Vaccinations During Cancer Treatment

Can Children Get Vaccinations During Childhood Cancer Treatment?

Childhood cancer patients may need to delay getting certain vaccines during cancer treatment.

Routine vaccines are those recommended for everyone in U.S. The Centers for Disease Control (CDC) publishes a recommended childhood vaccination schedule each year. Vaccination is sometimes referred to as immunization.

How Do Vaccines Work?

Vaccines teach the body how to defend itself when specific germs (such as viruses or bacteria) invade it.

• Vaccines give people a safe exposure to a small amount of parts of germs or to a germ that has been weakened (attenuated) or killed.
• Vaccines make the body’s defense system develop a response to that germ so that the body can recognize and fight it if exposed in the future. The immune system then learns to remember the germ and can recognize and attack it if the person is exposed to it later.
• As a result, the person may not become ill or could have a milder infection.
• One way that vaccines work is by reducing the chance of exposure to a germ if others around the person are also vaccinated.

Why Can’t Childhood Cancer Patients Receive Certain Vaccines?

Childhood cancer patients often have weakened immune systems during cancer treatment.

A vaccine requires a good immune response to be effective. Vaccines may not be effective when given to someone receiving treatment for cancer. The weakened immune system cannot respond normally by creating a memory of the germ to be able to attack it later.

In rare cases, vaccines that contain weakened (attenuated) virus can cause patients with very weakened immune systems to become sick if they receive them. Patients should not get these vaccines while their immune systems are weak. But it’s generally OK for people around them to receive them.

The routine vaccines that contain attenuated viruses — and should not usually be given to people with a weakened immune system — are:

• MMR (measles, mumps, rubella)
• Varicella (chickenpox)
• Nasal flu mist
• Rotavirus

What Vaccines Are Recommended During Treatment?

The Infectious Diseases Society of America recommends an annual flu shot for all children older than 6 months, including those receiving treatment for cancer. People need a flu shot once a year because the makeup of the flu shot is different each year. Influenza viruses are constantly changing, and the body’s immune response decreases over time.

Children with weakened immune systems should not receive the flu mist nasal vaccine because it contains live virus.

The flu shot is made with dead (inactivated) flu viruses. It is safe for people with cancer. It may be given at least 2 weeks before chemotherapy or between chemotherapy cycles.

Transplant patients may get a flu shot 6 months after transplant. If there is an influenza outbreak in the community, they may receive a flu shot 4 months after transplant.

Exceptions to these rules would be patients who are not likely to respond to the flu vaccine, although they are unlikely to be harmed by it. Patients not likely to respond include those who have received strong chemotherapy or those who have received anti B-cell antibodies within 6 months.

Children who are receiving treatment for cancer can generally receive all of the routine vaccines except the attenuated virus vaccines.

If your child has not completed their routine vaccines, you can talk with your doctor about continuing these to protect your child during treatment for cancer. Typically the shots given during this time need to be repeated after your child has finished treatment, because they might not be effective because of the weakened immune system. But they may also provide some protection.

When Can Children Resume Vaccinations After Treatment for Cancer?

The care team will advise families on when to resume the vaccination schedule. Patients may be immunized with vaccines with inactivated virus and live vaccines for chickenpox and MMR.

• In general, patients may resume vaccinations at least 3 months after the end of chemotherapy. They can follow a catch-up schedule. A catch-up schedule is for children whose vaccinations have been delayed.
• Patients who received anti B-cell antibodies should wait at least 6 months before resuming vaccinations.
• Transplant patients may have to wait longer. They will need to receive all new vaccinations because the transplant process has wiped out the immune system they had before the transplant. Their care team will let them know when they are ready to start vaccinations.
• Patients who received some routine vaccinations during chemotherapy should generally have a catch-up schedule as if those had not been given because it is not known whether they were effective or not.

Should Childhood Cancer Patients Be Exposed to People Who Have Had Vaccinations?

Siblings and adults who live with a childhood cancer patient should keep current on vaccinations to minimize the chances of exposing the child to a vaccine-preventable disease.

People in the household should not receive the oral polio vaccine. (This vaccine is not used in the United States.)

If an infant in the household has recently received rotavirus vaccination, all family members should wash hands thoroughly and frequently after contact with the vaccinated infant, especially when changing diapers. Transplant patients and those receiving cancer therapy should not change diapers at all.

Children with weakened immune systems should avoid any person who has had:

• A rash after recently receiving the chickenpox (varicella) vaccine
• The nasal flu vaccine within one week

For more information about vaccinations, visit:

• IDSA - Vaccination of the Immunocompromised Host
• CDC - Recommended Child and Adolescent Immunization Schedule
• CDC - Making the Vaccine Decision