Phillip S Blanchette1,2,3, Hannah Chung3, Kathleen I Pritchard4, Craig C Earle3,4, Michael A Campitelli3, Sarah A Buchan3,5,6, Kevin L Schwartz3,5,6, Natasha S Crowcroft3,5,6, Jonathan B Gubbay5,6,7, Timothy Karnauchow8,9, Kevin Katz6,10, Allison J McGeer6,11, James D McNally8, David C Richardson12, Susan E Richardson6,7, Laura C Rosella3,5,6, Andrew Simor6,13, Marek Smieja14, George Zahariadis15, Aaron Campigotto6,7, Jeffrey C Kwong3,5,6,16. 1. University of Western Ontario, London, Ontario, Canada. 2. London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada. 3. ICES London and Toronto, Ontario, Canada. 4. Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada. 5. Public Health Ontario, Toronto, Ontario, Canada. 6. University of Toronto, Toronto, Ontario, Canada. 7. The Hospital for Sick Children, Toronto, Ontario, Canada. 8. Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 9. University of Ottawa, Ottawa, Ontario, Canada. 10. North York General Hospital, Toronto, Ontario, Canada. 11. Mount Sinai Hospital, Ontario, Canada. 12. William Osler Health System, Brampton, Ontario, Canada. 13. Sunnybrook Health Science Centre, Toronto, Ontario, Canada. 14. McMaster University, Hamilton, Ontario, Canada. 15. Memorial University, St. John's, Newfoundland and Labrador, Canada. 16. University Health Network, Toronto, Ontario, Canada.
Abstract
PURPOSE: Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer. PATIENTS AND METHODS: We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time. RESULTS: We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies (P = .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer. CONCLUSION: Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
PURPOSE: Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer. PATIENTS AND METHODS: We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time. RESULTS: We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies (P = .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer. CONCLUSION: Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
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