The Lancet. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses

[Giuseppe]

Abstract. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses (The Lancet, edited)

The Lancet Infectious Diseases, Volume 9, Issue 8, Pages 493 - 504, August 2009
doi:10.1016/S1473-3099(09)70175-6

Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses

[Original Abstract: LINK. EDITED.]


Ken M Kunisaki MD a b , Edward N Janoff MD c d


Summary


Patients that are immunosuppressed might be at risk of serious influenza-associated complications. As a result, multiple guidelines recommend influenza vaccination for patients infected with HIV, who have received solid-organ transplants, who have received haemopoietic stem-cell transplants, and patients on haemodialysis. However, immunosuppression might also limit vaccine responses. To better inform policy, we reviewed the published work relevant to incidence, outcomes, and prevention of influenza infection in these patients, and in patients being treated chemotherapy and with systemic corticosteroids. Available data suggest that most immunosuppressed populations are indeed at higher risk of influenza-associated complications, have a general trend toward impaired humoral vaccine responses (although these data are mixed), and can be safely vaccinated?although longitudinal data are largely lacking. Randomised clinical trial data were limited to one study of HIV-infected patients with high vaccine efficacy. Better trial data would inform vaccination recommendations on the basis of efficacy and cost in these at-risk populations.

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[AlaskaDenise]

Re: The Lancet. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses

.................. However, immunosuppression might also limit vaccine responses. .......in patients being treated chemotherapy and with systemic corticosteroids. Available data suggest that most immunosuppressed populations are indeed at higher risk of influenza-associated complications, have a general trend toward impaired humoral vaccine responses (although these data are mixed), and can be safely vaccinated?although longitudinal data are largely lacking. Randomised clinical trial data were limited to one study of HIV-infected patients with high vaccine efficacy. .....------

Vaccination for chronically immunocompromised patients might be a very different situation that patients undergoing temporary chemotherapy. Cancer patients are generally advised to get any immunizations (e.g., pneumovax & influenza) in advance of chemotherapy.

Conclusion.

Patients on cancer chemotherapy should receive vaccination at least 2 weeks before initiation of treatment. Providers should avoid administering vaccination during chemotherapy or active radiation treatment because of suboptimal responses to vaccines. Active immunization has been shown to confer protective immunity to several infections in cancer patients at similar rates to healthy individuals.

http://opp.sagepub.com/cgi/content/abstract/12/3/143
(Journal of Oncology Pharmacy Practice)

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