Serologic response and clinical efficacy of influenza vaccination in children and young adults on chemotherapy for cancer

Daniel K. Choi*, Ramsay L Fuleihan, David O Walterhouse

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Influenza is a health risk to children receiving chemotherapy for cancer. An absolute lymphocyte count (ALC) >1,000 cells/mm3 has been associated with the ability to produce an immune response to influenza vaccine during chemotherapy. However, clinical efficacy of influenza vaccination during chemotherapy remains unclear. Procedure: We conducted a prospective cohort study in children receiving chemotherapy for cancer during two consecutive influenza seasons. Assessments of immune cells and serologic response were measured immediately before and after receiving influenza vaccine. Patients were monitored for influenza or influenza-like illness (ILI). Results: Two hundred fifty-nine patients were studied over 2 years. The seroresponse rate was 62% (98/157). The median ALC at vaccination was higher in seroresponders than nonresponders, 854 cells/mm3 versus 602 cells/mm3, respectively (P < 0.036). Univariate analysis showed that patients with an ALC <1,000 cells/mm3 at the time of vaccination were twice as likely to be sero-nonresponders (P < 0.02, OR = 2.4, 95% CI: 1.1–5.0). Twelve percent (31/259) of patients developed influenza, of whom all had fever at presentation, 26% (8/31) required hospitalization, and 81% (25/31) had chemotherapy delays. No deaths were associated with influenza infection. The proportion of patients with influenza was not different between seroresponders and nonresponders. Conclusions: Influenza infection following immunization remains a source of morbidity in children undergoing chemotherapy. Lymphopenia at vaccination predicted sero-nonresponse. Seroresponse was not associated with a decreased frequency of influenza infection or ILI when compared to sero-nonresponders, suggesting clinical effectiveness of vaccination is likely multifactorial. Further investigation into the efficacy of the influenza vaccine is needed to refine immunization recommendations.

Original languageEnglish (US)
Pages (from-to)2011-2018
Number of pages8
JournalPediatric Blood and Cancer
Volume63
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Human Influenza
Young Adult
Vaccination
Drug Therapy
Neoplasms
Influenza Vaccines
Lymphocyte Count
Immunization
Infection
Lymphopenia
Hospitalization
Cohort Studies
Fever
Prospective Studies
Morbidity
Health

Keywords

  • childhood cancer
  • infection prevention
  • influenza
  • supportive care
  • vaccination

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

@article{347f5c7f55ea4662bcb3d617f5a2b21c,
title = "Serologic response and clinical efficacy of influenza vaccination in children and young adults on chemotherapy for cancer",
abstract = "Background: Influenza is a health risk to children receiving chemotherapy for cancer. An absolute lymphocyte count (ALC) >1,000 cells/mm3 has been associated with the ability to produce an immune response to influenza vaccine during chemotherapy. However, clinical efficacy of influenza vaccination during chemotherapy remains unclear. Procedure: We conducted a prospective cohort study in children receiving chemotherapy for cancer during two consecutive influenza seasons. Assessments of immune cells and serologic response were measured immediately before and after receiving influenza vaccine. Patients were monitored for influenza or influenza-like illness (ILI). Results: Two hundred fifty-nine patients were studied over 2 years. The seroresponse rate was 62{\%} (98/157). The median ALC at vaccination was higher in seroresponders than nonresponders, 854 cells/mm3 versus 602 cells/mm3, respectively (P < 0.036). Univariate analysis showed that patients with an ALC <1,000 cells/mm3 at the time of vaccination were twice as likely to be sero-nonresponders (P < 0.02, OR = 2.4, 95{\%} CI: 1.1–5.0). Twelve percent (31/259) of patients developed influenza, of whom all had fever at presentation, 26{\%} (8/31) required hospitalization, and 81{\%} (25/31) had chemotherapy delays. No deaths were associated with influenza infection. The proportion of patients with influenza was not different between seroresponders and nonresponders. Conclusions: Influenza infection following immunization remains a source of morbidity in children undergoing chemotherapy. Lymphopenia at vaccination predicted sero-nonresponse. Seroresponse was not associated with a decreased frequency of influenza infection or ILI when compared to sero-nonresponders, suggesting clinical effectiveness of vaccination is likely multifactorial. Further investigation into the efficacy of the influenza vaccine is needed to refine immunization recommendations.",
keywords = "childhood cancer, infection prevention, influenza, supportive care, vaccination",
author = "Choi, {Daniel K.} and Fuleihan, {Ramsay L} and Walterhouse, {David O}",
year = "2016",
month = "11",
day = "1",
doi = "10.1002/pbc.26110",
language = "English (US)",
volume = "63",
pages = "2011--2018",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
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TY - JOUR

T1 - Serologic response and clinical efficacy of influenza vaccination in children and young adults on chemotherapy for cancer

AU - Choi, Daniel K.

