Flu in Kids With Cancer

Anne F. Reilly, MD, MPH


March 04, 2013

Editorial Collaboration

Medscape &

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I am Anne Reilly, Medical Director of the Oncology Division at the Children's Hospital of Philadelphia. Today I am going to talk about influenza in children with cancer. We know that healthy children get influenza, but in children who are being treated for cancer, influenza can be an even bigger problem than it is in healthy kids. Kids who are getting cancer therapy are immunosuppressed by their disease and by the treatments that we give, usually chemotherapy and radiation.

We know from the era before immunization that children who get cancer treatment are about twice as likely to get influenza as healthy children. And we know that when children with cancer get influenza, they tend to have more complications. We know that children with cancer who get the flu are more likely to be hospitalized. When those children are hospitalized, up to 20% of them will have severe respiratory complications such as pneumonia.

We know that about 10% of those children will end up in the intensive care unit needing more intense therapy, and about 1 in 6 of those children will end up with a bacterial superinfection. It is a really serious problem for our children. We know that influenza in kids getting cancer therapy lasts longer than in normal children, and we know that they shed virus for about twice as long as normal children so that they become an infection risk to the other people around them.

The other thing that's really important about influenza in children with cancer is that it interrupts their cancer therapy, for an average of about 3 weeks . That is a big deal for some of these children because the intensity of the therapy in treating cancer is very important to the overall cure of disease.

So, what do we do about influenza in children with cancer? There are 2 things that we can do. We can treat influenza when the children get it, and we can try to prevent them from ever getting the flu in the first place. From a treatment point of view, antivirals such as oseltamivir are available. The more quickly you recognize that the child has flu and start flu therapy, the better they are; usually within 48 hours is best.

We would recommend that you start treating before you even have the confirmatory testing, because if the testing comes back, you can always stop the antiviral if necessary. But if you had to wait for a day [for test results that were positive], you have already gotten that extra day and started, which would be better. We know that the antivirals can reduce the duration of fever in kids with flu, the risk of complications, and length of hospital stay, so it's definitely a benefit for children with cancer.

The other thing we like to do is immunize children against influenza. We know that in healthy children the flu vaccine works. In kids with cancer, the flu vaccine doesn't work quite as well, but it definitely has a positive benefit. We know that children who get the flu vaccine with cancer do actually mount an antibody response which, while not quite as good as in other kids, is pretty good. Kids with cancer do best if you can immunize them early in therapy or during a break in therapy. But the immunization is more important than waiting until the right time for the chemotherapy break.

Also really important is immunizing people around the child with cancer. If you can reduce their exposure to flu, then their chance of getting the flu is much less. So we recommend that family members, other children in the classroom, and definitely healthcare workers all have their flu vaccine to really try to protect our kids from getting the flu. In the end, if we can prevent flu and they never get it, things will be much better for our children all the way around.