Flu Vaccine Shortage and Cancer Patients

By Rachael Myers Lowe, cancerpage.com

(October 18, 2004) - Should cancer patients get the flu vaccine this year? According to the Centers for Disease Control, anyone diagnosed with cancer within the last 12 months and anyone who has ever been diagnosed with leukemia, lymphoma or blood cancer, falls into the high priority status group to get the flu shot.

Many cancer patients have severely damaged immune systems either because of their cancer or the treatments they’re getting to fight it. As a result, they are at increased risk of death if they catch the flu.   

But some oncologists question the usefulness of giving a vaccine to someone whose immune system is suppressed. The purpose of the vaccine, which has pieces of dead flu virus in it, is to fool the immune system into launching an attack against the virus so that when a person is exposed to the real thing the body is pre-armed to kill it.  If the body has no immune system to mount an attack, the vaccine is wasted.

Dr. Georgia Thomas of the MD Anderson Cancer Center’s Department of Employee Health Services disagrees.

“At any point in time, we’re really not sure how immune-suppressed that [cancer patient] is and any anti-body response may be enough to prevent infection,” she told cancerpage.com.

Dr. Bruce Cheson, head of Hematology and Director of Hematology Research at the
Lombardi Cancer Center at Georgetown University Hospital says Lombardi does not recommend blanket vaccinations for cancer patients.

“It depends on the immune system of the patient,” Cheson told cancerpage.com.

A patient receiving immune suppressing therapy is not likely to respond to a vaccine, Cheson says.  There are also patients won’t respond to the cancer because of their cancer, such as certain lymphomas and leukemias.

“I would recommend they not use up the supply - the rare supply - of vaccines, “Cheson adds.

Cheson says people who have recently completed therapy however should be vaccinated, and so should the people who come in close contact with them, like their families.

The Houston based cancer center has vaccinated about 700 cancer patients so far this season. They are also vaccinating a population of patient families and healthcare workers who may come into contact, even if briefly, with patients.

The MD Anderson definition of high priority groups is wider than that defined by the CDC.

“Unfortunately, the vaccine supply this year has made it very difficult to try to supply the vaccine to all the groups of people that we would hope to be vaccinated. But because of the  number of doses, household contacts and at-home caregivers of high risk people are not included in the priority groups this year,” the CDC’s Dr. Carolyn Bridges told cancerpage.com.

While the CDC guidelines don’t specify cancer patient families as a high priority for the scarce flu shots, Thomas says they need to be vaccinated too.

“I don’t think there’s any doubt but that a cancer patient is at serious risk if their primary caregiver gets influenza,” Thomas said.

“These (cancer) patients are at greater risk for the complications of the flu than are people in the general population, and therefore I can’t say I agree with that recommendation” Cheson says.

MD Anderson got its full order of flu vaccine doses this year - some10,000 doses - but other facilities and some whole communities were not so fortunate. Long lines and hours-long waits at flu shot clinics have been reported around the country.

QUESTIONS ABOUT FLUMIST

And unfortunately, the alternative flu vaccine is not an option for cancer patients and it’s debatable whether their families should get it.

The FluMist vaccine uses weak but live strains of the flu virus to activate the body’s immune system. As a result, cancer patients should not get a FluMist vaccine. That point is made clear in the drug’s labeling. The question is: can family members and caregivers take the live virus vaccine?

Bridges says the FluMist vaccine may be an option for household contacts and at-home caregivers of cancer patients though there’s no specific recommendation that these populations get the FluMist vaccine.

But, it is recommended that anyone getting the FluMist vaccine stay away from immune suppressed individuals about 7 days. That’s because studies have shown that with the FluMist vaccine flu virus can accumulate in the nose and throat of the vaccinated person and be transmitted. 

“We think the possibility is very small,”  Bridges adds.

MD Anderson, on the other hand,  is recommending families of cancer patients NOT get the FluMist vaccine. MedImmune, the maker of FluMist, did not return calls from cancerpage seeking an interview on this subject.

While FluMist has not been tested in patients with suppressed immune systems, research shows that the live virus can produce mild flu symptoms in a healthy person; live virus can grow in the healthy person’s nose and throat providing a way to transfer the flu to a cancer patient.

If the vaccine is unavailable, patients and their families have to be extra vigilant in their efforts to avoid infection. The CDC recommends the following tips:  

• Wash hands frequently. Lather up for at least 15 to 20 seconds each time.
• Cover the mouth and nose when you cough or sneeze.
• If soap and water aren’t available, use alcohol-based wipes or gel sanitizers.

Dr. Bridges says people who can’t get the vaccine should consider getting a prescription for one of the anti-viral medications available on the market.  More information is available on the anti-viral drugs on the CDD web site. (see link below. )

For More Information on Avoiding Infection, read the cancerpage “Managing Neutropenia” information page.

AUDIO CLIP

Dr. Cheson talks about who should get the flu vaccine. (1:36)

SOURCES:  

• CDC Stopping germs info sheet . 
• CDC 2004 Interim Influenza Vaccination Recommendations .
• CDC Anti-Viral Web Page
• Cancerpage telephone interview with Dr. Georgia Thomas, Associate Professor, Employee Health Services - Patient Care, MD Anderson Cancer Center. 10-15-04
• Cancerpage telephone interview with Dr. Carolyn Bridges, CDC National Immunization Program. 10-18-04

• Cancerpage interview with Dr. Bruce Cheson of the Lombardi Cancer Center 10-18-04.