Vaccinations for cancer patients: What to know

Certain types of chemotherapy and radiation therapy can weaken the immune system, putting cancer patients at increased risk for life-threatening infections. Because of this, many cancer patients may need to get revaccinated against diseases they received vaccines for as children. And some may require additional vaccines or boosters to help protect such against infections.

But not all common vaccines are recommended for every cancer patient. That’s because the benefits – and safety -- vary from patient to patient.

Vaccination recommendations for cancer patients

To do their job, vaccines require a healthy immune system that’s able to recognize and kill disease-causing germs. And it takes a healthy immune system at least 2 weeks from the time of vaccination to start recognizing and killing germs. That means vaccination timing is just as important as getting the vaccine itself.

In general, vaccines aren’t recommended during chemotherapy or radiation therapy. (Stem cell transplants have their own recommendations, so it’s important to speak with your doctor about vaccinations if you’re undergoing a transplant.) To ensure you’re getting the right vaccinations at the right time, talk to your doctor about the best vaccination timetable for you. 

So, which vaccines should you discuss with your oncologist? Below are the general vaccine recommendations for cancer patients.

Influenza vaccine (the flu shot): Talk to your doctor

You can typically get the flu shot at least 2 weeks before chemotherapy or between cycles of chemotherapy.

Cancer patients should 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. By protecting themselves from the flu, they’re also protecting you from getting it from them.

Tdap vaccine: You may need

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). This is especially important if you have a cut or other skin injuries (punctures, lacerations, scrapes or nail sticks), and came into contact with floodwaters in Houston after Hurricane Harvey. Talk to your doctor if you are exposed to someone with whooping cough.

Pneumococcal vaccine: Talk to your doctor

The pneumococcal vaccine helps to prevent serious lung, blood or brain infections caused by certain bacteria. It’s important to discuss this one with your doctor first, as recommendations may vary depending on your particular case. But generally, patients with cancer should receive two types of pneumococcal vaccine. These vaccines should be given 2 weeks prior to chemotherapy. Only stem cell transplant recipients are recommended to retake the vaccines after five years. Patients who got the vaccination before age 65 will need a booster of PPSV23 after they reach that age.

Polio vaccine: Most patients don’t need it

If you got the polio vaccine as a child, you don’t need it again after cancer treatment unless you have a low antibody level. Cancer patients who need revaccination should get the vaccine at least 4 weeks prior to chemotherapy or radiation therapy. Additionally, it’s important to note that patients should receive only the inactivated polio vaccine, not the oral polio vaccine. 

It’s recommended that family members also avoid the oral polio vaccine. If friends and family receive the oral polio vaccine, beware that this vaccination contains a live virus that can be passed on to people with weak immune systems.

If you have questions about the polio virus, talk to your doctor.

Shingles vaccine (Zostavax): Avoid if you’re undergoing chemo or radiation

Generally, the vaccine for shingles is given to adults age 60 or older who’ve had chicken pox to prevent shingles or to lessen the severity of shingles. Because the vaccine contains a live virus, it shouldn’t be given to patients undergoing chemo or radiation therapy or those taking drugs that suppress the immune system. If you are exposed to someone with shingles, please let your doctor know right away. Talk to your oncologist if you have any questions.

Varicella (chickenpox) vaccine: Many patients should avoid it

The chicken pox vaccine is given to prevent chicken pox in people who’ve never had the disease.  It’s only given to persons whose blood test does not show immunity to the Varicella Zoster Virus, which causes chicken pox.

Because the chicken pox vaccine includes a live virus, it shouldn’t be given to patients with leukemia, lymphoma or any cancer of the bone marrow or lymphatic system, as well as those with weak immune systems or who are undergoing chemotherapy.

But household members and close contacts who aren’t immune to the chickenpox virus should be vaccinated. This is important to protect patients undergoing chemotherapy. If you’re exposed to chickenpox during chemotherapy or radiation therapy, talk to your oncologist about treatment options.

 MMR (measles-mumps-rubella) vaccine: Avoid it if you have a weak immune system

MMR contains a live virus, so patients with weak immune systems should not get the vaccine. If you’re exposed to someone with measles/mumps or rubella, be sure to tell your doctor.

It’s safe for your family members to get the MMR vaccine.

HPV vaccine: Parents and young adults should talk to their doctors

The HPV vaccine can protect against several types of cancer caused by the human papillomavirus (HPV), including cervical cancer, anal cancer, penile cancer, throat/tonsil cancer, vaginal cancer and vulvar cancer. Because it’s most effective when administered before HPV exposure, MD Anderson recommends giving the HPV vaccine to boys and girls around age 11 or 12. Girls should get it by age 26, and boys should get it by age 21. Parents of young children – cancer patients and non-cancer patients alike – should speak with their pediatrician about getting their children vaccinated. This two-shot series is the best way to provide maximum protection from cancer.

If you have any concerns about a contagious diseases 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, such as the hepatitis A and meningococcus vaccines. And make sure to ask what vaccines your household family members need as well.

Shobha Pai is a physician assistant at MD Anderson in The Woodlands.

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