infection control & hospital epidemiology october 2015, vol. 36, no. 10 concise communication
Influenza Vaccination in Patients With Cancer: Factors Associated With Vaccination Practices for Patients and Their Household Members
Ella J. Ariza-Heredia, MD; Jacques Azzi, MD; Dimpy P. Shah, MD, PhD; Lior Nesher, MD; Shashank S. Ghantoji, MD; Lamprinos Michailidis, MD; Lisa Marsh, RN; Roy F. Chemaly, MD, MPH, FACP, FIDSA
Presented in part: IDWeek 2014; Philadelphia, PA; October 8-12, 2014 (Poster 1120).
Infect. Control Hosp. Epidemiol. 2015;36(10):1239–1241
Influenza infection causes serious illness and death in patients with cancer. However, immunization with annual flu vaccine is low. We demonstrated that a recommendation by the patient’s oncologist was the strongest predictor of vaccination not only for patients but also for their households, under- scoring the importance of a well-informed provider. Patients with cancer experience greater morbidity and
and the reasons for household members not undergoing vacci- nation when that was the case (Online Appendix A). Demographic information, including age, sex, race, spoken
language, marital status, type of insurance, religion, previous influenza vaccination, and place of residency (urban versus rural), was obtained. Data on vaccine eligibility for the nonvaccinated patients according to guidelines,2,5 type and status ofmalignancy, stem-cell transplant, comorbidities, received chemotherapy, clinical variables, treatment, and outcomes were also collected. The influenza vaccination status of the patients and house-
hold members represented the main predictive variable in this study. Descriptive statistics were used to summarize the demographic and clinical characteristics of participants. A bivariate analysis was conducted to compare factors pre- dictive of vaccination in the vaccinated and nonvaccinated participants. These characteristics were compared using a χ2 test or Fisher exact test for categorical variables and t test or Wilcoxon rank sum test for continuous variables to identify their associations with outcome. Univariable and multivariable logistic regression analyses were used to calculate the odds ratios and 95% CIs for the effect of the patient and household member vaccination status on the outcomes of interest. A 2-sided P level of .05 was considered statistically significant.
results
mortality of influenza infections than the general population.1 Annual inactivated influenza vaccination is recommended for immunocompromised patients who are at least 6 months old and for their familymembers by the Centers forDisease Control and Prevention and the Infectious Diseases Society of America.2 Unfortunately, low vaccination coverage (9%–40%) has been reported in patients with cancer and stem cell transplant.3,4 With the aim of understanding the barriers that prevent
wide vaccination uptake among cancer patients and their household, we evaluated the influenza vaccination practices at a tertiary cancer center.
methods
Patients 18 years or older who had influenza infection confirmed in our microbiology laboratory were contacted by telephone and asked to provide verbal consent to participate in this observational study. In addition, a waiver of consent to obtain available data from the patients’ medical records in case the patient and/or a designated person could not be contacted in 2 different attempts was requested. The study was approved by our institutional review board. The telephone survey included questions about the influenza
vaccine, whether the vaccine was recommended by their provi- der, the main reason for the patient not receiving the vaccine when that was the case, household members’ vaccination status,
the flu vaccine, and 64 (53%) did not. Four patients (3%) did not remember whether they had undergone vaccination, and they were excluded from the analysis.Wedetermined that 39 patients (61%) of the nonvaccinated patients had been eligible to receive the influenza vaccine by current recommendations.2,5 Recommendation by a healthcare provider was the strongest predictor of vaccination. Patients whose oncologists recom- mended the vaccine were more likely to have been vaccinated than were those who did not receive such recommendation (crude odds ratio, 6.96 [95% CI, 2.92-16.55]; P<.001). Furthermore, age older than 50 years was also a significant predictor of vaccination (crude odds ratio, 2.39 [95% CI, 1.09–5.25]; P=.029) (Table 1). In terms of sociodemographic factors, we describe a trend of
We identified 154 eligible patients with laboratory-confirmed influenza. One hundred eight patients consented verbally to participate in the survey, for a response rate of 70%. We also included vaccination rates in 12 patients from medical records. The survey showed that 52 (43%) of the 120 patients received
more frequent vaccination in white and Asian patients than in Hispanic and African Americans patients, although it was not statistically significant (P=.19). There was no association between vaccination status and the other demographic and clinical variables (Table 1). Of the 64 patients who did not receive the influenza vaccine and who responded to our survey, the main reason cited for
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