COMMENTARY

Immunizing Kids Who Have Cancer

Anne F. Reilly, MD, MPH

Disclosures

April 29, 2013

Editorial Collaboration

Medscape &

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I am Anne Reilly. I'm the Medical Director at the Division of Oncology at the Children's Hospital in Philadelphia. Today, I am going to talk about the use of immunizations in children who are receiving treatment for cancer.

We know that children with cancer are immunosuppressed in a variety of ways. First of all, they could be immunosuppressed by their disease, particularly if they have leukemia or lymphoma. We also know that the therapy we give causes them to be immunosuppressed. Both chemotherapy and radiation therapy can result in decreased white cell counts, particularly decreased leukocyte counts; decreased immunoglobulins; and impaired cellular immunity.

What do we do about vaccinating children with cancer? There are a couple of different approaches. First of all, we would like to avoid doing any harm. In general, you do not ever want to give a live virus vaccination, such as a measles, mumps, and rubella vaccination, to a child with cancer who is receiving active therapy. The immune system will start to get back to normal 3-6 months after chemotherapy or radiation therapy is finished. At that point, it becomes safe to administer a live virus vaccine. We do know that the immunity does not return to normal until probably 12 months after therapy in many children. It may be best to delay immunizations to that point in order to get the best effect.

There are other vaccines that in that period of time may not get a good response but aren't harmful, such as inactivated recombinant or polysaccharide vaccines. While you can give those vaccines, you cannot really expect a good result from them until probably 6-12 months after completing therapy.

The one vaccine that we do recommend that children on therapy get all the time is the influenza vaccine. Even though we know that children who are on cancer therapy have a blunted response to the influenza vaccine, they do actually have a response. It does seem to offer some protection. Particularly in the winter when flu is epidemic, it really is a benefit to children to have a flu vaccine.

The other thing we would like to remember is that the best way to protect children who are immunosuppressed from illnesses like these that can be treated with vaccines is to vaccinate the people around them. Making sure that family members, healthcare workers, children in school, and everyone else around the kids are vaccinated goes a long way in helping our children who are receiving cancer therapy to avoid getting some of these infections that could actually be prevented.

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