Influenza prophylaxis in a chosen population of cancer patients

Obecnie nowotwory często stanowią przyczynę zgonów na całym świecie. W Polsce choroba ta jest drugą (po schorzeniach układu krążenia) najczęstszą przyczyną zgonów. Profesor J. Oxford powiedział: „Można zaprzestać uprawiania seksu, aby zapobiec rozprzestrzenianiu się HIV, ale nie można przestać oddychać”. Chorzy na nowotwory wymagają specjalnej troski, gdyż ich układ immunologiczny jest osłabiony. Każdego roku zgodnie danymi Światowej Organizacji Zdrowia zachorowania z powodu grypy dotykają 330-1575 milionów ludzi, a śmierć wskutek tej choroby ponosi 0,5-1 miliona osób. Istnieją wysoko oczyszczone szczepionki przeciwko grypie oraz leki antygrypowe nowej generacji (tzw. inhibitory neuraminidazy). Komitet Doradczy ds. Szczepień Ochronnych oraz wiele towarzystw naukowych, w tym również Amerykańskie Towarzystwo Onkologiczne, rekomendują szczepienia przeciwko grypie, zwłaszcza wśród osób o podwyższonym ryzyku zachorowania na tę chorobę. W niniejszym artykule przedstawiono wyniki badań, którymi objęto onkologicznie chorych szczepionych przeciwko grypie. Wykazano, że szczepienia przeciwko grypie w tej grupie pacjentów niezależnie od protokołu leczenia są bezpieczne, efektywne i dobrze tolerowane. Można wnioskować, że powinno się rekomendować szczepienia przeciwko grypie w indywidualnych przypadkach.At present cancer is one of the most frequent causes of deaths not only in Poland but all over the world. In our country cancer is now the second most important cause of deaths preceded by circulatory diseases. Professor John Oxford once said: “You can stop having sex to prevent AIDS from spreading. But you can’t stop breathing”. Cancer patients need special care because their immunological system is weak. According to World Health Organisation data, every year 330-1,575 milion people are infected by the influenza virus, and 0.5-1 milion people die. Currently chromatographically pure inactivated vaccines against influenza and new generation anti-influenza drugs, ie neuraminidase inhibitors are available on the market. Vaccinations against influenza are recommended for people at high risk groups not only by Advisory Committee on Immunization Practiese but also by many scientific societies all over the world, including the American Cancer Society. This article presents the results of investigations in a selected population of cancer patients vaccinated with inactivated influenza vaccines. The author concludes that vaccinations against influenza in these groups of patients treated with different protocols are safe, effective and well tolerated. These results suggest that vaccinations can be recommended for cancer patients, depending on individual cases

Effect of influenza vaccinations on immune response and serum eotaxin level in patients with allergic bronchial asthma.

BACKGROUND: One of the most promising markers of allergic inflammation is eotaxin, which has a selective influence on the migration of eosinophils. Its serum content significantly correlates with the intensity of allergic symptoms, so it might be interesting to know whether vaccination has any influence on serum expression of this chemokine. AIMS: Comparison of the humoral response to influenza vaccine and post-vaccination changes in the serum eotaxin level in patients with allergic bronchial asthma and healthy controls. METHODS: Forty-two asthmatics and 45 healthy individuals were vaccinated with a single dose of influenza subunit vaccine (Influvac). The serum eotaxin level and the antibody response to haemagglutinin (HI) and neuraminidase (NI) glycoproteins were measured before and after vaccination. RESULTS: A significant increase of geometric mean titres of HI and NI was observed in both groups. There were no significant differences between the groups in meanfold increase of HI and NI titres, response rate and protective level of HI. After vaccination, a significant decrease of the mean serum eotaxin value was observed in patients with asthma (149.4 +/- 71.0 versus 125.1 +/- 67.0, p= 0.0017), while no similar effect was present in healthy individuals (153.4 +/- 56.9 versus 159.3 +/- 54.4, p= 0.5). CONCLUSIONS: The results indicate that in patients with allergic bronchial asthma influenza vaccinations assure efficient protective antibody level and modulate the serum level of eotaxin

