Tag: johns Hopkins

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 While Immunosuppressed

It seems to be a big surprise to many folks, but kids can get most vaccines when they are immunosuppressed. In fact, they sometimes get extra some extra vaccines, like Pneumovax, because the  “incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence.”

They should also get all of their vaccines if they are around someone who is immunosuppressed.

Surprised?

Vaccines While Immunosuppressed

Which vaccines your kids can get while they are immunosuppressed is going to depend greatly on the reason why they are  immunosuppressed.

Are they getting chemotherapy?

Did they just get a stem cell transplant?

Were they born with a specific immunodeficiency, like X-linked agammaglobulinemia, selective IgA deficiency, severe combined immunodeficiency, or chronic granulomatous disease?

Whatever the reason, they likely won’t get a medical exemption to skip all of their vaccines.

“Killed vaccines will not cause infection in immunodeficient or any other children. The fear of increased community-acquired vaccine-preventable diseases should lead to adherence to and completion of recommended immunization schedules in the community to reinforce herd immunity, such that all vaccine-preventable diseases become exceedingly rare.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

In most cases, immunocompromised kids can get all inactivated vaccines. It is only live vaccines that could pose a problem. Even then, it depends on the specific immunodeficiency as to whether avoiding live vaccines is necessary.

For example, after chemotherapy and a stem cell transplant, kids can usually get live vaccines.

Your doctors can review the latest guidelines to come up with a safe vaccination plan for your child with an immune system problem. If necessary, consultation with an infectious diseases or immunology specialist can also be helpful.

Don’t overlook other causes of possible immunosuppression when getting vaccinated, like taking daily oral steroids for more than two weeks, certain biologic immune modulators, or other medications like methotrexate, azathioprine, 6-mercaptopurine.

“Limited evidence indicates that inactivated vaccines generally have the same safety profile in immunocompromised patients as in immunocompetent individuals. However, the magnitude, breadth, and persistence of the immune response to vaccination may be reduced or absent in immunocompromised persons.”

2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

And keep in mind that just because they can and should get vaccinated, it doesn’t mean that their vaccines are going to work as well as in someone who isn’t immunocompromised.

That’s why herd immunity is so important for these kids.

Vaccines for Close Contacts of Immunocompromised People

What about people who come into contacts with kids and adults who are immunocompromised?

Can they get vaccines?

“Close contacts of patients with compromised immunity should not receive live oral poliovirus vaccine because they might shed the virus and infect a patient with compromised immunity. Close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

Yes, close contacts can get vaccinated, especially since we don’t use the oral polio vaccine in the United States anymore.

There are some exceptions for the smallpox vaccine, which few people get, and Flumist, but only in very specific situations, including a recent hematopoietic stem cell transplant.

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

Worried about shedding?

You should be worried about getting a vaccine-preventable disease and giving it to those around you with immune system problems. That’s the real risk!

This is the modern anti-vaccine movement - taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.
This is the modern anti-vaccine movement – scaring parents and taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.

And no, you are not being selfish to expect those around you to get vaccinated.

Vaccines are safe and necessary – for all of us.

More on Vaccines While Immunosuppressed