Some cancers or cancer treatments can cause immunosuppression. This is when the immune system doesn’t work as well as it should so it is less able to fight infections or diseases. Immunizations may be given to help boost immunity.
Talk to your doctor or healthcare team if you have questions about immunizations during or after cancer treatment. Some immunizations must be avoided in some cases because they could be dangerous, especially if your immune system is severely suppressed.
The Canadian Immunization Guide recommends immunization guidelines and schedules for people with certain medical conditions, such as those with immunosuppression.
Immunization against tetanus and diphtheria can usually be given on a standard schedule every 10 years.
Talk to your healthcare team about immunizations needed for travelling. The Canadian Immunization Guide has immunization information for travellers. Health Canada also has a travel medicine program. You may need to be immunized 2–3 months before a trip so that immunizations have time to take effect. The actual immunizations required will vary depending on your age, health and medical conditions, as well as where and why you are travelling.
People who have bone marrow or stem cell transplants will have immunizations tailored to their specific situation. It can take 6–12 months for the immune system to recover after a transplant. Revaccination may not be done for 1–2 years after the transplant. Some people may need to get all the standard vaccines again. Live vaccines should not be given for 2 years after transplant and some live vaccines may never be given.
If you are immunosuppressed, your healthcare team may suggest that people close to you receive all currently recommended vaccinations. These people may include immediate family, parents and siblings or people who live with you. This will help reduce your exposure to these diseases. Recommended vaccines may include:
- varicella vaccine
- flu vaccine
- meningococcal C conjugate vaccine
- pneumococcal conjugate vaccine
Live vaccines contain weakened living viruses. Your body reacts to the virus and develops an immune response to it. Live vaccines include those given for:
- varicella zoster virus (chicken pox and shingles)
- German measles (rubella)
People receiving some cancer treatments, such as chemotherapy or radiation therapy, should not be given live vaccines. If you need a live vaccine, it is usually given 6 months after you finish completing therapy. A killed vaccine may be used, but it is unclear how effective these vaccines are.
Some people receiving cancer treatment may be told to avoid children or people recently immunized with a live vaccine. This is usually only a precaution for people whose immune system is severely suppressed, such as people who have had a bone marrow or stem cell transplant. Check with your doctor about which vaccines to avoid and for how long.
People who live with someone who is immunosuppressed may receive certain live or killed vaccines without causing a risk to the person with cancer. In rare cases, live viruses may affect people with severe immunosuppression, such as after a bone marrow or stem cell transplant.
After the oral polio vaccine is given, the virus can be shed (passed on) for up to 12 weeks. This vaccine shouldn’t be given to people who live with someone receiving cancer treatment. An inactive polio virus vaccine may be used, although this vaccine may not be as effective.
The varicella zoster virus vaccine is given to prevent or lessen the symptoms of shingles in people over the age of 60. If you are immunosuppressed, ask your healthcare team about this vaccine before someone close to you receives it.
The smallpox vaccine has practically wiped out the disease in North America, so the vaccine is rarely given. However, there is still a small risk that this disease could come back in the future. If smallpox re-emerges, the vaccine shouldn’t be given to people who are immunosuppressed. Family and household members of someone receiving cancer treatment shouldn’t receive the vaccine either because the virus can be shed up to 21 days after immunization.
The flu shot, or influenza vaccine, and the pneumonia vaccine (Pneumovax) are not live vaccines. People with cancer, their immediate family and household members can usually have these vaccines.
The pneumococcal vaccine is given to prevent pneumonia in people with lymphoma, multiple myeloma, chronic lymphocytic leukemia and some other cancers. This vaccine is given when you are first diagnosed and then usually every 5 years.
In Canada, the influenza vaccine is usually offered in the fall each year. There are 2 main forms of the flu vaccines. Live vaccines are given as a nasal spray. Inactivated vaccines are made from a dead virus. They are given as shots or injections.
People with cancer who are immunosuppressed need to be careful about the type of flu vaccine they get. It is safe for people with cancer to get the injected vaccine because it uses a dead virus. They shouldn’t get the nasal spray because it is made from a live vaccine. Even a very weak live virus can cause a serious illness in immunosuppressed people. Family and household members can safely get the nasal spray unless the person with cancer is severely immunosuppressed after a stem cell or bone marrow transplant.
If you are currently receiving chemotherapy, the best time to get the flu vaccine is 48 hours before or after treatment. This is when your blood counts are still near the normal range. People with cancer should not receive the flu vaccine if they are allergic to any of the vaccine components or if they have a platelet count below 20,000.
Talk to your doctor or healthcare team before getting the flu vaccine.
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