-Author name in bold denotes the presenting author
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1586 Influenza Vaccination in Asplenia: Improving Quality of Care in Time of Coronavirus

Program: Oral and Poster Abstracts
Session: 901. Health Services Research—Non-Malignant Conditions: Poster I
Hematology Disease Topics & Pathways:
Coronaviruses, SARS-CoV-2/COVID-19, viral, Biological, Adult, Diseases, Therapies, Pediatric, Biological Processes, Technology and Procedures, Young Adult, Infectious Diseases, Study Population, Clinically relevant, vaccines
Saturday, December 5, 2020, 7:00 AM-3:30 PM

Nicoletta Di Maio1*, Giovanna Russo2*, Susanna Barella, MD3*, Gian Luca Forni, MD4*, Raffaella Colombatti, MD, PhD5, Lucia Notarangelo6*, Giovanna Graziadei, MD7*, Antonella Sau, MD8*, Luciana Rigoli9*, Piero Farruggia10*, Saveria Campisi, MD11*, Tommaso Casini12*, Manuela Balocco, MD13*, Gianluca Boscarol14*, Ilaria Capolsini, MD15*, Paolo Grotto, MD16*, Fiorina Giona, MD17, Ilaria Lazzareschi, MD18*, Pellegrina Pugliese, MD19*, Francesca Fioredda, PhD20*, Silvia Fasoli21*, Maria Caterina Putti, MD22*, Maddalena Migliavacca, MD, PhD23*, Corti Paola, MD24*, Serena Tripodi, MD25*, Paola Saracco, MD26*, Simone Ferrero, MD27, Assunta Tornesello, MD28*, Marilena Serra, MD29*, Saverio Ladogana, MD30*, Giovanni Palazzi, MD31*, Federico Verzegnassi, MD32*, Carlo Baronci, MD33*, Giuseppe Palumbo, MD34*, Simone Cesaro, MD35,36*, Laura Sainati, MD37*, Flavia Rivellini, MD38*, Rosanna Di Concilio, MD39*, Vania Munaretto, MD40*, Elena Facchini, MD41*, Paola Giordano, MD42*, Maria Grazia Sanna43*, Silverio Perrotta, MD44* and Maddalena Casale, MD, PhD45,46

1Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
2Pediatric Hematology/Oncology Unit, Azienda Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
3Università di Cagliari, Cagliari, Italy
4Centro della Microcitemia, Ospedali Galliera, Genova, Italy
5Department of Womens' and Child Health, Clinic of Pediatric Hematology Oncology, Azienda Ospedaliera-Università di Padova, PADOVA, ITALY, Italy
6Childrens' Hospital, Spedali Civili, Brescia, ITA
7Department of Internal Medicine, UOC Medicina Generale, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy, Italy
8Pediatric Onco-hematology Unit, Santo Spirito Hospital Pescara, Pescara, Italy
9Unità Operativa Complessa di Pediatria d’Urgenza, Policlinico "G. Martino", Messina, Italy
10Pediatric Hematology and Oncology Unit, A.R.N.A.S. Ospedale Civico,, PALERMO, Italy
11Ospedale Umberto I, Siracusa, Italy
12Centro Talassemie ed Emoglobinopatie, Ospedale “Meyer”, Firenze, Italy
13Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera, Genoa, Italy
14Ospedale di Bolzano, Bolzano, Italy
15Hospital “S.Maria della Misericordia”, Perugia, Italy
16Ospedale di Treviso, Treviso, Italy
17Department of Translational and Precision Medicine - Hematology Division, Sapienza University of Rome, Rome, Italy
18Policlinico Gemelli-Unità Cattolica Sacro Cuore, Rome, Italy
19Policlinico Umberto I, Rome, Italy
20Hematology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
21Azienda Ospedaliera Carlo Poma, Mantova, Italy
22Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padova, Italy
23Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
24Ospedale San Gerardo, Monza, Italy
25Fondazione IRCCS "San Matteo", Pavia, Italy
26University Hospital, City of Health and Science of Turin, and Pediatric Hematology, Queen Margaret’s Children's Hospital, Turin, Italy
27Hematology, University of Torino and Hospital "Città della Salute e della Scienza di Torino", Torino, Italy
28Italian Association of Pediatric Hematology Oncology (AIEOP) Coagulation Disorders Working Group, Lecce, Italy
29Day Hospital di Talassemia, Ospedale “V. Fazzi”, Lecce, Italy
30Department of Pediatrics, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
31Azienda Ospedaliera-Università di Modena, Modena, Italy
32Institute for Maternal and Child Health (I.R.C.C.S) Burlo Garofolo, Trieste, Italy
33Pediatric Hospital Bambino Gesù, Rome, ITA
34Department of Hematology and Oncology, Ospedale Bambino Gesù, Rome, Italy
35The Pediatric Hematology–Oncology, Woman and Child Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
36Policlinico G.B. Rossi, Verona, Italy
37Azienda Ospedaliera Universitaria, Padova, Italy
38Ospedale Tortora, Nocera Inferiore, ITA
39Dipartimento di Pediatria, Ospedale "Umberto I", Nocera Inferiore, Italy
40Clinic of Pediatric Hematology Oncology, Department of Woman's and Child's Health, Azienda Ospedaliera-Università di Padova, Padova, Italy
41U.O. di Pediatria -Prof A. Pession, Azienda Ospedaliero-Universitaria di Bologna - Policlinico “S. Orsola-Malpighi”, Bologna, Italy
42Pediatric Unit, Azienda Ospedaliera Universitaria Concorziale Policlinico di Bari, Bari, Italy
44Università degli Studi della Campania Luigi Vanvitelli, Napoli, ITA
45Università degli studi della Campania Luigi Vanvitelli, Naples, ITA
46Università degli studi della Campania Luigi Vanvitelli, Naples, Italy


