Influenza in children with cancer

doi:10.1016/S0022-3476(89)80325-7

The Journal of Pediatrics

Volume 115, Issue 1, July 1989, Pages 33-39

https://doi.org/10.1016/S0022-3476(89)80325-7 Get rights and content

We prospectively followed a group of unimmunized, immunosuppressed children with cancer to determine their relative risk of influenza and the severity of infection compared with those of siblings or matched community controls. The incidence of influenza infection was higher in children with cancer (23/73, 32%) than in control subjects (10/70, 14%, p=0.02). A preseason hemagglutination inhibition titer≥1:32, generally used as a marker of successful immunization in vaccine trials, was protective for all children in the control groups, but did not prevent influenza infection in 24% of the patients with cancer. Infection rates of patients and community controls with titers ≥1:32 differed significantly (p=0.006). No significant differences were noted in duration of reported symptoms between groups, and clinical complications occurred too infrequently to analyze. However, 2 (11%) of 18 of the cancer patients with positive culture results were hospitalized during the illness and one patient developed a nosocomial infection. None of the control children was hospitalized. These findings suggest the need for further study of the immunologic response of immunosuppressed children to influenza infection and a clinical efficacy trial of the influenza vaccine in these patients.

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Cited by (109)

Lessons learnt from influenza vaccination in immunocompromised children undergoing treatment for cancer
2023, The Lancet Child and Adolescent Health
Influenza infection contributes substantially to global morbidity and mortality, with children undergoing treatment for cancer among the most vulnerable due to immunosuppression associated with disease and treatment. However, influenza remains one of the most common vaccine-preventable diseases. Despite international guidelines recommending inactivated influenza vaccination on the basis of data supporting efficacy and an excellent safety profile in this population, uptake has often been suboptimal due to persisting hesitancy among both patients and oncologists regarding the ability of the vaccine to mount a sufficient immune response, the optimal vaccine schedule and timing, and the best method to assess response in immunocompromised populations. In this Review, we discuss the evidence regarding influenza vaccination in children with cancer, factors that influence response, and highlight strategies to optimise vaccination. Host immune factors play a substantial role, thus principles learnt from influenza vaccination can be broadly applied for the use of inactivated vaccines in children with cancer.
The Effectiveness of Trivalent Inactivated Influenza Vaccine in Children with Acute Leukemia
2017, Journal of Pediatrics
The objective of this study was to determine the effectiveness of trivalent inactivated influenza vaccine (TIV) for the prevention of laboratory-confirmed influenza and influenza-like illnesses (ILI) among children and adolescents receiving therapy for acute leukemia.
A retrospective review of the demographic and clinical characteristics of 498 patients at a pediatric cancer center who received therapy for acute leukemia during 3 successive influenza seasons (2010-2011 through 2012-2013).
In 498 patient seasons with a known immunization history (median age, 6 years; range, 1-21), 354 patients (71.1%) were immunized with TIV and 98 (19.7%) received a booster dose of vaccine. Vaccinated and unvaccinated patients had generally similar demographic characteristics. There were no differences in the overall rates of influenza or ILI between vaccinated and unvaccinated patients overall, or in any individual season. There was no difference in the rates of influenza or ILI between patients who received 1 dose of vaccine and those who received 2 doses. Time to first influenza infection and time to first ILI in vaccinated and unvaccinated patients were not different.
TIV did not protect children and adolescents with acute leukemia against laboratory-confirmed influenza or ILI. Future prospective studies should assess TIV effectiveness in high-risk subpopulations and alternative strategies to prevent influenza should be considered in this population.
Vaccination of Immunocompromised Hosts
2017, Plotkin's Vaccines
Immunogenicity and safety of high-dose trivalent inactivated influenza vaccine compared to standard-dose vaccine in children and young adults with cancer or HIV infection
2016, Vaccine
Citation Excerpt :
Influenza remains a major cause of morbidity and mortality among immunocompromised children, resulting in prolonged illness and viral shedding, delays in chemotherapy, and increase in the incidence of hospitalization [1–7].
Approaches to improve the immune response of immunocompromised patients to influenza vaccination are needed.