Vaccination against influenza in pregnant women – safety and effectiveness

Influenza is a major cause of morbidity and mortality worldwide. During seasonal influenza epidemics and pandemics, pregnancy places otherwise healthy women at an increased risk of complications from influenza. The factors believed to increase the susceptibility of complicated influenza infection during pregnancy are linked to the physiologic changes, including immunologic changes (attenuation of the cell-mediated immune responses, selective suppression of T-helper 1 cell mediated immunity while the adaptive humoral immunity remains unimpaired), increased cardiac output and oxygen consumption and tidal volume. Pregnant women have similar incidence of seasonal influenza as the general population, however, because of the physiological changes, they are at an increased risk of complications (including secondary pneumonia, acute respiratory insufficiency, increased risk of stillbirth, premature deliveries) and death. Immunization of pregnant women against influenza is currently recommended in many countries. Vaccination against influenza with trivalent inactivated vaccine (TIV) has been proven to be safe and effective. Lack of harmful effect of TIV on pregnant women and newborns has been demonstrated in several studies: no increased risk of spontaneous abortions, preterm birth, low birth weight, congenital malformations, cesarean section have been reported. Vaccination against influenza has been proven to be effective in reducing rates and severity of the disease in vaccinated mothers and their children. Several studies revealed a decreased risk of influenza-like illnesses among mothers who were vaccinated during pregnancy, but also a decreased risk of laboratory confirmed cases of influenza and hospitalizations due to influenza and its complications among newborns and infants born to vaccinated mothers. Currently available inactivated influenza vaccines are not licensed for use in infants younger than 6 months. Protection of young infants against the infection in early life thus requires a cocooning strategy to reduce the number of vulnerable individuals among care givers and contacts. Neonates and infants may be also protected against influenza directly by antibodies of maternal origin that cross the placenta or are transferred via breast milk. The duration of passively acquired antibodies depends on the initial blood concentration and is probably less than 6 months. Vaccine coverage among pregnant women remains low. Possible explanations include lack of education by health care workers, the feeling among the general public that influenza is not a serious problem, and the failure of prenatal care providers to offer the vaccine. Overall, the most important factor for a woman to decide to be immunized during pregnancy was to have a clear recommendation from the health care provider. Reasons evoked by obstetricians for not providing influenza vaccines included lack sufficient data on safety and efficacy, concerns about the medical legal risks of vaccination during pregnancy and the perception that pregnant women would not want to be vaccinated. Educational intervention targeting health care workers in charge of pregnant women should be primary implemented to provide higher influenza vaccine coverage and to protect pregnant women and young infants from influenza related morbidity

Laboratory diagnosis of influenza

Influenza has always been and still is the cause of considerable morbidity and, consequently, frequent multiorgan complications, often irreversible and even fatal. It is an acute infectious disease caused by type A, B and C viruses, members of the family Orthomyxoviridae. Infections caused by the influenza virus are reported in every epidemic season. Influenza infections should be considered not only in the aspect of health, but also in the quantifiable, measurable economic aspect. For many years, influenza has been one of the basic priorities of public health. Virological and epidemiological surveillance of influenza, which is implemented in each epidemiological season, is one of the key elements of public health. Virological surveillance involves laboratory confirmation of infection, while epidemiological surveillance involves monitoring of actual and suspected cases of influenza. Laboratory diagnosis is performed to confirm influenza virus antigen in the material collected from the patient, isolate the virus and confirm viral infection based on increased serum antibody levels. Isolating influenza viruses that circulate in a given epidemiological season is necessary to prepare a vaccine against influenza. An early and correct virological diagnosis of respiratory infection, with particular reference to influenza, is currently of great importance in terms of both medical and economic aspects. The paper discusses influenza diagnostic methods currently used in Poland to help physicians in deciding whether laboratory confirmation of diagnosis is justified in the aspect of possible treatment to avoid influenza-induced multiple organ complications