National Immunisation Advisory Committee Recommendation for the 2018/2019 Influenza Vaccination Campaign
Please note the following recommendations from the National Immunisation Advisory Committee (NIAC) - these will be included in revised chapters of the Immunisation Guidelines:
- Influenza vaccination is strongly recommended annually for most cancer patients.
- If a person receiving chemotherapy has not received influenza vaccine 2 weeks or more before commencing treatment, the vaccine should be given during chemotherapy. However, the response to the vaccine may be blunted. A second vaccine is recommended in the same influenza season, a minimum of 4 weeks following a course of chemotherapy, if lymphocyte count is ≥ 1.0 x 109/L regardless of whether they have received influenza vaccines in previous seasons.
- Patients on combination checkpoint inhibitors (e.g. ipilimumab plus nivolumab) SHOULD NOT receive any influenza vaccines, because of significant increased incidence of immune-related adverse reactions.
- Families and care providers of patients with cancer should be encouraged to receive an inactivated influenza vaccine, preferably before treatment is started.
The National Immunisation Advisory Committee has been asked to review its advice regarding influenza vaccination of patients receiving combination checkpoint inhibitors.
Immunotherapy, by inhibiting immune checkpoint pathways, has revolutionised the field of oncology. However, by altering the immune response to fight cancer, a new class of side effects has emerged known as immune-related adverse events (irAEs). These adverse events, which may be life-threatening, are due to over-activation of the immune system. They can involve almost any organ or organ system, and can occur at any stage of a patient’s treatment course. Combination checkpoint inhibitor therapy has been shown to be more toxic than targeting a single checkpoint pathway.
In a few people receiving Ipilimumab or combination therapy, fatal irAEs occurred after receipt of an influenza vaccination. The theoretical risk that any event that stimulates the immune system could trigger the onset of irAEs means a possible role of influenza vaccination cannot be discounted.
There are currently no international consensus statements on the use of influenza vaccines in people receiving combination immune checkpoint inhibitor treatments.
Until further evidence emerges, NIAC continues to advise that patients on combination checkpoint inhibitors (e.g. ipilumumab plus nivolumab) should not receive any influenza vaccines, because of a potential association with immune-related adverse reactions.
When possible, seasonal influenza vaccine should be given at least two weeks before treatment is started.
Families and care providers should be strongly encouraged to receive an inactivated influenza vaccine (unless contraindicated), to minimise influenza exposure risk to patients with cancer.
If a patient is in contact with a confirmed case of influenza or has symptoms of influenza, early medical advice should be sought and chemoprophylaxis or treatment with antivirals considered as per national guidelines.
The following information materials are available for the 2018/2019 influenza campaign
Information is also available from the following websites
This page was updated on 4 February 2019