Asplenic patients are at high risk of potentially fatal invasive infections, such as sepsis, meningitis, and pneumonia. It has been shown that infection from influenza viruses can precede or increase the risk of bacterial infection and of serious complications of the underlying disease. International and national guidelines recommend annual influenza vaccination in asplenic subjects. Following the Covid-19 pandemic, the major government and medical-scientific institutions in the US and in Europe have been planning how to contain infection during the 2020-2021 influenza season. Extending influenza vaccination is the safest and most effective way to reduce the circulation of influenza virus and to promote the correct diagnosis and management of suspected cases of SARS-CoV-2. Influenza vaccination also reduces complications associated with the underlying disease and visits to Emergency Units. Our study aims to evaluate influenza vaccination in a large population of asplenic patients and explore the main causes for non-vaccination to identify critical areas for improvement in the vaccination programme in these at-risk patients for the 2020-2021 influenza season.


The Italian Network of Asplenia (INA) is made up of 88 doctors working in 50 clinical centers in 27 cities and 16 of the 20 regions of Italy. It aims to build a large, prospective cohort of asplenic patients throughout Italy through which to study the interaction between asplenia and its associated underlying conditions, collecting precise, accurate data also in cases of rarer diseases. The study also aims to improve the quality of healthcare for this at-risk population. The number of patients enrolled in the Network who had had at least one dose of influenza vaccine at the time of diagnosis of asplenia was retrieved from the INA database. All participating centers were asked to answer a questionnaire to report the main obstacles for influenza vaccination.


At 1st August 2020, 1,670 patients had been enrolled in the INA (783 females; 887 males). All underlying causes of asplenia are shown in Table 1. Only 466 (28%) patients had had at least one influenza vaccination, while 1,204 (72%) had never been vaccinated since diagnosis of asplenia. Thirty-five (70%) of the 50 centers answered the questionnaire. Main causes of non-vaccination were physicians' ambivalence concerning vaccination and patients' inadequate awareness or logistical problems.


These data show very low seasonal influenza vaccination cover even though asplenic patients are considered at-risk of complications associated with infection from influenza viruses. Since the 2020-2021 influenza season could see influenza viruses in circulation with SARS-CoV-2, influenza vaccination must be expanded as widely as possible, in particular to subjects of all ages at high risk. These results reveal important areas of concern in the management of asplenic patients and the need to improve the quality of information to physicians and patients alike. The INA co-ordinating center will launch a campaign to provide information and organize ad hoc meetings to widen influenza vaccination coverage in asplenic patients and reduce the pressure on the national health service during the next influenza season.

Disclosures: Forni: Novartis: Membership on an entity's Board of Directors or advisory committees. Colombatti: Addmedica: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees. Giona: Sanofi Genzyme: Research Funding, Speakers Bureau; Takeda: Speakers Bureau; Novartis: Research Funding. Ferrero: Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; EUSA Pharma: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Research Funding, Speakers Bureau; Servier: Speakers Bureau. Perrotta: Novartis: Consultancy, Research Funding, Speakers Bureau. Casale: Novartis: Membership on an entity's Board of Directors or advisory committees.

*signifies non-member of ASH