Influenza virus vaccine in B-cell chronic lymphocytic leukaemia patients. Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. Epidemiology of Influenza A virus infection in patients with acute or chronic leukemia Summary of clinical trials of inactivated influenza vaccine - 1978. Influenza immunization of adult patients with malignant diseases. Immunogenicity of influenza vaccine in patients with hemato-oncological disorders. INFLUENZA IN CHILDREN WITH CANCER Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial
The clinical reaction and the immunological response to influenza virus vaccine were studied in 43 B-cell chronic lymphocytic leukaemia patients .  The Vaxigrip vaccine was administered containing the antigens A/Ghizhou/54/89 , A/Singapore/6/86 , and B/Yamagata/16/88 . The side-effects observed were minimal and well tolerated . Antibody production with titres > 1:20 on day 15 was observed at least for one antigen in 35 patients ( 81 % ) . In 23 of them ( 63 % ) this response was retained on days 30 and 60 . Patients with IgG levels ( < 700 mg/dl ) responded less well as compared to those having normal IgG levels ( > 700 mg/dl ) CONTEXT A growing proportion of young children in the United States participate in day care , and these children are considered to be at high risk for influenza infection . Whether vaccinating day care children reduces household transmission of influenza is not known . OBJECTIVE To evaluate the effect of  vaccinating day care children  on reducing influenza-related morbidity among their household contacts . DESIGN Single-blind , r and omized controlled trial conducted during the 1996 - 1997 influenza season . SETTING Ten day care centers for children of US Navy personnel in San Diego , Calif. PARTICIPANTS A total of 149 day care attendees ( aged 24 - 60 months ) and their families were r and omized ; 127 children and their 328 household contacts received 2 vaccine doses and were included in the analysis . INTERVENTIONS Inactivated influenza vaccine was administered to 60 children with 162 household contacts , and hepatitis A vaccine as a control was administered to 67 age-matched children with 166 household contacts . MAIN OUTCOME MEASURES Information regarding febrile respiratory illnesses and related morbidity for household contacts of influenza-vaccinated vs control children ( subgrouped by influenza-vaccinated and unvaccinated contacts ) , obtained by telephone interviews with parents every 2 weeks from November 1996 through April 1997 . RESULTS Influenza-unvaccinated household contacts ( n = 120 ) of influenza-vaccinated day care children had 42 % fewer febrile respiratory illnesses ( P = .04 ) compared with unvaccinated household contacts of control children . Among school-aged household contacts ( aged 5 - 17 years ) , there was an 80 % reduction among contacts of vaccinated children ( n = 28 ) vs contacts of unvaccinated children ( n = 31 ) in febrile respiratory illnesses ( P = .01 ) , as well as reductions of more than 70 % in school days missed ( P = .02 ) , reported earaches ( P = .02 ) , physician visits ( P = .007 ) , physician-prescribed antibiotics ( P = .02 ) , and adults who missed work to take care of ill children ( P = .04 ) . CONCLUSIONS These results indicate that vaccinating day care children against influenza helps reduce influenza-related morbidity among their household contacts , particularly among school-aged contacts . Future studies should be conducted in civilian population s to assess the full effect of vaccinating day care children against influenza . JAMA . 2000;284:1677 - 1682 Influenze infection is a significant cause of morbidity and mortality in immunocompromised hosts , but its importance in adult cancer patients is largely undescribed . We therefore conducted a prospect i ve study of the incidence and clinical features of influenza infection in patients with acute or chronic leukemia . The cohort , which consisted of all adult leukemia patients undergoing remission-induction chemotherapy during the 1991–1992 influenza epidemic , was followed prospect ively for development of signs and symptoms of acute infection of the upper or lower respiratory tract . Of these 294 patients , 111 received chemotherapy as in patients and 183 as out patients . Throat swabs and nasal washes for viral culture were obtained from all symptomatic patients , who were then followed until all signs and symptoms resolved . Symptoms of respiratory tract infection developed in 37 leukemia patients ( 13 % ) . Among these , influenza ( A/Beijing/H3N2 ) caused 3 ( 21 % ) of the 14 infections that developed during hospitalization but only 1 ( 4 % ) of the 23 that developed in the community ( P=0.14 ) . Influenza patients presented with fever , rhinorrhea , nasal congestion , headache , and myalgia ; those with other infections presented with signs and symptoms of lower respiratory tract infection ( productive cough , rales , or rhonchi ) . Development of pneumonia was common in influenza patients , 1 of whom died from a secondary fungal and gram-negative pneumonia . Influenza A virus infections accounted for a substantial protion of acute respiratory infections among adult leukemia patients during a community epidemic . Most infections appeared to be nosocomial and the most likely sources were visitors or hospital personnel . Immunization of house-hold contacts and hospital staff may reduce the risk of influenza infection and its pulmonary complications