Vaccinations and Flu Shots for People with Cancer

Should people with cancer get any vaccines?

It’s generally recommended that vaccines not be given during chemo or radiation treatments – the only exception to this is the flu shot. This is mainly because vaccines need an immune system response to work, and you may not get an adequate response during cancer treatment.

The immune system is a group of cells, tissues, and organs that work together to resist infection by germs, such as bacteria or viruses. Cancer and cancer treatment can weaken a person’s immune system so that it won’t work as well as it should. It’s important to know which vaccines are safe for people with weak immune systems. Before receiving any vaccines, talk to your doctor about your cancer, cancer treatment, risk factors for the vaccine-preventable disease, whether you need the vaccine, and the best time for you to get it.

Vaccines, which are also called immunizations or vaccinations, are used to help a person’s immune system recognize and fight certain infections or diseases.

Live versus inactivated vaccines

For people with cancer: It's important to remember there is a difference between a vaccine with a live virus and one with an inactive virus. It's also important that people with cancer who might have a weak immune system talk to their doctor about whether they can get vaccines. In general, anyone with a weak immune system should not get any vaccines that contain live virus. There are a few vaccines that contain live viruses, which can sometimes cause infections in people with weak immune systems that can become life-threatening. Your doctor can help guide you about which vaccines are safe while your immune system is weak. Be sure to also talk to your doctor before anyone you spend a lot of time with (such as your children or other household members) gets any vaccines.

For family and caregivers of people who have cancer: If you live with or spend a lot of time with a person who has cancer and might have a weakened immune system, it's important to talk to the doctor if you, your child, or your loved one is due for a vaccination of any kind. Usually, most age-appropriate vaccines can be given, but there are some exceptions.

Flu shots

The flu shot is a vaccine that is given to reduce your risk of getting influenza (a viral infection often called "the flu"). In patients with cancer and weakened immune systems, it's important to prevent the flu because it can be serious and sometimes life-threatening. It is recommended that cancer patients get the flu shot that has an inactive (dead) flu virus every year. The vaccine is needed every year because research has shown there is usually a different kind of flu virus expected each year, so the vaccines are a little different each year to help be as effective as possible. Your cancer care team will tell you when the best time to receive the flu vaccine is 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 flu vaccine. Family members of a person with cancer can safely get the nasal spray (at least in some flu seasons) unless the patient has a severely weak 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 has recently had a stem cell or bone marrow transplant.

It is recommended that people who live with or care for a person at high risk for flu-related problems get the flu vaccine, too. This means that if you’re being treated for cancer, your family members, caregivers, and children age 6 months and older living at home should get the flu shot. Talk to your doctor for more information or if you have questions about your specific situation.

MMR (Measles-Mumps-Rubella) vaccine

This vaccine is used to 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 virus. But it’s safe for other household members to get it. If needed, your doctor may consider giving you the vaccine before cancer treatment starts. Talk to your doctor for more information or if you have questions about your situation.

After exposure to measles: If the person being treated for cancer is exposed to someone with measles, let the doctor know right away. Sometimes, medications can be given to help fight the measles infection before it starts.

Talk to your doctor about your risk, and if you need to receive the MMR vaccine.

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. Your doctor may recommend one or more doses of the pneumococcal vaccine, depending on your age and health. In cases where patients are having their spleen removed, this vaccine may be give before surgery or sometimes after the surgery. Ask your doctor if you need to receive the pneumococcal vaccine and when you need to get it.

Meningococcal vaccines

This vaccine helps prevent meningococcal disease, which can cause meningitis or other infections. This vaccine should not be given during cancer treatment. It may be offered before treatment, or after the patient’s immune system has recovered.  In cases where a patient is having the spleen removed, this vaccine may be given before surgery. Talk to your doctor to see if and when you may need to receive 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, only should 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. People who get the live virus vaccine can pass the virus on to people with weak immune systems.

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 OK for household members of the person with weak immunity to get the varicella vaccine. Talk to your doctor for more information or if you have questions.

If you’re exposed to chickenpox: A person with weak immunity who has been around someone with chickenpox should call the doctor right away.

Shingles (varicella zoster) vaccine

This vaccine is given to adults age 50 and older who have had chickenpox or shingles in the past to help prevent shingles or make symptoms of shingles less severe.

If you have a weak immune system from cancer or cancer treatment, talk to your doctor about chicken pox and shingles vaccine options and whether one of these vaccines might be right for you. Also, tell your doctor if you know you have been exposed to chickenpox or shingles.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Ariza-Heredia EJ, Chemaly RF. Practical review of immunizations in adult patients with cancer. Human Vaccines & Immunotherapy. 2015; 11(11): 2606-2614.

Brant JM, Stringer LH. Neutropenia & infection. In Brown CG, ed. A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:377-378

Centers for Disease Control and Prevention (CDC). Altered immunocompetence. 2017. Accessed at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html on August 29, 2019.

National Comprehensive Cancer Network (NCCN). Prevention and treatment of cancer-related infections. 2018. Version 1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/PDF/infections.pdf on August 29, 2019.

Palmore TN, Parta M, Cuellar-Rodriguez J, Gea-Banacloche JC. Infections in the cancer patient. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2037-2068.

Shah MK, Kamboj M. Immunizing cancer patients: Which patients? Which vaccines? When to give? Oncology.  2018; 32(5):254-258.

References

Ariza-Heredia EJ, Chemaly RF. Practical review of immunizations in adult patients with cancer. Human Vaccines & Immunotherapy. 2015; 11(11): 2606-2614.

Brant JM, Stringer LH. Neutropenia & infection. In Brown CG, ed. A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:377-378

Centers for Disease Control and Prevention (CDC). Altered immunocompetence. 2017. Accessed at https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html on August 29, 2019.

National Comprehensive Cancer Network (NCCN). Prevention and treatment of cancer-related infections. 2018. Version 1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/PDF/infections.pdf on August 29, 2019.

Palmore TN, Parta M, Cuellar-Rodriguez J, Gea-Banacloche JC. Infections in the cancer patient. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2037-2068.

Shah MK, Kamboj M. Immunizing cancer patients: Which patients? Which vaccines? When to give? Oncology.  2018; 32(5):254-258.

Last Medical Review: February 1, 2020 Last Revised: February 1, 2020

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