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Observational study of vaccination in cancer patients: How can vaccine coverage be improved? - 15/12/19

Étude observationnelle sur la vaccination chez les patients atteints de cancer : comment améliorer la couverture vaccinale ?

Doi : 10.1016/j.medmal.2019.11.006 
A. Monier a, b, M. Puyade c, M.P. Gallego Hernanz d, P. Bouchaert e, X. Leleu d, f, J.M. Tourani e, F. Roblot a, b, g, B. Rammaert a, b, g,
a Faculté de médecine et pharmacie, University of Poitiers, Poitiers, France 
b Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France 
c Service de médecine interne, CHU de Poitiers, Poitiers, France 
d Service d’hématologie et thérapie cellulaire, CHU de Poitiers, Poitiers, France 
e Service d’oncologie médicale, CHU de Poitiers, Poitiers, France 
f Inserm CIC 1402, Poitiers, France 
g Inserm U1070, Poitiers, France 

Corresponding author.
In corso di stampa. Prove corrette dall'autore. Disponibile online dal Sunday 15 December 2019
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Highlights

Patients presenting with cancer should benefit from vaccines as they are exposed to a heightened risk of invasive pneumococcal diseases (IPD) and influenza illness, leading to an increased risk of morbi-mortality.
Cancer patients are under vaccinated against the two main frequent and threatening diseases (IPD and the flu) with vaccination coverage of 7.2% and 28.6%, respectively.
Factors associated with appropriate vaccination in oncology and hematology include age ≥65 years, information received from family physicians, being treated for an hematological malignancy, and having a positive opinion about vaccination.

Il testo completo di questo articolo è disponibile in PDF.

Abstract

Background

Chemotherapy increases the risk of infections, often severe, and some of them are vaccine-preventable infections. We aimed to assess vaccination coverage and associated factors in oncology and hematology patients.

Methods

Consecutive adult patients followed in a French university hospital for hematological malignancy or solid cancer voluntarily completed an anonymous questionnaire in September and October 2016. It included questions on underlying disease, chemotherapy, flu, and pneumococcal vaccination uptakes, and attitudes toward vaccination. Factors associated with vaccination uptake were assessed by multivariate logistic regression.

Results

The response rate was 41.9% (N=671) among 1,600 questionnaires distributed; 232 patients had underlying hematological malignancy and 439 had solid cancer. Half of the patients were aged over 65 years. Chemotherapy was ongoing or discontinued for less than one year in 74.7% of patients. In patients aged <65 years undergoing chemotherapy, flu vaccination rate was 19.9% whereas patients aged >65 years had coverage of 47%. Pneumococcal vaccine uptake was 7.3%. However, 64.7% of patients were favorable to vaccination. Vaccine uptake was associated with age >65 years (OR 4.5 [2.9–7.0]), information about vaccination delivered by the family physician (OR 12.9 [5.5–30.1]), follow-up in hematology unit (OR 2.0 [1.3–3.1]), and positive opinion about vaccination (OR 2.0 [1.3–3.1]).

Conclusion

Despite specific recommendations regarding immunocompromised patients, anti-pneumococcal and flu vaccinations were rarely conducted, even in elderly patients. Targeted information campaigns to family physicians, oncologists, and patients should be implemented to improve vaccine coverage in patients with underlying malignancies.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Immunocompromised host, Cancer, Vaccination


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