Adherence to national vaccination guidelines among pediatric cancer patients: a retrospective study from two tertiary care centers in Switzerland.
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BACKGROUND: Childhood cancer diagnosis and treatment cause significant immunosuppression, increasing vulnerability to vaccine-preventable diseases and disrupting routine vaccination schedules. In Switzerland, vaccination guidelines to support physicians caring for these patients were published in 2022. Adherence to these recommendations among pediatric cancer patients remains unknown. METHODS: We conducted a retrospective chart review of pediatric cancer patients (0-16 years at diagnosis) treated at two Swiss tertiary care centers between June 2022 and November 2024. Vaccine uptake was assessed at diagnosis, during, and after treatment using descriptive analyses. Exploratory analyses evaluated risk factors for under-vaccination, and occurrence of vaccine-preventable diseases was documented. RESULTS: Among 105 participants (median age at diagnosis 7.6 years [IQR 2.7-12.9]), uptake of vaccines recommended during treatment was low (pneumococcal conjugate vaccine 5%, influenza vaccine 10%, COVID-19 vaccine 19%). Post-treatment vaccine uptake was delayed and insufficient, ranging from 0 to 41% within 0-3 months following recommendation date and from 15 to 76% thereafter, depending on the vaccine. Younger age at diagnosis was associated with complete post-treatment vaccine uptake (p = 0.03). Vaccine-preventable diseases, including COVID-19, influenza, varicella, herpes zoster, and pertussis, occurred in 30/105 participants (29%). Most vaccines during (82%), and all vaccines after treatment (100%), were administered in primary care. CONCLUSION: In a setting where post-treatment vaccination relies exclusively on primary care and no structured in-hospital measures are set in place, vaccine uptake among pediatric cancer patients remained insufficient. Targeted strategies are needed to improve guidelines adherence and reduce the burden of vaccine-preventable diseases, particularly among older children.