There are three types of vaccines: inactived, toxoid, and live attenuated vaccines. Inactivated vaccines such as Inlfuenza and pneumococcal which can be administered during chemotherapy; however, the ability to protect is decreased due to the inability of the body to form an immune response during chemotherapy. It is best to get these types of vaccinations at least two weeks before start of chemotherapy or other immunosuppressive therapy or between treatments. This type of vaccinations are not considered harmful (unless there is a significant decrease in white blood cells) during immunosuppressive therapy but may not be as effective. Vaccine response differs depending on the type of cancer. For example, people with breast cancer will have a 66% response rate and people with lung cancer will have a 78% response rate to the influenza vaccine.
It is recommended that the influenza vaccination should be offered to all cancer patients except those receiving intensive chemotherapy for cancers such as acute leukemia receiving induction or consolidation therapy. Also family members and others that are close to patients with cancer should also be vaccinated against influenza. It is recommended that cancer patients receive intramuscular inactivated vaccine and not the intranasal vaccine.
Pneumococcal infection is seen especially with people who have multiple myeloma, lung cancer, chronic lymphocytic leukemia and lymphoma. The risk of infection for people with breast cancer is not at the same level as the cancers mentioned but can be consider a possibility. Pneumococcal vaccination (pneumovax or prevar) is a inactive vaccination.
Tetanus diphtheria and pertussis are also inactive vaccines. These diseases can lead to complications such as pneumonia or seizure.
Chemotherapy especially if using rituximab may cause the loss of immunity to Hepatitis B and cause liver damage. Therefore your, immunity to Hepatitis B should be assessed.
Live attenuated vaccinations have live virus; however, the virus is rendered weaker. These vaccinations do have the potential to induce an infection in immunocompromised people. These should be given at least 4 weeks prior to the start of chemotherapy or radiation therapy. And at least 3 months after the completion of chemotherapy.
Varicella and zoster vaccines for chicken pox and shingles, respectively, are examples of live attenuated vaccinations. These should have at least 4 weeks before the start of chemo. There is a low risk of varicella zoster infection but it can occur if not done in recommended range. It is important to discuss this with your oncologist for the risk/benefits for these vaccinations especially after chemotherapy.
Significant problems can occur in patients with cancer from measles. There has been an increase in measles outbreaks due to decrease in vaccinating children and this has caused an increased risk for cancer patients and other immunocompromised patients.
If traveling outside the United States discuss with your oncologist about vaccines such as Hepatitis A, thyroid, polio, and malaria. Hepatitis A, intramuscular polio are inactive vaccinations. Oral polio and oral typhoid are live attenuated vaccines and should not be administered in immunocompromised patients. However, if you are actively receiving chemotherapy it is not recommended to travel to places that have a high infection risk for illnesses.
Household members
It is recommended that family members should remain up -to-date with their vaccinations
As always, talk to your oncologist before receiving any vaccination.