Influenza vaccines in immunosuppressed adults with cancer

Bitterman, Roni; Eliakim‐Raz, Noa; Vinograd, Inbal; Trestioreanu, Anca Zalmanovici; Leibovici, Leonard; Paul, Mical

doi:10.1002/14651858.cd008983.pub3

Cited by 114 publications

(107 citation statements)

References 96 publications

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“…Bacterial infections and viral reactivations are well-known complications of neutropenia and lymphopenia, but it is less clear to what extent the severity of de novo viral infections is also affected. Although there are data suggesting that chemotherapy-treated patients with cancer are at risk for severe complications of influenza 6,7 , it is unclear how this might generalize to COVID-19. A recent study has reported increased incidence and morbidity of COVID-19 in patients with cancer 8 , but those findings were rightly challenged by others 9,10 .…”

Section: Clinical Activitiesmentioning

confidence: 99%

Caring for patients with cancer in the COVID-19 era

Haar

Hoes

Coles

et al. 2020

Nat Med

283

296

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Section: Clinical Activitiesmentioning

confidence: 99%

Caring for patients with cancer in the COVID-19 era

Haar

Hoes

Coles

et al. 2020

Nat Med

283

296

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“…Our primary outcome combined influenza hospitalisations and deaths but was dominated by the former; it is plausible that there may be a lower threshold for hospitalisation in cancer survivors which could have exaggerated the difference in risk of the primary outcome between cancer survivors and controls, but is unlikely to fully explain the large associations we observed. Finally, we had some missing data on smoking and BMI data, and we excluded those with missing data from the analysis; this is unlikely to affect our findings under the Improving influenza vaccination coverage among cancer survivors should be a priority, as the vaccine is both effective and safe 29,30 but coverage has been reported in the range of 50% to 76% among cancer survivors in the US and in the UK. 31,32 Immunisation for streptococcus pneumoniae may also be considered.…”

Section: Discussionmentioning

confidence: 99%

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

Carreira

Strongman

Peppa

et al. 2020

Preprint

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Background People with active cancer are recognised as at risk of COVID-19 complications, but it is unclear whether the much larger population of cancer survivors is at elevated risk. We aimed to address this by comparing cancer survivors and cancer-free controls for (i) prevalence of comorbidities considered risk factors for COVID-19; and (ii) risk of severe influenza, as a marker of susceptibility to severe outcomes from epidemic respiratory viruses. Methods We included survivors (≥1 year) of the 20 most common cancers, and age, sex and general practice-matched cancer-free controls, derived from UK primary care data linked to cancer registrations, hospital admissions and death registrations. Comorbidity prevalences were calculated 1 and 5 years from cancer diagnosis. Risk of hospitalisation or death due to influenza was compared using Cox models adjusted for baseline demographics and comorbidities. Findings 108,215 cancer survivors and 523,541 cancer-free controls were included. Cancer survivors had more asthma, other respiratory, cardiac, diabetes, neurological, renal, and liver disease, and less obesity, compared with controls, but there was variation by cancer site. There were 205 influenza hospitalisations/deaths, with cancer survivors at higher risk than controls (adjusted HR 2.78, 95% CI 2.04-3.80). Haematological cancer survivors had large elevated risks persisting for >10 years (HR overall 15.17, 7.84-29.35; HR >10 years from cancer diagnosis 10.06, 2.47-40.93). Survivors of other cancers had evidence of raised risk up to 5 years from cancer diagnosis only (HR 2.22, 1.31-3.74). Interpretation Risks of severe COVID-19 outcomes are likely to be elevated in cancer survivors. This should be taken into account in policies targeted at clinical risk groups, and vaccination for both influenza, and, when available, COVID-19, should be encouraged in cancer survivors.

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“… 36 37 A Cochrane meta-analysis also found vaccinated cancer patients had a significantly lower all-cause mortality than those who did not get vaccinated. 3 However, despite public health recommendations, the documented rates of vaccination are only 30% to 50% among patients with cancer, similar to the general population. 38 39 In contrast to their relatively low vaccination rates, proactive education approaches that raise awareness about the necessity of vaccination among cancer patients is warranted.…”

Section: Discussionmentioning

confidence: 99%

Influenza in hospitalised patients with malignancy: a propensity score matching analysis

Zhang

Sun

et al. 2020

ESMO Open

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BackgroundPatients with malignancy are vulnerable to influenza viruses and are at high risk of developing serious complications. However, few studies have investigated the impact of influenza infection among hospitalised patients with malignancy.MethodsCancer-related hospitalisations were identified by using data from National Inpatient Sample in the USA between 2012 and 2014. We conducted a 1:1 propensity score matching analysis to compare the in-hospital outcomes between cancer patients with and without influenza. Multivariate logistic regression analyses were also performed to identify independent prognosis predictors of mortality.ResultsWe identified 13 186 849 weighted cancer-related hospitalisations during the study period, and 47 850 of them (0.36%) had a concomitant diagnosis of influenza. After propensity score matching, cancer patients with concomitant influenza had a higher mortality (5.4% vs 4.2%; OR, 1.30; 95% CI, 1.13 to 1.49; p<0.001), longer length of stay (6.3 days vs 5.6 days; p<0.001) but lower costs (US$14 605.9 vs US$14 625.5; p<0.001) in hospital than those without influenza. In addition, cancer patients with influenza had a higher incidence of complications, including pneumonia (18.4% vs 13.2%; OR, 1.49; 95% CI, 1.37 to 1.62; p<0.001), neutropenia (7.1% vs 3.4%; OR, 2.18; 95% CI, 1.91 to 2.50; p<0.001), sepsis (19.5% vs 9.3%; OR, 2.36; 95% CI, 2.16 to 2.58; p<0.001), dehydration (14.8% vs 8.8%; OR, 1.80; 95% CI, 1.65 to 1.97; p<0.001) and acute kidney injury (19.9% vs 17.6%; OR, 1.16; 95% CI, 1.08 to 1.25; p<0.001) than those without influenza. Older age, no insurance, more comorbidities, lung cancer and haematological malignancy were independently associated with higher mortality.ConclusionInfluenza is associated with worse in-hospital clinical outcomes among hospitalised patients with malignancy. Annual influenza vaccination and early initiation of antiviral therapy are recommended in this high-risk population.

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Influenza vaccines in immunosuppressed adults with cancer

Abstract: and the ImmunoCompromised (UNIIC) Study Group. Influenza vaccination for immunocompromised patients: systematic review and meta-analysis by etiology.

Cited by 114 publications

References 96 publications

Caring for patients with cancer in the COVID-19 era

Caring for patients with cancer in the COVID-19 era

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

Influenza in hospitalised patients with malignancy: a propensity score matching analysis

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