in leukemia patients This report summarizes the clinical trials of the A/USSR/77 ( H1N1 ) influenza vaccines  performed in 1978 . A total of 2,091 subjects participated in these trials . The results of these clinical trials indicated that two doses of H1N1 viral antigen were necessary to produce serum titers of hemagglutinin-inhibiting ( HAI ) antibody of greater than 1:40 in 80 % or more of the test subjects younger than 25 years of age , who were unlikely to have experienced natural infection during the earlier period of prevalence of H1N1 virus ( 1947 - 1957 ) . Only one dose of the A/Texas/77 ( H3N2 ) or B/Hong Kong/72 antigen was necessary to stimulate equivalent titers of HAI antibody in serum . Thus , previous natural exposure to H1N1 viruses primed individuals 26 years of age or older to respond to H1N1 antigens . No major differences in antigenicity were noted between whole-virus and split-virus vaccines . No differences in reaction indexes measuring systemic reactions were noted when vaccine types were compared . Only one vaccine was associated with a reaction index appreciably higher than that of placebo . The relatively uniform antibody responses observed were attributed to the newer methods of vaccine st and ardization introduced after the clinical trials in 1976 . No cases of vaccine-related neurological problems , including Guillain-Barré syndrome , were found during these trials . Vaccines containing 7 - 21 micrograms of each viral antigen were antigenic and were well tolerated To characterize the immunogenicity of influenza vaccine in patients with malignant disease , 21 patients with lymphoreticular neoplasms and 21 patients with solid tumors were immunized with inactivated influenza A/New Jersey/76 whole virus vaccine . The patients were r and omized with respect to time of vaccine administration in relation to administration of chemotherapy . Fourfold or greater antibody titer increases occurred in 94 % of controls and 71 % of cancer patients ( P less than 0.05 ) , and the magnitude of antibody response was also significantly lower in cancer patients ( P less than 0.01 ) . There was no correlation of antibody responsiveness with sex , age , tumor type , absolute lymphocyte count , disease status , or type of chemotherapeutic agent used . Fifty percent of patients immunized at the time of chemotherapy administration showed seroconversion , which is significantly less than the 93 % response rate observed in patients immunized between chemotherapy courses . It is thus recommended that individuals with malignant disease should receive influenza immunization between chemotherapy courses The aim of this study was to measure the production of antihemagglutinin and antineuraminidase antibodies in patients with proliferative diseases of the hematopoietic or lymphatic system , immunized with influenza vaccine in the epidemic season 1995/96 . Twenty patients between 22 and 84 years volunteered for vaccination and were vaccinated subcutaneously with a single dose of split trivalent influenza vaccine ( " Fluarix " , SmithKline Beecham ) in autumn 1995 at the out patients clinic , General Hospital , Toruń , Pol and , where they were being treated with anti-cancer chemotherapy . The vaccine consisted of a 0.5 ml dose containing 15 microg hemagglutinin ( HA ) of each of the following strains : A/Singapore/6/86 ( H1N1 ) , A/Johannesburg/33/94 ( H3N2 ) and B/Beijing/184/93 . Neuraminidase activity amounted to 17.24x10(-3 ) U/ml . Antibody production was determined in sera collected before vaccination , 10 days and 28 days after vaccination by the hemagglutinin inhibition test ( HI ) and neuraminidase inhibition test ( NI ) . Mean fold increase values after vaccination were statistically significant in patients undergoing cytostatic treatment . After 28 days mean fold increase of antihemagglutinin antibodies ranged from 7.9 to 25.2 , while in the case of antineuraminidase antibodies these values were between 12.4 and 14.3 . It is notable that no adverse reactions were observed after immunization and none of the patients was infected with influenza virus , in spite of the fact that there was a local epidemic in the Toruń region when the study was carried out . The results presented in this paper confirm the beneficial effect of influenza vaccination in high-risk groups of patients with proliferative diseases of the hematopoietic and lymphatic systems Although annual influenza(flu ) vaccination is recommended for patients ( pts ) in design ated high-risk categories , little data exist to support these recommendations in pediatric pts . We prospect ively followed a group of oncology pts ( OP ) on chemRx or off Rx for < 1 . who were not immunized against flu during 2 flu seasons to determine their relative risk of infection and complications compared with matched sibling control ( SC ) and community control(CC ) groups . Results of culture & serology data ( episodes/patient seasons ) show a higher occurrence of flu in the OP group(33 % ) than in the SC(22 % ) or the CC groups ( 14 % p=.01 chi-sq ) . A “ protective ” preseason titer of≥1:32 did not prevent flu in 20 % of the OP group compared with 4 % of the SC and 2 % of the CC groups(p .02 ) . No significant differences were noted in duration of reported symptoms between groups and clinical complications occurred too infrequently to analyze . 