Guidelines on vaccinations in paediatric haematology and oncology patients
Simone Cesaro1, Mareva Giacchino2, Francesca Fioredda3
1Paediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Ospedale Borgo Roma, P.le L.A. Scuro 10, 37134 Verona, Italy.
Insights
Vaccinations in children undergoing chemotherapy require careful timing. Live-attenuated vaccines are generally not recommended during intensive treatment, but family vaccinations should continue.
Area of Science:
- Pediatric Oncology
- Immunology
- Infectious Disease Prevention
Background:
- Vaccinations are crucial for preventing infectious diseases.
- Chemotherapy can suppress the immune system in children, potentially affecting vaccine efficacy.
Purpose of the Study:
- To provide guidelines on vaccinating pediatric cancer patients during chemotherapy.
- To review the literature on vaccination efficacy and safety in this population.
Main Methods:
- A panel of experts from the Italian Association of Pediatric Hematology Oncology (AIEOP) developed guidelines.
- A literature review was conducted for studies published between 1980 and 2013.
Main Results:
- Hepatitis A and B vaccinations are effective during intensive chemotherapy.
- Vaccinations with toxoid, protein subunits, or bacterial antigens are best postponed to less intensive phases.
- Live-attenuated virus vaccines are generally not recommended during intensive chemotherapy, except for varicella.
- Family members should maintain their recommended vaccination schedules.
- While antibody levels may be low post-chemotherapy, immunological memory is often preserved.
Conclusions:
- Vaccination strategies must be adapted based on chemotherapy intensity.
- Post-chemotherapy recovery allows for effective revaccination and booster responses.
- Ensuring patient and family vaccination contributes to herd immunity and protects vulnerable individuals.
Objective:
Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children.
Patients And Methods:
A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed.
Results And Conclusion:
During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.
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