Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Events

Patient and family education in HSCT: improving awareness of respiratory virus infection and influenza vaccination. A descriptive study and brief intervention

Bone Marrow Transplantation volume 45, pages 656–661 (2010)Cite this article

Abstract

To prevent respiratory virus (RV) infection after hematopoietic SCT (HSCT), patient and household members are advised to have annual influenza vaccinations and avoid symptomatic contacts. The object of this study was to measure and increase patient/household awareness of RV infection and preventive measures. We used a self-administered questionnaire before/after a 5-min educational module (2006–2007) and interviews with HSCT patients (2005–2007). The subjects were patients and their households attending pre-HSCT education in an Australian HSCT Unit. Outcome measures were awareness of RV infection post-HSCT and effective prevention strategies; household influenza vaccination on admission for HSCT. In all, 139 out of 205 (68%) participants completed both questionnaires. Baseline knowledge of RV infection risk was high; knowledge of prevention was low. Intervention increased awareness that influenza post-HSCT could be fatal or require intensive care (68–87%, P=0.003), knowledge of effective prevention strategies (41–78%, P<0.0001) including vaccination (11–58%, P<0.0001), and belief among family/friends (but not patients) that household vaccination reduces influenza risk post-HSCT (57–97%, P<0.0001 and 76–81%, P=0.2, respectively). Household vaccination at HSCT admission was 71% for attenders and 30% for non-participants (RR 2.38, 95% confidence interval (CI) 1.49–3.80, P<0.0001). We concluded that patient and family pre-HSCT education increases awareness of RV prevention strategies and household influenza vaccination.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Roghmann M, Ball K, Erdmann D, Lovchik J, Anderson LJ, Edelman R . Active surveillance for respiratory virus infections in adults who have undergone bone marrow and peripheral blood stem cell transplantation. Bone Marrow Transplant 2003; 32: 1085–1088.

    Article  CAS  PubMed  Google Scholar 

  2. van Kraaij MGJ, van Elden LJR, van Loom AM, Hendriksen KA, Laterveer L, Dekker AW et al. Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture. Clin Infect Dis 2005; 40: 662–669.

    Article  PubMed  Google Scholar 

  3. Martino R, Porras RP, Rabella N, Williams JV, Ramila E, Margall N et al. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respiratory tract infections by respiratory viruses in adult recipients of hematopoietic stem cell transplants for hematologic malignancies. Am Soc Blood Marrow Transplant 2005; 11: 781–796.

    Article  Google Scholar 

  4. Ljungman P, Ward KN, Crooks BN, Parker A, Martino R, Shaw PJ et al. Respiratory virus infections after stem cell transplantation: a prospective study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2001; 28: 479–484.

    Article  CAS  PubMed  Google Scholar 

  5. Couch RB, Englund JA, Whimbey E . Respiratory viral infections in immunocompetent and immunocompromised persons. Am J Med 1997; 102: 2–9.

    Article  CAS  PubMed  Google Scholar 

  6. Whimbey E, Champlin RE, Couch RB, Englund JA, Goodrich JM, Raad I et al. Community respiratory virus infections among hospitalized adult bone marrow transplant recipients. Clin Infect Dis 1996; 22: 778–782.

    Article  CAS  PubMed  Google Scholar 

  7. Nichols WG, Guthrie KA, Corey L, Boeckh M . Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality and the effect of antiviral therapy. Clin Infect Dis 2004; 39: 1300–1306.

    Article  PubMed  Google Scholar 

  8. Machado CM, Boas LSV, Mendes AVA, da Rocha IF, Sturaro D, Dulley FL et al. Use of oseltamivir to control influenza complications after bone marrow transplantation. Bone Marrow Transplant 2004; 34: 111–114.

    Article  CAS  PubMed  Google Scholar 

  9. Moscona A . Global transmission of oseltamivir-resistant influenza. N Engl J Med 2009; 360: 953–956.

    Article  CAS  PubMed  Google Scholar 

  10. Ison MG, Gubareva LV, Atmar RL, Treanor JJ, Hayden FG . Recovery of drug-resistant influenza virus from immunocompromised patients: a case series. J Infect Dis 2007; 193: 760–764.

    Article  Google Scholar 

  11. Gooskens J, Jonges M, Claas EC, Meijer A, van den Broek PJ, Kroes AM et al. Morbidity and mortality associated with nosocomial transmission of oseltamivir-resistant influenza A(H1N1) virus. JAMA 2009; 301: 1042–1046.

    Article  CAS  PubMed  Google Scholar 

  12. van der Vries E, van den Berg B, Schutten M . Fatal oseltamivir-resistant influenza virus infection. N Engl J Med 2008; 359: 1074–1076.

    Article  CAS  PubMed  Google Scholar 

  13. DiMecheli V, Rivetti D, Deeks JJ, Jefferson TO . Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews 2004, Issue no. 3, Art. no.: CD001269.

  14. Engelhard D, Nagler A, Hardan I, Morag A, Aker M, Baciu H et al. Antibody response to a two-dose regimen of influenza vaccine in allogeneic T cell-depleted and autologous BMT recipients. Bone Marrow Transplant 2001; 28: 775–781.

