Influenza vaccination for immunocompromised patients: summary of a systematic review and meta‐analysis

Beck, Charles R.; McKenzie, Bruce C.; Hashim, Ahmed; Harris, Rebecca; Zanuzdana, Arina; Agboado, Gabriel; Orton, Elizabeth; Béchard-Evans, Laura; Morgan, Gemma; Stevenson, Charlotte; Weston, Rachel; Mukaigawara, Mitsuru; Enstone, Joanne; Augustine, Glenda; Butt, Mobasher; Kim, Sophie; Puleston, Richard; Dabke, Girija; Howard, Robert; O'Boyle, Julie; O’Brien, Mary Ann; Ahyow, Lauren; Denness, Helene; Farmer, Siobhan; Figureroa, Jose; Fisher, Paul; Greaves, Felix; Haroon, Munib; Haroon, Sophie; Hird, Caroline; Isba, Rachel; Ishola, David; Kerac, Marko; Parish, Vivienne; Roberts, Jonathan C.; Rosser, Julia; Theaker, Sarah; Wallace, Dean; Wigglesworth, Neil; Lingard, Liz; Vinogradova, Yana; Horiuchi, Hiroshi; Peñalver, Javier; Nguyen-Van-Tam, Jonathan S.

doi:10.1111/irv.12084

Cited by 29 publications

(21 citation statements)

References 8 publications

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“…Pneumococcal and injectable influenza are the only two vaccines universally recommended in all cases of immunosuppression . Their efficacy seems to be similar to that we observe in immunocompetent individuals . But other studies show that seroprotection and seroconversion are lower concerning influenza vaccine in those high‐risk group and that some therapeutic adjustments may be needed to achieve a better serologic response as a high‐dose trivalent inactivated influenza vaccine rather than standard‐dose vaccine in patients with solid tumours …”

Section: Introductionsupporting

confidence: 74%

Vaccination for influenza and pneumococcus in patients with gastrointestinal cancer or inflammatory bowel disease: A prospective cohort study of methods for improving coverage

Sitte

Frentiu

Baumann

et al. 2018

Aliment Pharmacol Ther

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Summary Background Although influenza and pneumococcal vaccinations for high‐risk populations are recommended by current guidelines, vaccination coverage is low in patients with gastrointestinal cancer (GC) or inflammatory bowel disease (IBD). Aim To evaluate the impact of a specialised infectious disease consultation on vaccination coverage rates in these patients. Methods Between December 2016 and April 2017, all patients with GC or IBD followed in the outpatient clinic of the Gastroenterology department at the Nancy University Hospital enrolled in a 3‐phase vaccination programme. Phase 1: Initial questionnaire (vaccination status, knowledge about vaccines and possible barriers to vaccination); Phase 2: Infectious disease consultation; Phase 3: Subsequent questionnaire (evolution of patients’ knowledge about vaccination). Results A total of 366 patients were included (GC = 99, IBD = 267). Vaccination rate was 34.7% for influenza and 14.5% for pneumococcus. About 43% of the patients feared side effects of vaccines. After the initial questionnaire, 49.3% of the interested patients participated in a specialised vaccination consultation (n = 102). 87.3% (n = 89) received new vaccination, 41.2% changed their mind about vaccination, and 92.2% would recommend this programme to other patients. Among vaccinated patients, 97.8% (n = 87) received pneumococcal vaccine, 40.4% received tetanus‐diphtheria‐polio vaccine, and 7.9% received influenza vaccine. In GC patients, anti‐pneumococcal vaccination rate was 87.5% after the specialised consultation compared with 10.1% before. In IBD patients, corresponding rates were 85.7% and 16.1%. Conclusions A specialised infectious disease consultation can improve GC and IBD patients’ knowledge about vaccination and vaccination coverage. This approach could be applied to all high‐risk populations.

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Section: Introductionsupporting

confidence: 74%

Vaccination for influenza and pneumococcus in patients with gastrointestinal cancer or inflammatory bowel disease: A prospective cohort study of methods for improving coverage

Sitte

Frentiu

Baumann

et al. 2018

Aliment Pharmacol Ther

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“…In addition, a single dose of PCV13 should also be administered either > 8 weeks before PPSV23 or > 1 year aft er PPSV23 ( 10 ). Pneumococcal vaccination can be safely administered at the same Vaccination against infl uenza has been shown to reduce the risk of infection in several populations, including otherwise healthy adults and children, as well as those with various comorbidities including asthma, cancer, and immunocompromised populations ( 31 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

391

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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“…35 Evidence for the effectiveness of influenza vaccines in preventing pneumonia among patients with HIV infection is also limited. 36 While these findings warrant replication in other settings, they highlight the vulnerability of older adults and patients with immunosuppressive conditions, and the need for additional measures to reduce their risk of influenza infection and related complications.…”

Section: Discussionmentioning

confidence: 89%

Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination

Grijalva

Zhu

Williams

et al. 2015

JAMA

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Importance Few studies have evaluated the relationship between influenza vaccination and pneumonia, a serious complication of influenza infection. Objective Assess the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia. Design, Setting and Participants The Etiology of Pneumonia in the Community (EPIC) study was a prospective observational multicenter study of hospitalizations for community-acquired pneumonia conducted from January 2010 through June 2012 in four US sites. We used EPIC study data from patients ≥6 months of age with laboratory-confirmed influenza infection and verified vaccination status during the influenza seasons, and excluded patients with recent hospitalization, from chronic care residential facilities, and with severe immunosuppression. Logistic regression was used to calculate odds ratios, comparing the odds of vaccination between influenza-positive (cases) and influenza-negative (controls) pneumonia patients, controlling for demographics, co-morbidities, season, study site and timing of disease onset. Vaccine effectiveness was estimated as (1-odds ratio) × 100%. Exposure Influenza vaccination, verified through record review. Outcome Influenza pneumonia, confirmed by real-time reverse transcription-polymerase chain reaction performed on nasal/oropharyngeal swabs. Results Overall, 2767 patients hospitalized for pneumonia were eligible for the study; 162 (5.9%) were influenza positive. Twenty-eight (17%) of 162 cases with influenza-associated pneumonia and 766 (29%) of 2605 controls with influenza-negative pneumonia had been vaccinated. The adjusted odds ratio of prior influenza vaccination between cases and controls was 0.43 (95% CI 0.28–0.68 [estimated vaccine effectiveness 56.7% (95% CI 31.9–72.5)]). Conclusions and relevance Among children and adults hospitalized with community-acquired pneumonia, those with laboratory confirmed influenza-associated pneumonia, compared to those with pneumonia not associated with influenza, had lower odds of having received influenza vaccination.

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Influenza vaccination for immunocompromised patients: summary of a systematic review and meta‐analysis

Cited by 29 publications

References 8 publications

Vaccination for influenza and pneumococcus in patients with gastrointestinal cancer or inflammatory bowel disease: A prospective cohort study of methods for improving coverage

Vaccination for influenza and pneumococcus in patients with gastrointestinal cancer or inflammatory bowel disease: A prospective cohort study of methods for improving coverage

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination

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