I have lung cancer. Should I be vaccinated against the flu? – GECP and PULMONALE join to answer all your questions questions
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At the beginning of each vaccination season, lung cancer patients frequently have doubts about whether it is beneficial and safe to get the flu vaccine. This year, the COVID-19 pandemic has brought even more uncertainties on this topic. For this reason, the Lung Cancer Study Group (GECP) and the Portuguese Association for the Fight Against Lung Cancer (PULMONALE) joined efforts to clarify all the issues related to this theme, in a campaign that intends to deconstruct unfounded fears, and alert to the importance of influenza vaccination in this population.
What is the flu vaccine for?
It is the main weapon against infection by the influenza virus, preventing this illness and its most serious possible complications.
How does the vaccine work?
The flu vaccine exposes our body to the inactivated virus, leading it to produce antibodies, so it is prepared for a more effective response in case of a later infection. The vaccine is different every year, containing the three or four strains of influenza that research predicts will be more prevalent each year.
Why should patients with lung cancer be vaccinated?
When compared to the general population, influenza infection is associated with increased risk of complications and mortality in cancer patients. Influenza viruses mainly affect the respiratory system, being pneumonia one of its main complications. In this way, lung cancer patients are especially vulnerable, since in many cases their lungs are already committed. In addition, many lung cancer patients also have other chronic diseases, including chronic obstructive pulmonary disease (COPD), which adds additional risk of flu complications.
When should I be vaccinated against the flu?
Ideally, the vaccine should be administered about two weeks before each flu season, which is the time, on average, it takes the body to produce antibodies. However, the vaccination period islonger. ItstartsinOctoberofeachyear,andallriskgroupsshouldbevaccinatedbytheend of the year.
I’m having chemotherapy. Should I be vaccinated against the flu?
The flu vaccine does not contain a live virus, so there is no risk of developing infection, even though you are immunosuppressed. However, if immunosuppression exists, the vaccine may not be effective in creating immunity.
Mortality associated with influenza infection in cancer patients under chemotherapy is much higher than that of the general population, around 10%. For this reason, the vaccine is recommended in patients undergoing chemotherapy and should ideally be administered two weeks before treatment starts. When administered already during chemotherapy, it should be given between cycles, at a time when leukocyte values are expected to be at their maximum.
I’m on immunotherapy. Can I be vaccinated against the flu?
Immunotherapy is a relatively recent therapy, with no evidence yet strong enough to recommend or contraindicate the use of influenza vaccine in this situation.
Two main questions arise: whether the vaccine is effective, and whether it is safe in this setting. Available data suggest that the vaccine is equally effective in these patients. After administration of the vaccine, levels of antibodies in the blood were sufficiently high to provide protection. As for safety, some studies have pointed to a potential risk that the vaccine could increase immunomediated adverse effects that may occur in patients undergoing immunotherapy. However, subsequent studies have not confirmed this hypothesis, showing that the vaccine is safe in these patients.
Based on these results, some entities, such as the Advisory Committee on Immunization Practices (ACIP), already recommend the annual vaccination against influenza cancer patients undergoing immunotherapy, while others consider that they are still further studies are needed.
Bayle A, Khettab M, Lucibello F, et al. Immunogenicity and safety of influenza vaccination in cancer patients receiving checkpoint inhibitors targeting PD-1 or PD-L1. Annals of Oncology; https://doi.org/10.1016/j.annonc.2020.03.290
Why do I have to be vaccinated against the flu every year?
Annual flu vaccination is critical for two reasons. The first is that protection afforded by the vaccine gradually declines in the six months following its application. The second is that every year there is a variation in Influenza subtypes circulating, which means that the immunity that the vaccine offers in a year, is not valid in the following year.
Even after vaccination, is it possible to have the flu?
Yes. Even receiving the vaccine, it is possible to have the flu. Especially if the virus subtypes present in the vaccine that year did not completely match the viruses circulating that year. However, even if you have the flu, the disease should not be as serious as it would be if you have not been vaccinated.
Regardless of influenza vaccination, you should always adopt behaviors to reduce the risk of infection, including measures of etiquette respiratory (when sneezing or coughing protect your mouth with a tissue or with the forearm and do not use your hands; use single-use tissues), washing frequent use of hands with soap and water and reduction of contact with other people, as far as possible.
Can the vaccine itself cause disease?
There is a misconception that we can “get” flu through the vaccine. What can happen is the development of some effects that “mimic” flu symptoms, such as mild fever, muscle pain or nausea. Swelling or pain may also occur in the area where the vaccine was administered.
Are lung cancer patients entitled to a free vaccine?
Norm 016/2020 of 25/09/2020 of the DGS defines the groups covered by free vaccination. The vaccine is not free of charge for cancer patients in general, but only for those who are undergoing chemotherapy or have another form of immunosuppression, and for patients from the National Integrated Continuing Care Network. Free vaccination is also predicted in people over 65 years old, and those with COPD, often coexisting in patients with lung cancer.
For people not covered by free vaccination, the flu vaccine is dispensed in community pharmacies through medical prescription, with 37% share.
Does the flu vaccine protect against COVID-19?
No. Flu and COVID-19 are both contagious respiratory diseases, but they are caused by different viruses. COVID-19 is caused by a new coronavirus (called SARS-CoV-2) and the flu is caused by virus influenza. At the moment, there is still no vaccine to prevent COVID-19, and the best way to prevent disease, is to avoid exposure to this virus.
It should be noted, however, that getting the flu vaccine in the 2020-2021 season is more important than ever as it can help reduce the overall impact of disease population, reduce the burden on our health systems in response to the pandemic and save medical resources for patient care with COVID-19.
Check with your attending physician if you should be vaccinated and where it can be the administered.
GECP and PULMONALE also warn that in order to reduce mortality related to influenza in lung cancer patients, efforts are needed to improve vaccination rates not only in patients, but also in their families, cohabitants and caregivers, and among healthcare professionals.