2/18(11 % ) of the culture ⊕ OP group were hospitalized during their illness and an additional 1/18 had a nosocomial infection . None of the control children were hospitalized . We conclude that OP 's are at greater risk of acquiring flu than are normal children . The duration of their symptoms appears similar to that in normal children but hospitalization may accompany infection more frequently . A preseason titer of ≥1:32 , often used as a marker of successful immunization in flu vaccine trials , was poorly protective in the OP group but was protective in controls . Our findings have significant implication s for vaccination recommendations and suggest the need for a clinical efficacy trial of the flu vaccine CONTEXT Although the cost-effectiveness and cost-benefit of influenza vaccination are well established for persons aged 65 years or older , the benefits for healthy adults younger than 65 years are less clear . OBJECTIVE To evaluate the effectiveness and cost-benefit of influenza vaccine in preventing influenza-like illness ( ILI ) and reducing societal costs of ILI  among healthy working adults . DESIGN Double-blind , r and omized , placebo-controlled trial conducted during 2 influenza seasons . SETTING AND PARTICIPANTS Healthy adults aged 18 to 64 years and employed full-time by a US manufacturing company ( for 1997 - 1998 season , n = 1184 ; for 1998 - 1999 season , n = 1191 ) . INTERVENTIONS For each season , participants were r and omly assigned to receive either trivalent inactivated influenza vaccine ( n = 595 in 1997 - 1998 and n = 587 in 1998 - 1999 ) or sterile saline injection ( placebo ; n = 589 in 1997 - 1998 and n = 604 in 1998 - 1999 ) . Participants in 1997 - 1998 were rer and omized if they participated in 1998 - 1999 . MAIN OUTCOME MEASURES Influenza-like illnesses and associated physician visits and work absenteeism reported in biweekly question naires by all participants , and serologically confirmed influenza illness among 23 % of participants in each year ( n = 275 in 1997 - 1998 ; n = 278 in 1998 - 1999 ) ; societal cost of ILI per vaccinated vs unvaccinated person . RESULTS For 1997 - 1998 and 1998 - 1999 , respectively , 95 % ( 1130/1184 ) and 99 % ( 1178/1191 ) of participants had complete follow-up , and 23 % in each year had serologic testing . In 1997 - 1998 , when the vaccine virus differed from the predominant circulating viruses , vaccine efficacy against serologically confirmed influenza illness was 50 % ( P = .33 ) . In this season , vaccination did not reduce ILI , physician visits , or lost workdays ; the net societal cost was $ 65.59 per person compared with no vaccination . In 1998 - 1999 , the vaccine and predominant circulating viruses were well matched . Vaccine efficacy was 86 % ( P = .001 ) , and vaccination reduced ILI , physician visits , and lost workdays by 34 % , 42 % , and 32 % , respectively . However , vaccination result ed in a net societal cost of $ 11.17 per person compared with no vaccination . CONCLUSION Influenza vaccination of healthy working adults younger than 65 years can reduce the rates of ILI , lost workdays , and physician visits during years when the vaccine and circulating viruses are similar , but vaccination may not provide overall economic benefits in most years . JAMA . 2000;284:1655 - 1663 BACKGROUND Vaccination of health-care workers has been cl aim ed to prevent nosocomial influenza infection of elderly patients in long-term care . Data are , however , limited on this strategy . We aim ed to find out whether vaccination of health-care workers lowers mortality and the frequency of virologically proven influenza in such patients . METHODS In a parallel-group study , health-care workers in 20 long-term elderly-care hospitals ( range 44 - 105 patients ) were r and omly offered  or not offered influenza vaccine  ( cluster r and omisation , stratified for policy for vaccination of patients and hospital size ) . All deaths among patients were recorded over 6 months in the winter of 1996 - 97 . We selected a r and om sample of 50 % of patients for virological surveillance for influenza , with combined nasal and throat swabs taken every 2 weeks during the epidemic period . Swabs were tested by tissue culture and PCR for influenza viruses A and B. FINDINGS Influenza vaccine uptake in health-care workers was 50.9 % in hospitals in which they were routinely offered vaccine , compared with 4.9 % in those in which they were not . The uncorrected rate of mortality in patients was 102 ( 13.6 % ) of 749 in vaccine hospitals compared with 154 ( 22.4 % ) of 688 in no-vaccine hospitals ( odds ratio 0.58 [ 95 % CI 0.40 - 0.84 ] , p=0.014 ) . The two groups did not differ for proportions of patients positive for influenza infection ( 5.4 % and 6.7 % , respectively ) ; at necropsy , PCR was positive in none of 17 patients from vaccine hospitals and six ( 20 % ) of 30 from no-vaccine hospitals ( p=0.055 ) . INTERPRETATION Vaccination of health-care workers was associated with a substantial decrease in mortality among patients . However , virological surveillance showed no associated decrease in non-fatal influenza infection in patients
Influenza infection is a potential cause of excess morbidity in patients who are immunosuppressed because of haemato-oncological malignancy or its treatment .
Therefore vaccination against influenza is recommended in these patient groups .
This systematic review of the literature and vaccine manafacturers ' data assesses the current levels of knowledge concerning influenza vaccination in this patient group .