influenza vaccine in cancer patients 1241
the most significant determining factor for immunization for the patients. Literature on influenza vaccination in general population and other immunocompromised populations7 supports the importance of the role of the physician in vacci- nation decisions, and this is not an exception in oncological patients, resulting in our study in an approximately 7-fold greater likelihood of vaccination when patients receive a recommendations by their provider. Furthermore, 61% of the nonvaccinated patients met criteria for vaccination, under- scoring how providers should be well informed of current recommendations and the benefits of influenza vaccination in patients with cancer. This study also highlights the unrecog- nized effect of the oncologists’ recommendations on house- hold vaccination. Because immunocompromised patients are at greater risk for complications from influenza than the gen- eral population, providing an indirect protective effect via herd immunity (cocooning) by vaccination of family members becomes a crucial aspect of reducing their risk of infection.8 Furthermore, we found that patients older than 50 years
single-institution study of patients with influenza, which may limit the generalizability of the results. In addition, we had to rely on patient reports to obtain data on the recommendations for influenza vaccination. Such reports are subject to patients’ interpretation of physician recommendations. In conclusion, physician attitudes and recommendations
play major roles in the influenza vaccination decisions of cancer patients and their household members. One targeted intervention should be to strengthen the recommendation of physicians, especially oncologists, encouraging their partici- pation in promoting influenza vaccination of both patients and their family members.
acknowledgments
We acknowledgeMichaelWorley, ScientificPublications, and especially our patients at MD Anderson Cancer Center who were willing to participate in our survey. Financial support. None reported.
severity of illness in this specific cohort of patients should be interpreted with caution owing to the design of our study that identified only patients who had influenza infection, which systematically underestimates the effectiveness of the vaccine. Our study had a number of limitations because this was a
were more likely to have received the influenza vaccine than were younger patients, probably related to the perception of being at higher risk of complications at older age. Different from other studies, concerns about vaccine side effects or effectiveness were not identified as significant barriers to vaccination in patients with cancer.9,10 Lastly, the lack of protection of the influenza vaccine on
we sought to determine factors associated with decisions regarding influenza vaccination in a cohort of cancer patients diagnosed with influenza and their household members. In our cohort, healthcare provider’s recommendation was
Potential conflicts of interest. R. F. C. reports that he has received research
funding from Gilead, GlaxoSmithKline, ADMA Biologics, Ansun Biopharma, and
Roche.All other authors report no conflicts of interest relevant to this article.
Affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas. Address correspondence to Ella J. Ariza-Heredia, MD, Department of
Infectious Diseases, Infection Control and Employee Health, Unit 1460, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (
eariza@mdanderson.org).
Received April 23, 2015; accepted: June 1, 2015; electronically published
July 1, 2015 © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0017. DOI: 10.1017/ice.2015.150
supplementary materials
To view Supplementary Materials for this article, please visit
http://dx.doi.org/10.1017/ice.2015.150
references 1. Kunisaki KM, Janoff EN. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. Lancet Infect Dis 2009;9: 493–504.
2. Rubin LG, LevinMJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58 309–318.
3. Pedrazzoli P, Baldanti F, Donatelli I, et al. Vaccination for seasonal influenza in patients with cancer: recommendations of the Italian Society of Medical Oncology (AIOM). Ann Oncol 2014;25:1243–1247.
4. Ariza-Heredia EJ, Gulbis AM, Stolar KR, et al. Vaccination guidelines after hematopoietic stem cell transplantation: practi- tioners’ knowledge, attitudes, and gap between guidelines and clinical practice. Transpl Infect Dis 2014;16:878–886.
5. Fiore AE, Shay DK, Broder K, et al. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP) 2008 MMWR Recomm Rep 2008;57:1–60.
6. Dexter LJ, Teare MD, Dexter M, Siriwardena AN, Read RC. Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice. BMJ Open 2012:2 pii:e000851.
7. Loulergue P, Mir O, Alexandre J, Ropert S, Goldwasser F, Launay O. Low influenza vaccination rate among patients receiving chemotherapy for cancer. Ann Oncol 2008;19:1658.
8. Fine P, Eames K, Heymann DL. “Herd immunity”: a rough guide. Clin Infect Dis 2011;52:911–916.
10. Earle CC. Influenza vaccination in elderly patients with advanced colorectal cancer. J Clin Oncol 2003;21:1161–1166.
9. Zimmerman RK, Santibanez TA, Janosky JE, et al. What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and Veterans Affairs practices. Am J Med 2003;114:31–38.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140