Protecting Pediatric Oncology Patients From Influenza

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. The Oncologist 2013;18:204 -211 Implications for Practice: Pediatric oncology patients can have very severe infections with the influenza virus. Their vulnerability is due to chronic illness and immune suppression. Simple strategies, such as ensuring vaccination, infection control measures, and education regarding personal protection can protect this population that is susceptible to severe influenza.

Does vaccine dose predict response to the monovalent pandemic H1N1 influenza a vaccine in children with acute lymphoblastic leukemia? A single‐centre study

“…A full dose of vaccine was also associated with a significantly greater magnitude of immunological response after (Table IV, P ¼ 0.04) and after two doses (Table V, P < 0.001), an association confirmed by performing ANOVA of repeated measures (probability > F < 0.0001). A similar "doseresponse effect has been reported in other contexts [16] and may represent a potential strategy to further improve immunogenicity of influenza vaccine in children with ALL. A potential confounder to this effect of dose on vaccine immunogenicity is the older age (!13 years) of the children receiving the adult dose of the vaccine.…”

The importance of immunization in cancer prevention, treatment, and survivorship

“…A recent multicenter study of 115 patients with solid tumors who were infected with influenza A (H1N1) in 2009 found high rates of hospitalization (50%), pneumonia (23%), and death (9.5%) . Up to two‐thirds of children receiving cancer therapy who contract influenza are hospitalized, for 2 to 7 days on average, with respiratory complications such as pneumonia, respiratory failure, and a need for ventilator support in 10% to 20% of patients . In addition to influenza‐related morbidity, influenza infection in children can result in treatment delays averaging 3 weeks, potentially affecting long‐term prognosis .…”

“…Up to two‐thirds of children receiving cancer therapy who contract influenza are hospitalized, for 2 to 7 days on average, with respiratory complications such as pneumonia, respiratory failure, and a need for ventilator support in 10% to 20% of patients . In addition to influenza‐related morbidity, influenza infection in children can result in treatment delays averaging 3 weeks, potentially affecting long‐term prognosis . Vaccination of pediatric patients with cancer and family members is an important prevention strategy .…”

“…In addition to influenza‐related morbidity, influenza infection in children can result in treatment delays averaging 3 weeks, potentially affecting long‐term prognosis . Vaccination of pediatric patients with cancer and family members is an important prevention strategy . In addition, vaccination of health care workers is critical to prevent nosocomial transmission of influenza to patients with cancer.…”

Vaccinations in children on immunosuppressive medications for renal disease

“…However, patients on RTX and those with active disease had a poorer response [50,51]. In studies in children with hematological malignancies, patients were found to have protective anti-influenza antibody rates of 30-70 % post-vaccination, with increases in the number and magnitude of the doses sometimes required for improved responses [52,53].…”