Immunisations and cancer treatment
Immunisation includes several vaccines children and adults routinely have to protect against infections.
Your resistance to infection can sometimes be low if you have or have recently had some cancer treatments. These include:
- chemotherapy
- radiotherapy
- some immunotherapy drugs
- some targeted cancer drugs
- long-term steroids
- removal of the spleen
The effect of treatment on your immune system depends on the cancer drug and the dose of your drug or radiotherapy treatment.
There are some vaccinations you shouldn't have when you have low immunity because they could make you feel very ill. You might also need to avoid contact with other people who have had certain types of vaccination.
This page is about vaccines as part of the immunisation programme and whether people with cancer should have them.
Researchers are also looking at vaccines as a possible way of treating cancer. We have more information on this.
Having immunisations during treatment
There are two main types of vaccines. These are live vaccines and inactivated (not live) vaccines.
You shouldn't have immunisations with live vaccines while having cancer treatment or for some months afterwards. This is because live vaccines contain a very weak version of the illness they are vaccinating you against. Check with your healthcare team how long you shouldn’t have live immunisations. This depends on your type of cancer treatment.
Flu vaccine
Some pre school and school children have the flu vaccine as a nasal spray. The nasal spray contains a live but weakened form of the flu vaccine. Talk to their healthcare team if your child has cancer. The doctor may recommend that your child doesn’t have the nasal spray if they have a very weakened immune system. In this situation, your child might have the flu vaccine injection instead.
Adults with cancer can have the flu vaccine injection because this is not a live vaccine. If you are having cancer treatment, do ask your doctor about the best time to have this. This will depend on your situation and the type of treatment you are having.
Pneumococcal vaccine
Your doctor might suggest you have the pneumococcal vaccine if your immunity is low. The pneumococcal vaccine protects against pneumococcal infections. These infections could lead to illnesses such as:
- an infection of the lung (pneumonia)
- blood poisoning (septicaemia)
- an infection of the protective membranes surrounding the brain and spinal cord (meningitis)
There are two different types of pneumococcal vaccine. These are the:
- pneumococcal polysaccharide vaccine (PPV)
- pneumococcal conjugate vaccine (PCV)
These are not live vaccines. You should have both vaccines (PCV then PPV 2 months later) if you have severe low immunity. For example, you have acute or chronic leukaemia.
You should have PPV if you are due to have your spleen removed (a splenectomy) or your spleen is not working well.
When you have it
The pneumococcal vaccine is available at any time of the year. Check with your doctor when it is best to have it in your situation.
Ideally, you should have the vaccine at least 4 to 6 weeks before:
- having your spleen removed
- starting chemotherapy or radiotherapy
If this is impossible, you can have it up to 2 weeks before treatment.
You could have it afterwards if you did not receive a pneumococcal vaccination before treatment. But you should wait at least 3 months after chemotherapy or radiotherapy treatment has finished. You can have it 2 weeks after your spleen has been removed.
Check with your specialist about the best time. This might vary depending on your situation.
For example, leukaemia patients should have PCV from 6 months after chemotherapy. Those who have had a stem cell or bone marrow transplant should have PCV around 9 to 12 months after their transplant.
You need to have PPV every 5 years if you have had your spleen removed or your spleen is not working well.
Coronavirus (COVID-19) vaccine
Specialists say that everyone having systemic anti cancer therapy (SACT) should be considered for the vaccines. Your cancer treatment can also go ahead if you've had the vaccine, and it is unnecessary to be delayed because of it.
Every year, the Government creates a priority list for people who most need the coronavirus vaccine. Some people with cancer will come under the group who are extremely vulnerable if they are not in one of the other high priority groups.
Travel vaccinations
You might need to have other vaccinations if you are travelling.
Contact with other people who have had vaccines
It’s safe for you to be in contact with other people who've had live vaccines as injections. But there is a very small risk from people who’ve had live vaccines taken by mouth (oral vaccines such as tablets or capsules).
Avoid contact with anyone who has recently had the oral typhoid vaccine. The typhoid vaccine is available as an injection or capsule. People in the UK would only have this vaccine if they plan to travel abroad to certain countries.
There is usually no risk to you from any child who has had vaccines as part of the national immunisation programme. This applies to most childhood vaccines in the UK including:
- inactivated polio
- MMR
- diphtheria
- whooping cough
- tetanus
- BCG (for tuberculosis)
- Haemophilus influenzae type b
- meningococcal (MenACWY, MenB, MenC)
- pneumococcal
- Human papillomavirus (HPV)
The exceptions are the rotavirus vaccine and the flu vaccine nasal spray (see below). You will need to take some precautions if your immunity is very low.
Some pre school and primary school children have the flu vaccine as a nasal spray. If your immune system is severely weakened, you should avoid contact with children who have had this type of flu vaccine. This is for 2 weeks following their vaccination.
This is because the nasal spray contains a live but weakened form of the flu vaccine. So there is a very small chance that the vaccine virus could be passed on to you and cause flu. The injection does not contain a live form, so these precautions do not apply to contact with people who have had the injection.
Check with your doctor if you are unsure whether your cancer or its treatment has severely weakened your immune system.
Babies have a vaccine at 8 and 12 weeks old called the rotavirus vaccine. Rotavirus causes sickness and diarrhoea. The vaccine contains a very weakened form of the rotavirus. The baby swallows the vaccine, and rotavirus passes out in their poo for about 2 weeks afterwards.
This vaccine could pose a risk to you if your immunity is low. There is a small risk you could catch the rotavirus infection while changing their nappy.
However, there is a far greater risk to a person having cancer treatment if they share a house with a baby that doesn't have the vaccine. The baby is more likely to pick up the virus from other babies and children, which is much more infectious than the vaccine.
There is no need to avoid all contact with a vaccinated baby. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
Varicella (chickenpox) is a very infectious disease caused by the varicella zoster virus. This virus also causes shingles. Anyone who has had chickenpox in the past may develop shingles.
Who has these vaccines?
The chickenpox vaccine (Varivax and Varilix) is not part of the childhood immunisation programme. The vaccine is only offered to people on the NHS if they are in close contact with someone with a weak immune system and could become very unwell with chickenpox. For example, children might need the vaccine if they are in close contact with a brother or sister, parent or grandparent who is having cancer treatment that weakens the immune system.
Adults in their 70s are offered the shingles vaccine (Zostavax).
Contact with chickenpox
Chickenpox could make you very unwell if your immune system is weak due to cancer or its treatment.
Contact your GP or consultant if you have been in contact with chickenpox. Your consultant might recommend you have an injection of ready-made antibodies. This medicine tries to prevent infection with chickenpox. Or reduce the symptoms and side effects if you develop chickenpox.
Contact with those who have been vaccinated
The company that makes the chickenpox vaccine (Varivax) has specific advice for people with low immunity. They recommend trying to avoid close contact with anyone who has had the chickenpox vaccine for up to 6 weeks following the vaccination.
The risk of a person developing chickenpox or shingles due to contact with a vaccinated person is very low. Avoiding contact is not always possible and practical. You don’t have to avoid contact unless the vaccinated person develops a rash.
Some people may develop a rash following their chickenpox or shingles vaccine. There is a very small risk that the vaccine virus could be passed on from the rash of the vaccinated person to a person with a weak immune system.
Anyone with a vaccine related rash should try to limit exposure to the person with a weak immune system. They should do this until the rash disappears or until there are no new signs of a rash within a 24 hour period.
Speak to your specialist nurse or GP for advice on your situation.
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