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Indian Journal of Cancer, Vol. 47, No. 3, July-September, 2010, pp. 339-343 Review Article Important vaccines used as tools for tertiary prevention in oncology patients Wiwanitkit V Wiwanitkit House, Bangkhae, Bangkok - 10160, Thailand Code Number: cn10080 PMID: 20587914 DOI: 10.4103/0019-509X.64716 Abstract For the prevention of many diseases, vaccination is considered to be a good method. At present, a number of vaccines are available. The concept of vaccination for oncology patients as a tertiary prevention protocol was introduced recently. A literature review on this topic was performed. For reviewing, the author used the electronic search for the keyword "vaccine" and "cancer" on PubMed for inclusion of the previously published articles and further search of reference papers on vaccines as tools for tertiary prevention in oncology patients was done. In this article, the important vaccines for oncology patients are briefly discussed. There are many interesting vaccinations that are useful for tertiary prevention in oncology patients.Keywords: Cancer, tertiary prevention, vaccination Introduction Several infectious diseases are part of public health problems today. People of all age groups have a chance of getting an infection. At present, the concept "prevention is better than cure" can be applied for the management of infectious diseases. There are many methods for the control of infectious diseases; however, an effective means is vaccination. There are many vaccines available at present and these vaccines can be good preventive tools for infectious diseases. The principle of vaccination is active immunization. The basic concept of vaccination for oncology patients is similar to that for healthy subjects. However, there are some specific concerns for the oncology patients. [1] The topics on immunologic response and adverse immunologic-induced side effects are widely discussed elsewhere. [2],[3] However, the clinical usefulness of vaccination as a tertiary prevention in oncology patients is still accepted. [1] Any vaccine can be given to the oncology patient if there is an indication and no contraindication. Nevertheless, there are some vaccines that are specifically recommended for the oncology patients. These vaccines are summarized and discussed in this specific article. For reviewing, the author used the electronic search for the keyword "vaccine" and "cancer" on PubMed for inclusion of the previously published works and further search for reference papers on vaccines as tools for tertiary prevention in oncology patients was done. Five important vaccinations, which are widely used for the prevention of serious and problematic infections among the oncology patients are detailed in this report. Influenza Vaccination Influenza is a viral infection of the respiratory tract. The clinical signs and symptoms of high fever with respiratory manifestations are common. In some serious cases, the lower respiratory tract involvement can be observed. Severe pneumonia could be present, which can lead to death. In oncology patients, infection by influenza could be a serious problem. It is proposed that the oncology patients might have increased risk of serious clinical outcomes if they are afflicted with influenza. [4] The influenza vaccination [3] is recommended for oncology patients. The first recommendation was made by a gynecologist. This was for the tertiary prevention in a patient with uterine cancer. [5] It is proven that patients getting vaccinated had a significant longer survival period. [6] However, the oncologists presently seem to neglect the usage of influenza vaccination. [7] There is an urgent need to increase the awareness of the benefits of influenza vaccine among the general oncologists. [8] Because influenza vaccination can reduce the infection rate and mortality due to influenza among oncology patients, it is suggested that all oncology patients should get this vaccine. [3] Important trials on the efficacy and safety of influenza vaccination in oncology patients are summarized and listed in [Table - 1]. [9],[10],[11],[12] There are many reports confirming the safety of influenza vaccination in oncology patients, either adult or infant. [13],[14] Although vaccine is administered to the oncology patients who undergo chemotherapy, its efficacy and safety need not be doubted. [15] In conclusion, the influenza vaccination is effective and safe for oncology patients. However, it should be noted that there have never been any reports on the oncology patients with severe immune impairment; hence, the vaccination cannot be guaranteed for its efficacy and safety in such cases. Hence, this vaccination is mainly recommended for oncology patients during the period they are free from immunosuppressive therapy. [3],[11] An annual intramuscular injection of influenza vaccine of the same dosage (0.5 mL) as is given to healthy individuals is recommended to be administered. Pneumococcal Vaccination Pneumococcal infection is an important bacterial infection. The main clinical manifestation of pneumococcal infection is respiratory presentation. The lung involvement is common and can lead to death. The risk population for this infection is the immunocompromised host, including the oncology patient. [16] Pneumococcal infection should be included in the differential diagnosis of fever of unknown origin in oncology patients. [17] Increased risk for development of severe infection and subsequent mortality is seen in oncology patients. [18] The pneumococcal vaccination is recommended for the oncology patients. However, the rate of usage of pneumococcal