title: Immunogenicity and clinical effectiveness of the trivalent inactivated influenza vaccine in immunocompromised children undergoing treatment for cancer.
abstract: Influenza is associated with significant morbidity and mortality in children receiving therapy for cancer, yet recommendation for, and uptake of the seasonal vaccine remains poor. One hundred children undergoing treatment for cancer were vaccinated with the trivalent inactivated influenza vaccine according to national guidelines in 2010 and 2011. Influenza-specific hemagglutinin inhibition antibody titers were performed on blood samples taken prior to each vaccination and 4 weeks following the final vaccination. A nasopharyngeal aspirate for influenza was performed on all children who developed an influenza-like illness. Following vaccination, seroprotection and seroconversion rates were 55 and 43% for H3N2, 61 and 43% for H1N1, and 41 and 33% for B strain, respectively. Overall, there was a significant geometric mean fold increase to H3N2 (GMFI 4.56, 95% CI 3.19-6.52, P < 0.01) and H1N1 (GMFI 4.44, 95% CI 3.19-6.19, P < 0.01) strains. Seroconversion was significantly more likely in children with solid compared with hematological malignancies and in children <10 years of age who received a two-dose schedule compared to one. Influenza infection occurred in 2% of the vaccinated study population, compared with 6.8% in unvaccinated controls, providing an adjusted estimated vaccine effectiveness of 72% (95% CI -26-94%). There were no serious adverse events and a low reactogenicity rate of 3%. The trivalent inactivated influenza vaccine is safe, immunogenic, provides clinical protection and should be administered annually to immunosuppressed children receiving treatment for cancer. All children <10 years of age should receive a two-dose schedule.
authors.affiliation: Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.|Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.|School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Rishi S
authors.initials: RS
authors.lastname: Kotecha
authors.affiliation: Department of Infectious Diseases, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Ushma D
authors.initials: UD
authors.lastname: Wadia
authors.affiliation: Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Jacoby
authors.affiliation: Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Ryan
authors.affiliation: Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.|School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.|Department of Infectious Diseases, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Blyth
authors.affiliation: Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Keil
authors.affiliation: Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.|Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.|School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Gottardo
authors.affiliation: Department of Haematology and Oncology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.|Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.|School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Cole
authors.affiliation: WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Barr
authors.affiliation: Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia, 6872, Australia.|School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia, 6840, Australia.|Department of Paediatrics, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia, 6840, Australia.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Richmond
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D007252:Influenza Vaccines / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D018655:Lymphocyte Count; D008297:Male; D009369:Neoplasms / Q000276:immunology* / Q000628:therapy; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care
chemical_list: D007252:Influenza Vaccines
keywords: Cancer; chemotherapy; immunocompromised; influenza; pediatric; vaccination