Doctor, Doctor: Focus on the Flu

Network - Winter 2010

We asked Bruno Palma Granwehr, M.D., who is board certified in internal medicine and medical oncology, and an assistant professor in the Department of Infectious Diseases, what cancer patients and survivors should know about flu vaccines and treatments.

Should cancer patients get flu shots for both seasonal influenza and novel (2009) H1N1?

Bruno Palma Granwehr,
M.D.

Seasonal vaccine is recommended for patients 50 and over, pregnant women, children 6 months to 18 years old, and other high-risk groups, including people with respiratory conditions (for example, asthma), metabolic diseases (for example, diabetes mellitus), those with conditions that compromise their immune systems, and those who are caretakers of high-risk patients (including health care workers and household contacts of those at risk).

The 2009 H1N1 vaccine is targeted to different groups: pregnant women, those who take care of infants under 6 months old, health care workers, those between the ages of 6 months and 24 years, and people 25-64 years of age who are at higher risk for 2009 H1N1 virus infection (same high risk as seasonal influenza vaccine).

Why should patients get these vaccines?

The seasonal vaccine protects against different strains of influenza virus than the 2009 H1N1 vaccine. Since the 2009 H1N1 virus is the predominant circulating virus in the United States, current patients and cancer survivors should receive both vaccines if they are in appropriate categories.

Are there situations where it might be unsafe or unwise to get one?

There may be little benefit to those who are receiving active chemotherapy or stem cell transplant, when the likelihood of being able to mount a response is low. In those situations, it is critical for care providers to receive influenza immunization to protect patients from it. In addition, those who are allergic to eggs or have had previous allergic response to influenza immunization should not receive the vaccine.

Some people say they develop flu-like symptoms after getting the flu shot. Why might this happen?

The flu shot (or “inactivated” vaccine) cannot result in influenza infection, but the response to the influenza shot may result in some generalized symptoms, including fever and muscle pain. Since the vaccine is provided during respiratory viral season, some people may have another respiratory viral infection at the time of their immunization. Typically, when I ask those who “had the worst flu of their lives” after receiving the vaccine, none of them have had influenza confirmed in a health care provider’s office.

Are there any other considerations for cancer patients?

Many cancer patients are at high risk for severe influenza virus infections and are as likely as the general population to respond to the vaccine. If available, patients can receive seasonal and 2009 H1N1 vaccine at the same time. Timing of vaccination may be important if the patient is receiving chemotherapy or undergoing stem cell transplant. They should talk with their physicians.

If a cancer patient develops the flu, is it safe for him or her to take Tamiflu^®?

Tamiflu is generally safe for cancer patients, other than those with a prior allergic response to Tamiflu (oseltamivir) or Relenza® (zanamivir). Nausea and vomiting have been reported, and Tamiflu is considered a pregnancy Class C drug, so it should be used with caution in this population. As with any medication, risks and benefits should be weighed before treatment.