Vaccination coverage in hematological patients undergoing chemotherapy: Should we move towards personalized vaccination?

Introduction: Immunocompromised patients are at high-risk for severe influenza and invasive pneumo-coccal diseases (IPD). Despite the French Public Health Council (FPHC) and the 7th European Conference on Infections in Leukaemia (ECIL7) recommendations, vaccination coverage remains insufficient. This study aimed to estimate the coverage and determinants of influenza, pneumococcal and diphtheria-teta nus-poliomyelitis (dTP) vaccinations in hematological patients underlying chemotherapy. Methods: A survey was distributed to all patients of the hematology day hospital assessing vaccine uptakes and general opinion about vaccination. Vaccine uptakes were collected from medical and vacci-nation records; knowledge of and attitudes towards vaccinations in immunocompromised patients were evaluated for each general practitioner (GP) by phone call. Adequacy between vaccine uptakes and indi-cation or not to vaccinate according to ECIL7 guidelines was assessed. Factors associated with vaccine uptakes were assessed by multivariate logistic regression. Results: Among 145 patients, 66 % were aged 65 years or older, 40 % were followed for lymphoma and 38 % for multiple myeloma, 39 % were treated with anti-CD20 antibodies. Vaccination coverage was suboptimal for influenza (45-56 %), dTP (44 %) and IPD (16-19 %) regardless of the guidelines followed, with a wide vari-ation in rates by information source (19-76 %). Adequacy rate with ECIL7 recommendations were 63 % and 87 % for influenza and IPD respectively. Information of patients on specific vaccinations was positively asso-ciated with flu and IPD vaccinations, as well as favorable attitude toward vaccination and age > 65 years for flu vaccination, and recommendation by hematologist for pneumococcal vaccination. Conclusion: Despite vaccination opportunities, the complexity of these specific recommendations and the lack of communication between the health actors could explain the suboptimal vaccination coverage in this high-risk population. A proactive attitude of all actors in the city and hospital, including better patient infor-mation and a personalized and evolving vaccination schedule to help GPs to coordinate vaccination would allow to improve vaccine coverage. (c) 2021 Elsevier Ltd. All rights reserved.