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The Efficacy of Influenza Vaccination in a Pediatric Oncology Population

Reilly, Anne MD*; Kersun, Leslie S. MD*; McDonald, Kenyetta BS; Weinberg, Adriana MD; Jawad, Abbas F. PhD§; Sullivan, Kathleen E. MD, PhD

Journal of Pediatric Hematology/Oncology: July 2010 - Volume 32 - Issue 5 - p e177-e181
doi: 10.1097/MPH.0b013e3181d869f3
Online Articles: Original Articles

There is little known about the impact of the timing of influenza vaccine administration on seroconversion in patients on chemotherapy. Recommendations for other vaccines state that the vaccines should be readministered several months after the completion of chemotherapy outside of the stem cell transplant setting. This is not often possible with the influenza vaccine because of its seasonal nature. To examine whether certain times during chemotherapy are more favorable for seroconversion, we examined vaccine responses in a cohort of children on chemotherapy. Pediatric patients on chemotherapy were recruited over the 2006 to 2008 influenza vaccine seasons. Sixty-eight acute lymphoblastic leukemia (ALL), 3 acute myeloid leukemia, and 18 sarcoma patients were evaluated. Clinical and laboratory features were recorded. The hemagglutination inhibition (HAI) assay was used to define serotype-specific responses. Seroconversion rates varied according to the type of chemotherapy during the vaccination period. In some cases, there was a late rise in titer, suggesting that a wild-type infection had occurred, leading to an estimate of vulnerability of this population. In patients with ALL, responses to the vaccine were greater when it was given early in the course of treatment. We conclude that seroconversion rates are well below the rates cited for the general population. The 3 acute myeloid leukemia patients had a particularly poor response to the vaccine. In the case of ALL patients, it may be possible to adjust the timing of the vaccine to optimize the response.

*Divisions of Oncology

Allergy Immunology

§Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA

Clinical Virology Laboratory, Department of Pathology, University of Colorado Denver, Denver, CO

Reprints: Kathleen E. Sullivan, MD, PhD, Division of Allergy Immunology, The Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104 (e-mail:

Received for publication December 18, 2009;; accepted February 7, 2010

Supported by NIH NO1-AI-50024.

© 2010 Lippincott Williams & Wilkins, Inc.