Tag: chemotherapy

Getting Vaccinated to Protect Those Who Can’t Get the Vaccines

Most people get vaccinated because those vaccines have the direct benefit of reducing their risk of getting a life-threatening vaccine preventable disease. Protecting those who can’t get vaccines is a secondary benefit.

Should you get vaccinated to protect those who can't get the vaccines?
Does rationalizing your decision in anti-vax Facebook groups help you feel better that you are putting kids with cancer at greater risk to get sick?

A secondary benefit that anti-vax folks go to great lengths to convince themselves isn’t real and justify their decision to leave their kids unvaccinated and unprotected..

Getting Vaccinated to Protect Those Who Can’t Get the Vaccines

Of course, none of their explanations really hold water.

None of the vaccines that are routinely used on the CDC immunization schedule are a risk if you are around kids with cancer or other immunodeficiencies, except for FluMist and those with severe issues, like being in a bone marrow transplant unit.

One of the biggest misconceptions though, is that in getting vaccinated, parents are putting their own kids at great risk to protect someone else.

Don't set your kid on fire to keep mine warm!
Don’t set your kid on fire to keep mine warm!

Of course, that’s not true.

Remember, vaccines are safe, with few risks.

That why the analogy of setting their own kids on fire to keep others warm doesn’t make any sense.

After all, unlike vaccinating their own child, setting their child on fire offers them no benefit!

And they should understand that the one and only reason that their kids don’t get more vaccine-preventable diseases in this dog eat dog world is because the vast majority of us vaccinate and protect our kids.

Herd immunity is indeed real. In addition to protecting those who can’t be vaccinated, it protects the free-riders, those who just don’t want to get vaccinated.

What about the idea that it is unrealistic for folks who are immunocompromised to expect that they can lead normal lives and avoid infections?

You can't avoid all risks of infection, but why not avoid those that you can?

While it is true that there are other infections out there besides those that are vaccine-preventable, wouldn’t you want to at least reduce those risks that you can?

But could it be, as much as they seem to believe in shedding, that they think they are being altruistic in not vaccinating their kids?

Anti-vax folks are all about the shedding...
Anti-vax folks are all about the shedding

They aren’t.

In most cases, there are no restrictions on vaccinating people who have contact with those with immune system problems.

What about the idea that vaccines cause cancer?

Vaccines prevent cancer!
Vaccines prevent cancer!

That isn’t true. In fact, there are several vaccines that prevent cancer!

What other misconceptions do they have?

Most of the reasons folks use to avoid vaccines have been refuted a thousand times.
Most of the reasons folks use to avoid vaccines have been refuted a thousand times.

Let’s look at those last few issues…

  • vaccines are not associated with autism
  • vaccines aren’t perfect, but they do work very well
  • vaccines do help those with immune system problems, sometimes directly and more often because of herd immunity
  • people who have cancer are often vaccinated before they have chemo, but that protection gets wiped out during treatment and they can’t get caught up until after they have completed all of their treatments
  • kids with cancer might get some vaccines, but typically don’t get live vaccines

What about the idea that your unvaccinated child isn’t sick, so can’t get anyone else sick?

While that is a very common argument among anti-vax parents, it is very important that if your child is unvaccinated, then they are at much greater risk to catch a vaccine-preventable disease. And since you are often contagious even before you show symptoms, they might unknowingly expose many other people before they even realize that they are sick.

Hopefully you now understand it was never really a question.

That's why you get vaccinated, to protect those who can't get the vaccines!

Vaccinate and protect your kids.

If you don’t, in addition to putting them at risk to get sick, you put everyone around them at risk, including some who are at very high risk for severe complications from vaccine preventable diseases.

More on Risks from Unvaccinated Kids

Are Rates of Cancer in Children Skyrocketing?

Why do some folks think that rates of cancer in children are skyrocketing?

If you want to do something during Childhood Cancer Awareness Month, encourage folks to get vaccinated and protected so that they don't put people with cancer, who are likely immunosuppressed at risk to get a vaccine-preventable disease.
If you want to do something during Childhood Cancer Awareness Month, encourage folks to get vaccinated and protected so that they don’t put people with cancer, who are likely immunosuppressed at risk to get a vaccine-preventable disease.

Oh, the usual suspects…

Are Rates of Cancer in Children Skyrocketing?

Cancer is actually one of the leading causes of death, but it is not the leading causes of death in children.

Childhood cancer is not the leading cause of death.

And cancer rates in children are not skyrocketing.

“We identified 120,137 childhood and adolescent cancer cases during 2001-2009 with an age-adjusted incidence rate of 171.01 per million. The overall rate of all cancers combined remained stable over time.”

Siegel et al on Cancer incidence rates and trends among children and adolescents in the United States, 2001-2009.

They have been very stable for many years.

So much for the anti-vax theory that vaccines can cause cancer

There’s more.

Not only are cancer rates in children not skyrocketing, fewer kids today are dying of cancer.

The death rate from childhood cancer has been decreasing.
The death rate from childhood cancer has been decreasing.

And now that they are actually getting vaccines that can prevent cancer, these children have an even lower risk of getting several cancers when they get older!

Even worse than pushing the idea that cancer rates are skyrocketing and that vaccines cause cancer, many of these same folks steer people with cancer away from life-saving medical treatments!

How can these folks publish advice that people with cancer should stop chemotherapy and radiation?!?
How can these folks publish advice that people with cancer should stop chemotherapy and radiation?!?

Surprised?

You shouldn’t be.

This is the modern anti-vaccine movement.

More on Cancer and Vaccines

People with Cancer Are at Risk from Unvaccinated Kids

We know that kids with cancer aren’t at risk from shedding if someone has recently been vaccinated.

Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.
Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.

The real risk comes from those who are unvaccinated.

People with Cancer Are at Risk from Unvaccinated Kids

Confused on how that works?

Kids with cancer typically have a compromised immune system, so are at greater risk for getting sick and catching infectious diseases. This includes a risk from vaccine-preventable diseases because they often can’t be vaccinated and any vaccines they had in the past might no longer provide protection.

Don’t believe me?

Want some examples?

  • a 6-year-old girl who was in remission for ALL and had just received her final dose of chemotherapy was admitted with fever and neutropenia, found to have measles, and died after 28 days of intense therapy (1989)
  • an 8-year-old being treated for leukemia developed chicken pox and died two weeks later (1998)
  • a partially vaccinated 4-year-old girl who was being treated for acute lymphoblastic leukemia (ALL) was exposed to a cousin with chicken pox and later developed multi-organ failure and died (2012)
  • a 26-year-old man who was being treated for chronic lymphocytic leukemia died in Switzerland after he became infected with measles (2017)
  • a 6-year-old boy with leukemia died in Italy after catching measles from his intentionally unvaccinated sibling (2017)

Of course, there are many more, including many kids with cancer who get exposed to a vaccine-preventable disease and have to get treated with immunoglobulin and hope they don’t get sick. And many more who do get sick and are treated in the hospital for weeks and months and thankfully, get better.

And there are even more who get caught up in quarantines because they have true medical contraindications to getting vaccinated, and so have to stay home from school with the intentionally unvaccinated kids whenever there is an outbreak of measles or chicken pox, etc.

What can we do about this?

Vaccinate our kids! We have a choice. These kids with cancer don’t.

More on People with Cancer at Risk from Unvaccinated Kids

Vaccines After Cancer and Chemotherapy

Most people know that children being treated for cancer have a suppressed immune system and are at extra risk for vaccine-preventable diseases.

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions benefit from herd immunity. (CC BY 2.0)

That’s one of the reasons that it is important for everyone to be vaccinated, so that herd immunity levels of protection can protect those who can’t get vaccines.

Vaccines After Cancer and Chemotherapy

But what happens after they complete their cancer treatments?

“The interval until immune reconstitution varies with the intensity and type of immunosuppressive therapy, radiation therapy, underlying disease, and other factors. Therefore, often it is not possible to make a definitive recommendation for an interval after cessation of immunosuppressive therapy when inactivated vaccines can be administered effectively or when live-virus vaccines can be administered safely and effectively.”

Red Book on Immunization in Immunocompromised Children

After they complete therapy for cancer, whether it is chemotherapy or a bone marrow transplant, many children need to get extra vaccines.

In the UK, for example, 6 months after completing “standard antileukemia chemotherapy,” children get a booster dose of DTaP, IPV, Hib, MenC, and MMR.

Why just a single booster dose?

Because most kids can continue to get non-live vaccines on schedule while they are getting standard chemotherapy. They get a booster dose when they finish chemotherapy because those vaccine doses they got while receiving treatment might not be as effective as usual and typically don’t count as valid doses.

Of course, if they were missing any doses, then they might need extra doses to catch up too.

“Three months after cancer chemotherapy, patients should be vaccinated with inactivated vaccines and the live vaccines for varicella; measles, mumps, and rubella; and measles, mumps, and rubella-varicella according to the CDC annual schedule that is routinely indicated for immunocompetent persons.”

2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

In contrast to those getting standard chemotherapy, if treatment involved a hematopoietic stem cell transplant (HSCT), then these children are essentially revaccinated:

  • beginning at 6 months after the HSCT, they should get 3 doses of DTaP if they are less than 7-years-old vs a dose of Tdap and 2 doses of Td if they are already 7-years-old
  • beginning at 3-6 months after the HSCT, they should get 3 doses of Prevnar
  • beginning at 6-12 months after the HSCT, they should get 3 doses of Hib
  • beginning at 6-12 months after the HSCT, they should get 3 doses of hepatitis B, followed by postvaccination anti-HBs titer testing
  • beginning at 6-12 months after the HSCT, they should get 3 doses of IPV
  • beginning at 6-12 months after the HSCT, they should get 2 doses of a meningocococcal vaccine (if they are already 11 to 18 years old)
  • beginning at 6-12 months after the HSCT, they should get 3 doses of  HPV vaccine (if they are already 11 to 26 years old)
  • beginning at 12 months after the HSCT, one dose of the Pneumovax vaccine
  • beginning at 24 months after the HSCT, two doses of MMR
  • beginning at 24 months after the HSCT, two doses of the chicken pox vaccine
  • a yearly flu shot

Why not just check titers instead of repeating all of those vaccines?

“protective” concentrations or titers in this population may not be as valid as in healthy children, leaving open the question regarding what levels to use as the basis for revaccination. Furthermore, there are some vaccines for which no serological correlate of protection exists (e.g., pertussis) or for which, in routine practice, it is too difficult to have levels measured (e.g., polio).

Soonie R. Patel et al. on Revaccination of Children after Completion of Standard Chemotherapy for Acute Leukemia

In Canada, they used to check titers at 1, 3, and 5 years after the end of chemotherapy and just vaccinate when titers dropped, but they switched to giving all kids a booster dose, as it works better.

What will your child’s immunization look like after completing treatment for cancer?

Although the specific recommendations will come from your child’s treatment team, they will likely look something like the guidelines included here.

What to Know About Vaccines After Cancer and Chemotherapy

Kids often have to get revaccinated, or at least get booster doses of their vaccines, after completing treatment for cancer.

More on Vaccines After Cancer and Chemotherapy