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Community acquired influenza requiring hospitalization: Vaccine status is unrelated to morbidity in children with cancer

Authors

  • Leslie S. Kersun MD,

    Corresponding author
    1. Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
    2. Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    • Division of Oncology, 4th Floor Wood Building, The Children's Hospital of Philadelphia, 34th & Civic Center Blvd. Philadelphia, PA 19104.
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  • Susan E. Coffin MD,

    1. Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
    2. Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Kateri H. Leckerman MS,

    1. Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Mary Ingram BS,

    1. Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Anne F. Reilly MD

    1. Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
    2. Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract

Background

Community acquired influenza can be severe and there are few data regarding hospitalization for children with cancer and influenza. Association between prior vaccination and infection severity has not been studied, although vaccination is standard practice.

Procedure

Patients with malignancy or prior stem cell transplant (SCT) were identified using a database of children with laboratory confirmed influenza (2000–2005). Other data collected included receipt of vaccine, absolute neutrophil count (ANC) and absolute lymphocyte count (ALC). These were compared with intensive care unit (ICU) stay, respiratory complications and hospital days.

Results

There were 39 patients with laboratory-confirmed influenza with a median age of 6.9 years. Twenty-four (62%) were on cancer therapy at time of infection and 18 (46%) had received the influenza vaccination that season. Measures of immune status included ANC at time of infection (median 1,530 cells/µl; inter-quartile range, 315, 4347), presence of graft versus host disease 2 (5%) and steroid therapy 4 (10%) patients. All had a low ALC (median 448 cells/µl; IQR 189, 861). Respiratory complications occurred in 8 (20%), ICU admissions in 4 (10%) and death in 2 (5%) patients. Median hospital stay was 2 days. All ICU admissions occurred in unvaccinated patients (P = 0.1). Vaccine status, ANC (<1,000 cells/µl vs. >1,000) and ALC (<500 cells/µl vs. >500) were not associated with length of stay or respiratory complications.

Conclusions

Influenza infection can be severe in children with cancer and complications occur despite vaccination. Prospective evaluation of vaccine response is worthy of future study. Pediatr Blood Cancer 2010; 54:79–82. © 2009 Wiley-Liss, Inc.

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