Vaccinations and Flu Shots for People with Cancer

Live vaccines versus inactivated vaccines

Some vaccines are made up of killed (inactivated) viruses. Other vaccines contain live, but weakened, viruses.

For people with cancer: In general, vaccines that contain live viruses are not recommended for anyone with a weak immune system. These vaccines can sometimes cause serious infections in people with weak immune systems.

Your health care team can help guide you about which vaccines are safe while your immune system is weak. Be sure to also talk to your health care team before anyone you spend a lot of time with, such as your children or other household members, gets any vaccines.

For family members and caregivers: If you live with or spend a lot of time with someone who has cancer and may have a weakened immune system, talk to your health care team before you or anyone close to you gets a vaccination of any kind. Usually, most age-appropriate vaccines can be given, but there are some exceptions.

Flu vaccines

The flu vaccine reduces risk of getting influenza (a viral infection often called "the flu"). In people with cancer and weakened immune systems, it's important to prevent the flu because it’s often more serious and is more likely to be life-threatening than in people with a normal immune system.

There is usually a different kind of flu virus expected each year, so the flu vaccines are a little different each year to help them be as effective as possible.

For people with cancer: It is recommended that people with cancer get a flu shot that has an inactive (dead) flu virus every year. Your cancer care team will tell you the best time for you to receive the flu vaccine depending on your cancer type and treatment.

The nasal mist version of the flu vaccine contains a weakened version of the live virus. People with cancer should not get the nasal mist version of the flu vaccine. 

For family members and caregivers: The flu vaccine is generally also recommended for people who live with or care for a person with cancer. If you’re being treated for cancer, your family members, caregivers, and household contacts should get the flu shot.

Family members and caregivers can usually get the nasal spray, at least in some flu seasons, unless the person with cancer has a severely weakened immune system and/or is being cared for in a germ-protected area. For example, household members should not get the nasal mist vaccine if a family member recently had a stem cell or bone marrow transplant.

Talk to your health care team for more information or if you have questions about your specific situation.

COVID-19 vaccines

Vaccines that can help protect against COVID are available. In people with weakened immune systems, COVID infections can be serious and are more likely to be life-threatening. Learn more about this in COVID-19 and Cancer.

COVID vaccines do not contain live viruses, so they are safe for people with weakened immune systems.

As with the flu, the virus that causes COVID-19 can change over time, resulting in new variants of the virus. This can make previous vaccines, and previous COVID infections, less likely to be protective if a person is exposed to a newer version of the virus.

For people with cancer: Cancer doctors typically advise that people with cancer and cancer survivors stay up to date with the most recent COVID vaccines. In some situations, a person might be advised to wait to get the vaccine, such as if they have a severely weakened immune system. Re-vaccination may be recommended following certain types of treatment.

For family members and caregivers: Doctors might also recommend the vaccine for family members and caregivers of people with cancer and weakened immunity, who are at higher risk for COVID-related problems.

Talk to your health care team for more information or if you have questions about your specific situation.

Respiratory syncytial virus (RSV) vaccines

In healthy older children and adults, RSV infection can cause symptoms like those from a common cold. But in very young children, older adults, and people with weakened immune systems, symptoms from an RSV infection can be severe.

RSV vaccines are available for adults aged 60 and over, as well as for younger adults who are at higher risk of major problems from RSV. These vaccines are made of either RSV proteins or messenger RNA (mRNA, a type of genetic material). They are not made of live viruses, so they are safe to give to people with weakened immune systems.

The RSV vaccine is recommended for people with weakened immune systems who are 60 years and older.

Tdap (tetanus, diphtheria, and pertussis) vaccines

People with cancer may be at increased risk of severe infection from pertussis (whooping cough) and complications from diphtheria and tetanus. The Tdap vaccine is not a live vaccine, which means it is safe for people with weakened immune systems.

