Vaccination for Cancer Patients: What you need to know?

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Cancer patients are at an increased risk for life-threatening infections. Certain diseases have higher incidence rates among cancer patients and are associated with worse clinical outcomes. It is recommended that cancer patients get vaccinated against these diseases and protect themselves. But not all common vaccines are recommended for every cancer patient because the benefits and safety vary from patient to patient. 

General recommendation for cancer patients is that they should be considered for age- and indication-appropriate vaccinations. Also, vaccination timing is just as important as getting the vaccine itself.

So, which vaccines should you discuss with your oncologist?

COVID-19 Vaccines: Cancer patients fall under the category of people with high-risk conditions who are extremely vulnerable to COVID-19 infection. 

  • COVID-19 vaccines should be given to all cancer patients, as well as household contacts and caregivers, when they are eligible to receive the vaccine. 
  • However, talk to your doctor to know more about the timing of getting the vaccine.

Influenza Vaccines: Cancer patients are at a higher risk for developing serious complications from influenza, with 3-4 times higher odds of hospitalization compared with age-matched controls.

  • You can typically get the flu shot at least 2 weeks before chemotherapy or between cycles of chemotherapy after discussion with your cancer specialist.
  • Do not get the nasal mist flu vaccine as it contains the weakened flu virus and can lead to an infection. The flu injection has the dead flu virus and is safe for cancer patients.
  • Your family members should also get the flu virus injection instead of the nasal mist. 

Pneumococcal Vaccines: Patients undergoing chemotherapy for solid tumors are at a 40-50-fold higher risk for the development of invasive pneumococcal disease compared with healthy adults, with case fatality rates approaching 35%. The pneumococcal vaccine helps to prevent serious lung, blood or brain infections caused by certain bacteria. 

  • There are 2 immunizations available for pneumonia:
    • PPSV23 – Recommended for adults age 65 and older
    • Prevnar -PCV13 – Recommended for children before the age of 2.
  • According to the CDC, people with cancer in general who have not received the PCV13 vaccine should receive the PCV13 vaccine, followed by recommended doses of PPSV23 vaccine after consulting your doctor.
  • To maximize the effectiveness, the vaccine should be given four to six weeks and at least two weeks before the start of the chemotherapy regimen. If not possible, should be delayed until three months after chemotherapy is completed. 
  • A repeat vaccination can be administered, but five years should elapse from the first dose.
  • Co-administration of pneumococcal vaccine and influenza vaccine is safe and effective. 
  • Family members and close contacts of cancer patients can be safely immunized with most, but not all, live vaccines.

Varicella (Chicken Pox) and Shingles (Varicella Zoster) Vaccines: Cancer patients have a higher overall incidence of zoster, compared with age-matched controls, particularly those with hematologic malignancies. Infection with Varicella Zoster Virus can cause herpes zoster infection (“shingles”), postherpetic neuralgia, and other serious complications.

  • Varicella vaccine is intended to prevent chickenpox in people who have never had it. 
  • Vaccine for shingles is given to adults age 60 or older who’ve had chicken pox to prevent shingles or to lessen its severity. 
  • Both of these are live virus vaccines. It should not be given to people with weak immune systems, or to people with leukemia, lymphoma, or any cancer of the bone marrow or lymphatic system unless it’s treated and under control. 
  • Caregivers who aren’t immune to these viruses should be vaccinated. 

Other Routine Vaccines

  • Tdap vaccine: If you haven’t received a tetanus shot in the past 10 years, talk to your doctor about whether you should get a Tdap, which a combination vaccine that protects against tetanus, diphtheria and pertussis (whooping cough). 
  • Human papillomavirus (HPV) vaccine: Should be offered to all young and adult cancer patients till the age of 26, if they have not previously received the series. 
  • Hepatitis A and B vaccines: Can be considered in cancer patients if another indication for vaccination is present. 
  • MMR (measles-mumps-rubella) vaccine: MMR contains a live virus, so it is contraindicated in highly immunocompromised cancer patients however, it is safe for your family members.

Routine vaccination in cancer patients and their household contacts is an important strategy for reducing morbidity and mortality in this vulnerable population. If you have any concerns about a contagious disease or want to get vaccinated, be sure to talk to your oncologist first. Additionally, if you’re planning to travel, ask your doctor if you need to take any other vaccinations, based on specific epidemiologic risks that may be encountered at the travel destination(s).

Know the Writer

Dr (Prof) Meenu Walia is a renowned Medical Oncologist (Cancer Specialist) with over 27 years of experience. She is India’s first DNB, Medical Oncologist and spearheads the Department of Medical Oncology & Hematology at Max Super Specialty Hospital (Patparganj, Vaishali and Noida). She has been decorated with various awards namely Bharat Jyoti Award and Medical Excellence by IMA multiple times. She is a keen cancer researcher and is actively involved with several NGOs working towards the welfare of cancer patients. She is a TEDx speaker and the author of a hugely popular book among cancer patients and caregivers, “Tips for Happiness in The Shadow of Cancer”.

Dr Meenu Walia receiving both the doses of COVID-19 Vaccine

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