AU - Fuleihan, Ramsay L

AU - Walterhouse, David O

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: Influenza is a health risk to children receiving chemotherapy for cancer. An absolute lymphocyte count (ALC) >1,000 cells/mm3 has been associated with the ability to produce an immune response to influenza vaccine during chemotherapy. However, clinical efficacy of influenza vaccination during chemotherapy remains unclear. Procedure: We conducted a prospective cohort study in children receiving chemotherapy for cancer during two consecutive influenza seasons. Assessments of immune cells and serologic response were measured immediately before and after receiving influenza vaccine. Patients were monitored for influenza or influenza-like illness (ILI). Results: Two hundred fifty-nine patients were studied over 2 years. The seroresponse rate was 62% (98/157). The median ALC at vaccination was higher in seroresponders than nonresponders, 854 cells/mm3 versus 602 cells/mm3, respectively (P < 0.036). Univariate analysis showed that patients with an ALC <1,000 cells/mm3 at the time of vaccination were twice as likely to be sero-nonresponders (P < 0.02, OR = 2.4, 95% CI: 1.1–5.0). Twelve percent (31/259) of patients developed influenza, of whom all had fever at presentation, 26% (8/31) required hospitalization, and 81% (25/31) had chemotherapy delays. No deaths were associated with influenza infection. The proportion of patients with influenza was not different between seroresponders and nonresponders. Conclusions: Influenza infection following immunization remains a source of morbidity in children undergoing chemotherapy. Lymphopenia at vaccination predicted sero-nonresponse. Seroresponse was not associated with a decreased frequency of influenza infection or ILI when compared to sero-nonresponders, suggesting clinical effectiveness of vaccination is likely multifactorial. Further investigation into the efficacy of the influenza vaccine is needed to refine immunization recommendations.

AB - Background: Influenza is a health risk to children receiving chemotherapy for cancer. An absolute lymphocyte count (ALC) >1,000 cells/mm3 has been associated with the ability to produce an immune response to influenza vaccine during chemotherapy. However, clinical efficacy of influenza vaccination during chemotherapy remains unclear. Procedure: We conducted a prospective cohort study in children receiving chemotherapy for cancer during two consecutive influenza seasons. Assessments of immune cells and serologic response were measured immediately before and after receiving influenza vaccine. Patients were monitored for influenza or influenza-like illness (ILI). Results: Two hundred fifty-nine patients were studied over 2 years. The seroresponse rate was 62% (98/157). The median ALC at vaccination was higher in seroresponders than nonresponders, 854 cells/mm3 versus 602 cells/mm3, respectively (P < 0.036). Univariate analysis showed that patients with an ALC <1,000 cells/mm3 at the time of vaccination were twice as likely to be sero-nonresponders (P < 0.02, OR = 2.4, 95% CI: 1.1–5.0). Twelve percent (31/259) of patients developed influenza, of whom all had fever at presentation, 26% (8/31) required hospitalization, and 81% (25/31) had chemotherapy delays. No deaths were associated with influenza infection. The proportion of patients with influenza was not different between seroresponders and nonresponders. Conclusions: Influenza infection following immunization remains a source of morbidity in children undergoing chemotherapy. Lymphopenia at vaccination predicted sero-nonresponse. Seroresponse was not associated with a decreased frequency of influenza infection or ILI when compared to sero-nonresponders, suggesting clinical effectiveness of vaccination is likely multifactorial. Further investigation into the efficacy of the influenza vaccine is needed to refine immunization recommendations.

KW - childhood cancer

KW - infection prevention

KW - influenza

KW - supportive care

KW - vaccination

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U2 - 10.1002/pbc.26110

DO - 10.1002/pbc.26110

M3 - Article

C2 - 27327360

AN - SCOPUS:84988423277

VL - 63

SP - 2011

EP - 2018

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

IS - 11

ER -