Children and young adults (3–21 years) with cancer or HIV infection were randomized to receive 2 doses of high-dose (HD) trivalent influenza vaccine (TIV) or of standard-dose (SD) TIV. Hemagglutination inhibition (HAI) antibody titers were measured against H1, H3, and B antigens after each dose and 9 months later. Seroconversion was defined as ≥4-fold rise in HAI titer comparing pre- and post-vaccine sera. Seroprotection was defined as a post-vaccine HAI titer ≥1:40. Reactogenicity events (RE) were solicited using a structured questionnaire 7 and 14 days after each dose of vaccine, and adverse events by medical record review for 21 days after each dose of vaccine.
Eighty-five participants were enrolled in the study; 27 with leukemia, 17 with solid tumor (ST), and 41 with HIV. Recipients of HD TIV had significantly greater fold increase in HAI titers to B antigen in leukemia group and to H1 antigen in ST group compared to SD TIV recipients. This increase was not documented in HIV group. There were no differences in seroconversion or seroprotection between HD TIV and SD TIV in all groups. There was no difference in the percentage of solicited RE in recipients of HD TIV (54% after dose 1 and 38% after dose 2) compared to SD TIV (40% after dose 1 and 20% after dose 2, p = 0.27 and 0.09 after dose 1 and 2, respectively).
HD TIV was more immunogenic than SD TIV in children and young adults with leukemia or ST, but not with HIV. HD TIV was safe and well-tolerated in children and young adults with leukemia, ST, or HIV.
Randomized Double-Blind Study of the Safety and Immunogenicity of Standard-Dose Trivalent Inactivated Influenza Vaccine versus High-Dose Trivalent Inactivated Influenza Vaccine in Adult Hematopoietic Stem Cell Transplantation Patients
2016, Biology of Blood and Marrow Transplantation
Citation Excerpt :
Patients with influenza pneumonia, which includes 9.5% to 75% of HCT recipients with influenza, have higher mortality rates [8-13]. In the community, an influenza epidemic can be associated with attack rates of 10% to 20% in the general population; however, attack rates are higher in individuals with cancer [14-17]. Moreover, significant morbidity and mortality were noted in HCT patients during the recent H1N1 pandemic, with several reports of pneumonia, lower respiratory tract infections, rhabdomyolysis, and death, including many individuals who were affected more than 6 months after their HCT [18-24].
Hematopoietic stem cell transplantation (HCT) survivors are less likely than matched healthy controls to mount a strong immune response to trivalent inactivated influenza vaccine (TIV). High-dose (HD) or standard-dose (SD) TIV were given to adult HCT subjects 18 years or older at least 6 months after transplantation. Subjects were randomized 2:1 to receive either the HD (60 μg hemagglutinin [HA]/strain/dose) or the SD (15 μg HA/strain/dose) TIV. Injection-site and systemic reactions were documented after each vaccination and immune responses were measured before and after each vaccination. A total of 44 subjects were enrolled (25 in year 1 and 19 in year 2), with 15 in the SD group and 29 in the HD group. The median time to vaccination after transplantation was 7.9 months (range, 6 to 106 months), the median age was 50 years (range, 19.6 to 73 years), and 61% were male. No differences in demographic or lab data were noted between groups; however, the HD group had higher median baseline total IgG level (676 versus 469 mg/dL, P = .025). No differences in individual injection-site or systemic reactions were noted between groups; however, more events of any injection-site symptom combined were reported in the HD group. No serious adverse events were attributed to vaccination. After vaccination, the HD group had a higher percentage of individuals with titers ≥1:40 and a higher geometric mean titer (GMT) against the H3N2 strain compared with that of the SD group. HD and SD TIV were found to be safe and well tolerated in adult HCT recipients. However, the HD group had higher frequency of injection-site reactions but the majority of the reactions were mild and resolved. The HD group had a higher percentage of individuals with post-vaccination titer ≥ 1:40 and GMT for H3N2 antigen, indicating better immunogenicity. These data support the need for a phase II immunogenicity trial in HCT recipients.
Influenza (Including Avian Influenza and Swine Influenza)
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

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^*: Supported by grants from the Robert Wood Johnson Foundation, The Thrasher Foundation, The Cancer Council of the United Way, and the Ontario Thoracic Society. The research was undertaken by Dr. Kempe in partial fulfillment of the requirements of a master of science degree in Community Health, Department of Preventive Medicine, University of Rochester.

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Original articleInfluenza in children with cancer*

Lancet

J Pediatr

J Pediatr

J Pediatr

J Pediatr

Influenza: a shot or not?

Pediatrics

Impact of type A influenza on children: a retrospective study

Am J Public Health

Rhinovirus and influenza type A infections as precipitants of asthma

Am Rev Respir Dis

Asiatic influenza in allergic patients with bronchial asthma

Int Arch Allergy

Viruses as precipitants of asthmatic attacks in children

JAMA

Original article
Influenza in children with cancer*