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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 associate 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,

As of 2010, the Advisory Committee on Immunization Practices recommends seasonal influenza vaccine for all patients over the age of 6 months, including high-risk groups. These groups include those with:
• respiratory conditions (for example, asthma)
• metabolic diseases (for example, diabetes mellitus)  
• 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 seasonal influenza vaccine includes both trivalent and quadrivalent formulations, both of which include type A/California/7/2009 (H1N1)-like virus (against 2009 pandemic H1N1 influenza). The quadrivalent vaccine includes a second influenza type B antigen.

Why should patients get these vaccines?

The influenza vaccine reduces the risk of influenza virus infection. The vaccine does not prevent all influenza infections, even if well matched with the circulating virus, but reduces the risk of and severity of infection. Even though patients may have decreased response to vaccine while on chemotherapy, undergoing radiation, or after surgery, a reduced response is better than the zero chance of response without immunization.

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

There may be decreased response to influenza vaccine in those patients who are receiving active chemotherapy or have other immunodeficiency, but the vaccine is still safe since, with the exception of the intranasal vaccine, NO LIVE VIRUS is present in the vaccine. Those who are allergic to eggs or have had previous allergic response to influenza immunization should not receive egg-derived vaccines. As of January 2013, the FDA has approved two influenza vaccines that were NOT egg-based, therefore presenting no risk to those with egg allergies.

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 (e.g., RSV, rhinovirus, adenovirus) 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.

© 2015 The University of Texas MD Anderson Cancer Center