For people with cancer: Adults with cancer should receive one dose of Tdap if they have never had it before, followed by a booster every 10 years. Your cancer care team may adjust vaccine timing depending on your treatment.

For family members and caregivers: Family members, caregivers, and close contacts should be fully up-to-date with Tdap, including receiving the one‑time Tdap dose if they have not previously had it.

Hepatitis B vaccines

Vaccination against the hepatitis B virus (HBV) is an important part of protecting people with cancer. HBV vaccines do not contain a live virus and are safe for adults with weakened immune systems.

HBV infections can be more severe in people with weakened immune systems, and chronic HBV infection increases the risk of liver cancer. Chronic HBV infections are more likely to cause severe illness in people with weakened immune systems.

Mpox (monkeypox) vaccine

Mpox (formerly known as monkeypox) is a contagious viral infection that can cause fever, swollen lymph nodes, and a painful rash. While most people recover, mpox can be more serious in people with weakened immune systems, including those getting cancer treatment.

This vaccine is recommended for adults who may be at higher risk of exposure, including certain sexual exposures, workplace exposures, or close contact with someone who has mpox.

Cancer treatments such as chemotherapy, immunotherapy, prolonged corticosteroid use, or stem cell transplant weaken the immune system, increasing the risk of more severe illness from mpox.

Shingles (varicella-zoster) vaccine

People with cancer are at higher risk of developing shingles. Vaccination can help prevent shingles or make symptoms from it less severe. The shingles vaccine does not contain a live virus.

This vaccine is generally recommended for adults with cancer.

People should get the shingles vaccine even if they’ve had chickenpox or shingles in the past. Chickenpox and shingles are caused by the same virus. Once a person recovers from chickenpox, the virus stays dormant (inactive) in the body. It can sometimes reactivate years later and cause shingles.

If you have a weak immune system from cancer or cancer treatment, talk to your health care team about the shingles vaccine and whether it might be right for you.

Pneumococcus (pneumococcal pneumonia) vaccine

This vaccine can help people with weak immune systems fight off certain lung, blood, or brain infections caused by certain bacteria.

One or more doses of the pneumococcal vaccine is generally recommended as part of routine adult cancer care. In cases where people are having their spleen removed, this vaccine may be given before surgery or sometimes after surgery.

Ask your cancer care team if you need to get the pneumococcal vaccine and when you need to get it.

MMR (measles-mumps-rubella) vaccine

This vaccine can help protect people from 3 viral diseases: measles, mumps, and rubella.

People who have weak immune systems should not get the MMR vaccine because it contains live viruses. But it may be recommended either before cancer treatment starts or after it is completed. It’s usually safe for other household members to get this vaccine.

Talk to your health care team for more information or if you have questions about your situation.

After exposure to measles: If you have a weakened immune system and are exposed to someone with measles, let your health care team know right away.

Meningococcal vaccine

This vaccine helps prevent meningococcal disease, which can cause meningitis or other infections.

This vaccine is typically not given during cancer treatment. It may be offered before treatment, or after a person’s immune system has recovered. In cases where a person is having their spleen removed, this vaccine might be given before surgery.

Talk to your health care team to see if and when you may need to get the meningococcal vaccine.

Polio vaccine

This vaccine is used to prevent polio, a viral infection linked to severe illness and physical disability. Since the vaccine came out in 1955, polio has become rare in the US.

Children who have weak immune systems, as well as their siblings and others who live with them, should only get inactivated polio virus vaccines.

Most doctors in the United States use only the inactivated polio vaccine, but you should ask to be sure. The older oral polio virus vaccine, which is taken by mouth, contains a live virus.

Varicella (chickenpox) vaccine

This vaccine is intended to prevent chickenpox in people who have never had it.

This is a live virus vaccine. 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.

It’s usually OK for household members of people with weak immunity to get the varicella vaccine, but talk to your health care team for more information or if you have questions.

If you’re exposed to chickenpox: If you have a weakened immune system and have been around someone with chickenpox, call your health care team right away.