1240 infection control & hospital epidemiology october 2015, vol. 36, no. 10


table 1. Influenza Vaccination Status in Patients with Cancer: Characteristics y and Underlying Medical Conditions Characteristic


Unvaccinated (N=64)


Median age at flu diagnosis ≤50 years >50 years


Sex Male Female


Race/ethnicity White Black


Hispanic Asian


Smoking statusa Never


Former/Current


41 (64) 23 (36)


34 (53) 12 (19) 15 (23) 3 (5)


36 (56) 27 (42)


Underlying condition Hematological malignancy 20 (31) Solid tumor HCT


Cancer statusb Active


Remission


Physician recommendation of vaccinationc No Yes


12 (19) 32 (50)


43 (67) 20 (31)


43 (67) 17 (27)


30 (58) 22 (42)


33 (63) 5 (10) 6 (12) 8 (15)


35 (67) 16 (31)


13 (25) 8 (15) 31(60)


29 (56) 21 (40)


12 (23) 33 (63)


statistically significant values (p<.005). aData was available for 114 patients for smoking status. bData was available for 113 patients for cancer status. cData was available for 105 patients for physician recommendations.


30 (47) 34 (53)


Vaccinated (N=52)


14 (27) 38 (73)


Crude odds ratio for receiving vaccination (95% CI)


1 [Reference]


2.39 (1.09–5.25) 1 [Reference]


1.31 (0.62–2.77) 1 [Reference]


0.43 (0.14–1.35) 0.41 (0.14–1.19) 2.75 (0.67–11.26)


1 [Reference]


0.61 (0.28–1.32) 1 [Reference]


1.03 (0.33–3.19) 1.49 (0.63–3.51)


1 [Reference] 1.56 (0.72–3.37) 1 [Reference] 6.96 (2.92–16.55) <.001 NOTE. Data are no. (%) of patients unless otherwise indicated. HCT, hematopoietic stem cell transplantation. Bold indicates .261 .21


.965 .361


.029 .484


.149 .102 .160


P value


nonvaccination was the recommendation against it by the patient’s oncologist (56 [88%]). Information on influenza vaccination of householdmembers for 88 patients was analyzed. Full household vaccination occurred in 38 (43%) of the house- holds. A healthcare provider’s recommendation against vacci- nation was also among the most common reasons behind the lack of vaccination (Figure 1). Notably, 16 household members (18%) had flu-like illness around the time patients were diag- nosed with influenza infection. Vaccination status did not have a significant effect on


hospital admission, progression to pneumonia, or mortality. In multivariable analysis, patients who experienced progres- sion to pneumonia were more likely to be neutropenic, to be older, and to have not received oseltamivir early in the course (all, P<.05)


discussion


figure 1. Primary reasons for not undergoing influenza vaccination. A, Patients’ answers; B, Household members’ answers.


Vaccination as a public health intervention has been shown to lessen or eliminate the burden of many infectious diseases. Proper understanding of the barriers to appropriate influenza vaccination coverage is essential for designing future improvement strategies to increase compliance.6 Therefore,


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