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\begin{document}

\title{The Effect of COVID- 19 Pandemic on Routine Adult Vaccination in Cancer
Patients}



\author[1]{Nesligül Özdemir }%
\author[2]{Aygin Bayraktar- Ekincioglu}%
\author[3]{Saadettin Kilickap}%
\affil[1]{Hacettepe University}%
\affil[2]{Hacettepe University Faculty of Pharmacy}%
\affil[3]{Hacettepe University Faculty of Medicine}%


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  \date{May 05, 2024}


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\textbf{Title:} The Effect of COVID- 19 Pandemic on Routine Adult
Vaccination in Cancer Patients

\textbf{Running title:} COVID-19 and Vaccination in Cancer Patients

\textbf{Authors:}

Nesligul Ozdemir; Hacettepe University Faculty of Pharmacy, Department
of Clinical Pharmacy, Ankara, Turkey,\emph{nesliozdmr@hotmail.com}

Aygin Bayraktar-Ekincioglu; Hacettepe University Faculty of Pharmacy,
Department of Clinical Pharmacy, Ankara,
Turkey,\emph{aygin@hacettepe.edu.tr}

Saadettin K\selectlanguage{polish}ı\selectlanguage{english}l\selectlanguage{polish}ı\selectlanguage{english}ckap; Hacettepe University Faculty of Medicine, Department
of Medical Oncology, Ankara,Turkey, skilickap@yahoo.com

\textbf{Corresponding author:}

Nesligul Ozdemir

Hacettepe University Faculty of Pharmacy, Department of Clinical
Pharmacy, Ankara, Turkey,

E-mail: nesliozdmr@hotmail.com

GSM: +90536 978 72 51

\textbf{Funding} : This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-profit sectors.

\textbf{Conflict of Interest Statement:} The authors declare no
conflicts of interest.

To the Editor,

Since the priority in health services becomes to control the COVID-19
pandemic, the management of other diseases and provision of preventive
healthcare services (such as vaccination) have remained secondary in a
period where the whole focus is directed to COVID-19 {[}1{]}. Patients
fear of becoming infected and ongoing national \& government measures
(such as curfew/lockdown or restriction in public transportation) cause
patients to delay hospital visits even if necessary. Therefore, routine
delivery of preventive healthcare services, such as vaccination has
distrupted.

COVID-19 presents severe course in elderly as well as patients with
chronic diseases and cancer {[}2{]}, in which concomittant diseases
affecting respiratory system prolong the course of infection and worsen
clinical situation in patients {[}3{]}. The administration of influenza
and pneumococcal vaccines in patients at high risk may reduce the burden
of secondary infections and contributes to resolution of COVID-19 with
fewer complications {[}4, 5{]}.

It has been known that adult vaccination rates are still lower than
expected, which is also affected by disrupted healthcare services due to
pandemic. Although few studies have examined the effects of pandemic on
childhood vaccination, its impact on adult vaccination has not been
investigated. Therefore, we would like to share cross-sectional and
COVID-19 related findings of an ongoing study, which was aimed to show
the impact of pneumococcal vaccine information provided to cancer
patients by a clinical pharmacist at outpatient settings in tertiary
care hospitals.

After the first COVID-19 case was seen in the country, Turkey on March
11th, 2020, the vaccination behavior of cancer patients was evaluated.
During the study, cancer patients' vaccination status after the
provision of vaccine information/recommendation were questioned at
monthly interval for 3 months and reasons for patients not being
vaccinated were also recorded.

According to the cross-sectional evaluation (March -- November 2020) in
this study, 102 out of 162 patients were not vaccinated at the end of 3
months. The reasons (n, \%) for not getting pneumoccocal vaccine were
reported as; not able to go healthcare facility due to COVID-19 (n=35,
34.32\%), vaccine is not available / out of stock (n=21, 20.59\%),
believed that it is not necessary (n=18, 17.65\%), prefer to ask the
specialist first, but not able to contact yet (n=6, 5.88\%), do not have
time to attend family physician (n=5, 4.9\%), started a new chemotherapy
protocol (n=5, 4.9\%), undecided (n=4, 3.9\%), fear of side effects
(n=3, 2.9\%), forget to have it (n=2, 1.9\%), pay no attention (n=2,
1.9\%) and family physician do not see it necessary (n=1, 0.9\%).
Although patients have hesitations to go healthcare facilities due to
the fear of COVID-19, the pharmacist persuaded 37\% of patients (n=60)
to visit healthcare services to get vaccine by informative and
encouraging counseling.

Vaccine-preventable diseases and associated complications cannot be
overcome due to disruption of healthcare services during the pandemic in
countries that have not reached intended rate in adult vaccination. We
believe that monitoring and reinforcement of patients on vaccination may
contribute to improved health outcomes in patients with cancer during
COVID-19 pandemic.

{[}1{]} Mitsuya H. Fight against COVID-19 but avoid disruption of
services for other communicable diseases (CDs) and noncommunicable
diseases (NCDs). Glob Health Med. 2020;2(6):343-5.

{[}2{]} Laires PA, Dias S, Gama A, Moniz M, Pedro AR, Soares P, et al.
The Association Between Chronic Disease and Serious COVID-19 Outcomes
and Its Influence on Risk Perception: Survey Study and Database
Analysis. JMIR Public Health Surveill. 2021;7(1):e22794.

{[}3{]} Oh TK, Song IA. Impact of coronavirus disease-2019 on chronic
respiratory disease in South Korea: an NHIS COVID-19 database cohort
study. BMC Pulm Med. 2021;21(1):12.

{[}4{]} Green I, Ashkenazi S, Merzon E, Vinker S, Golan-Cohen A. The
association of previous influenza vaccination and coronavirus
disease-2019. Hum Vaccin Immunother. 2020:1-7.

{[}5{]} Noale M, Trevisan C, Maggi S, Antonelli Incalzi R, Pedone C, Di
Bari M, et al. The Association between Influenza and Pneumococcal
Vaccinations and SARS-Cov-2 Infection: Data from the EPICOVID19
Web-Based Survey. Vaccines (Basel). 2020;8(3).

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