    Article  Google Scholar 

  15. Gandhi MK, Egner W, Sizer L, Inman I, Zambon M, Craig JI et al. Antibody responses to vaccinations given within the first two years after transplant are similar between autologous peripheral blood stem cell and bone marrow transplant recipients. Bone Marrow Transplant 2001; 28: 775–781.

    Article  CAS  PubMed  Google Scholar 

  16. Backer H . Counterpoint: in favor of mandatory influenza vaccine for all health care workers. Clin Infect Dis 2006; 42: 1144–1147.

    Article  PubMed  Google Scholar 

  17. Bridges CB, Harper SA, Fukuda K, Uyeki TM, Cox NJ, Singleton JA et al. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 52(RR-8). Morbidity & Mortality Weekly Report Recommendations & Reports, 2003, pp 1–34.

  18. Australian Technical Advisory Group on Immunisation, Australian Government Department of Health and Aging. The Australian Immunisation Handbook, 9th edn. National Health and Medical Research Council of Australia: Canberra, 2008, pp 190–193.

  19. Ljungman P, Engelhard D, de la Camara R, Einsele H, Locasciulli A, Martino R et al. Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT. Bone Marrow Transplant 2005; 35: 737–746.

    Article  CAS  PubMed  Google Scholar 

  20. National Centre for Infectious Diseases, Centers for Disease Control and Prevention. Guidelines for Preventing Opportunistic Infections among Hematopoietic Stem Cell Transplant Recipients: Recommendations of CDC, the Infectious Diseases Society of America, and the American Society of Blood and Marrow Transplantation, 49(RR-10). Centre for Disease Control and Prevention. Morbidity and Mortality Weekly Report, 2000, pp 1–128.

  21. Kirscht JP, Don PH, Kegeles SS, Rosenstock IM . A National Study of Health Beliefs. J Health Hum Behav 1966; 7: 248–254.

    Article  CAS  PubMed  Google Scholar 

  22. Glanz K, Rimer BK . Theory at a Glance: A Guide for Health Promotion, 2nd edn. NIH Publication No. 05-389. National Cancer Institute, National Institutes of Health, US Department of Health and Human Services: Washington, DC, 2005.

    Google Scholar 

  23. Stead LF, Bergson G, Lancaster T . Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2008, Issue no. 2, Art. no.: CD000165.

  24. Mac Donald R, Baken L, Nelson A, Nichol KL . Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients. Am J Prev Med 1999; 16: 173–177.

    Article  CAS  PubMed  Google Scholar 

  25. Skull SA, Andrews RM, Byrnes GB, Kelly HA, Nolan TM, Brown GV et al. Validity of self-reported influenza and pneumococcal vaccination status among a cohort of hospitalized elderly inpatients. Vaccine 2007; 25: 4775–4783.

    Article  PubMed  Google Scholar 

  26. Centre for Epidemiology and Research. Vaccinated against influenza in the last 12 months by age, persons aged 65 years and over, NSW, 2006. In: 2007 Report on Adult Health from the New South Wales Population Health Survey. NSW Department of Health: Sydney, 2008.

  27. Joseph C, Goddard N . Influenza vaccine uptake in the elderly: results from a rapid assessment of the effectiveness of new government policy in England for the winters 2000/2001 and 2001/2002. Vaccine 2003; 21: 1137–1148.

    Article  PubMed  Google Scholar 

  28. Chi R-C, Reiber GE, Neuzil KM . Influenza and pneumococcal vaccination in older veterans: results from the behavioral risk factor surveillance system. J Am Geriatr Soc 2006; 54: 217–223.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Mary McGurgan for coordinating the education forums, Masrura Kabir for database design, Tania Sorrell for review of paper, and the patients and families involved in this study. This study was supported by the National Health and Medical Research Council of Australia (NHMRC) through a Centre of Clinical Research Excellence Grant (# 264625), and through a NHMRC post-graduate medical award to PEF. All researchers were independent of the funder. PEF designed and executed the study, analysed results, did the principal writing, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. CFCJ and NMG contributed to study design, interpretation of results and writing of the paper. The NHMRC Clinical Centre for Research Excellence in Bioethics and Haematological Malignancies is funded by the National Health and Medical Research Council, Department of Health, Australian Government.

Author information

Authors and Affiliations

  1. Centre for Infectious Diseases and Microbiology and NHMRC Clinical Centre for Research Excellence in Bioethics and Haematological Malignancies, Westmead Hospital, Westmead, New South Wales, Australia

    P E Ferguson & N M Gilroy

  2. Centre for Values, Ethics and the Law in Medicine, The University of Sydney, New South Wales, Australia

    C F C Jordens

  3. NHMRC Clinical Centre for Research Excellence in Bioethics and Haematological Malignancies, Westmead Hospital, New South Wales, Australia

    C F C Jordens

Authors
  1. P E Ferguson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C F C Jordens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N M Gilroy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P E Ferguson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferguson, P., Jordens, C. & Gilroy, N. Patient and family education in HSCT: improving awareness of respiratory virus infection and influenza vaccination. A descriptive study and brief intervention. Bone Marrow Transplant 45, 656–661 (2010). https://doi.org/10.1038/bmt.2009.209

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.209

Keywords

Search

Advanced search

Quick links