogeneic hematopoietic stem cell transplantation (allo-HCT) is important for appropriate preventive strategies, effective diagnosis, accurate risk assessment of severe disease course, and/or treatment decision making in individual patients. The epidemiology of community acquired respiratory virus (CARV) infections among allo-HCT closely parallels incidence of infection in the community [1], although in immunocompromised patients these infections are notable for prolonged viral shedding, higher rates of pneumonia, late airflow obstruction, and mortality [2,3].…”

“…Established and validated risk factors for progression from upper respiratory tract disease (URTD) to lower respiratory tract disease (LRTD) and mortality include recipient age, smoking history, high APACHE II score, lymphopenia, high-dose total body irradiation, high-dose steroids, and presence of copathogens [4][5][6][7][8]. Validated risk scores have recently been proposed to predict respiratory syncytial virus (RSV) and influenza virus infections with greater accuracy [1,[9][10][11][12][13]. Despite the suspicion in real life practice that the timing of CARV infection after allo-HCT could be related to increased severity and mortality, there is a lack of strong evidence supporting this belief.…”