Meeting Abstract

JL523. Outcome Evaluation of Timing Recommendations for Influenza Vaccinations in Patients Receiving Intravenous Chemotherapy

Elizabeth A. Hageman, PharmD, BCPS, Cayuga Medical Center, Ithaca, New York, Alex D. Vondracek, PharmD, Cayuga Medical Center, Ithaca, New York, and Ryan Mack, Albany College of Pharmacy and Health Sciences, Albany, New York

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Abstracts From 
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017

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Objective: The Centers for Disease Control and Prevention (CDC) and the Infectious Disease Society of America (IDSA) recommend vaccinating cancer patients against influenza 2 weeks prior to the initiation of chemotherapy in order for a patient to acquire seroprotection. However, this recommendation does not address optimal timing of vaccine administration for patients already receiving intravenous (IV) chemotherapy during the flu season. Cayuga Hematology Oncology Associates (CHOA) created vaccine timing recommendations with the goal of administration in the middle of chemotherapy cycles to avoid the need for immunologic response during a patient’s nadir. These recommendations were put into practice during the 2016 to 2017 flu season. The purpose of this evaluation was to determine if the timing of the vaccine in the middle of the chemotherapy cycle resulted in fewer confirmed influenza infections.

Methods: A retrospective review of patients from the 2014 to 2015 and 2016 to 2017 influenza season compared the timing of the vaccination within 14-, 21-, and 28-day chemotherapy cycles to the rates of influenza infection before and after implementation of the recommendations. Citrix medication administration records and Meditech microbiology profiles were accessed to confirm flu vaccine administration and assess completed flu swab results. Patients were excluded from the study if they had weekly chemotherapy cycles, were receiving oral chemotherapy or did not have a documented influenza vaccination administration.

Results: Out of the 103 patient charts reviewed in this study, 47 patients in 2014 to 2015 and 56 patients in 2016 to 2017, no difference was found in the rates of influenza infection before and after implementation of the timing recommendations. 51% of patients in 2014 to 2015 and 27% of patients in 2016 to 2017 received their vaccinations within the recommended time frame. For all cycle lengths, the 2014 to 2015 group had higher rates of vaccinations administered within the recommended time period when compared to the 2016 to 2017 group. No patients in either group tested positive for influenza serotypes A and B. Discussion: No correlation was found in either group regarding flu vaccine and IV chemotherapy administration. While past studies suggested there may be significance in the timing of influenza vaccination in chemotherapy cycles, recent data has shown otherwise. The results from this retrospective review support recent data that the timing of vaccination may not influence the incidence of influenza infection.

Recommendations: (1) Completion of studies comparing influenza vaccine seroconversion rates to incidence of positive or negative flu swab results; (2) remove timing recommendations for influenza vaccinations for patients receiving intravenous chemotherapy.

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