vaccination among oncology patients is low. [7] Similar to the use of influenza vaccination, there is a concern on how to increase the awareness of the general oncologists in using pneumococcal vaccination as a tertiary prevention for their oncology patients. [7] Omlin et al noted that repeated assessments of the pneumococcal vaccination status in oncology patients could increase the rate of vaccination. [19] There are many reports confirming the safety and efficacy of using pneumococcal vaccination among the oncology patients. Use of pneumococcal vaccination is recommended in oncology patients at any period, as it is safe to use whether they are undergoing chemotherapy or not. [20],[21],[22] The main problem of this vaccination in oncology patients is the low immunogenicity. In a recent prospective, randomized trial of safety and immunogenicity, the response to pure polysaccharide pneumococcal vaccine was still low despite immune enhancement with multiple doses of granulocyte-macrophage-colony-stimulating factor. [22] This vaccination is still recommended because there is evidence that receiving the vaccine can significantly reduce the prevalence of disease among oncology patients. [23],[24] Nevertheless, there is a recent interesting report that priming with a conjugate vaccine might be a means to increase the immune response to pneumococcal vaccination for the oncology patients. [24],[25] The dosage of vaccination for the oncology patients is the same as that given to healthy individuals. Meningococcal Vaccination Meningococcal infection is another important bacterial infection. The main clinical manifestation of meningococcal infection is the neurologic presentation. The neurologic involvement is common and can lead to death. The risk population for this infection includes oncology patients. [26] The meningococcal vaccination is recommended for the oncology patients. [27] There are some reports confirming the safety and efficacy of using pneumococcal vaccination among oncology patients. [28] This vaccine is proved to have a better immunogenicity property in oncology patients than the meningococcal vaccine. [23] In oncology patients undergoing chemotherapy, revaccination has to be recommended. Patel et al noted that "Revaccination of children after standard chemotherapy is important, and protection can be achieved in the majority of these children using a simple schedule of 1 vaccine dosage at six months after completion of leukemia therapy." [29] The dosage of vaccination for the oncology patients is the same as that given to healthy individuals. Haemophilus influenzae Type B Vaccination H. influenzae type B (HIB) is another important bacterial infection. This can induce both respiratory and neurologic manifestations. An increased risk of severe manifestation of HIB among the oncology patients is documented. Unlike the other vaccines, HIB vaccine is important for children. The pediatric patients with cancer should get HIB vaccine. [30] On the other hand, there is also a concern about the induction of leukemia in children who get HIB vaccine. [31] However, the safety and efficacy of using HIB vaccination among oncology patients are confirmed. [32],[33],[34] There is evidence that this vaccine has high immunogenicity. [23] Protective immune response to the HIB vaccine if administered within a year of initiation of chemotherapy is still favorable. [34] Loss of antibodies after the treatment of cancer is very low compared with other vaccines. [35] The dosage of vaccination for the oncology patients is the same as that given to healthy individuals.. Rabies Vaccination Rabies is a serious neurologic infection. This occurs mainly due to bite by mammals. Most of the rabies cases occur in the tropical areas of the world and the animals that bring rabies to human beings are mainly dogs and cats. The treatment for rabies is usually the administration of postexposure vaccination. A basic rule is to administer the vaccine to those bitten by these animals and having a wound or bleeding. The vaccine can be given via either intramuscular or intradermal routes. For sure, the oncology patients who live in the endemic area of rabies may be exposed to the risk of getting in contact and bitten by animals infected with rabies.[36],[37] In such cases, the use of postexposure rabies vaccination is recommended. The dosage of vaccination for the oncology patients is the same as that given to healthy individuals.. Since rabies vaccination is not a preexposure prophylaxis and mainly used in the tropical countries, there is limited evidence on this specific vaccination for oncology patients. However, there must be an additional administration of rabies immunoglobulin as passive immunization. [38],[39] Conclusion In addition to the general infections, oncology patients have a risk for some specific preventable infections. This article stresses an important point that oncology patients should be vaccinated with certain vaccines because of the importance of preventing certain diseases. An important concern is that all patients with cancer do not mount a good immune response to vaccination and so, the clinical response is doubtful. In this specific article, 5 important widely used vaccines are summarized to provide an "evidence for practice" [Table - 2] and [Table - 3]. It can be seen that oncology patients have a high risk for getting severe infections and vaccination seems to be quite useful. References
Copyright 2010 - Indian Journal of Cancer The following images related to this document are available:Photo images[cn10080t2.jpg] [cn10080t1.jpg] [cn10080t3.jpg] |
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