TOPICS
Immunization
Guide | Resources |Rituxan
& Flu Shots | Household Contact | Shingles
Vaccine
Small Pox Vaccination |
Immunizations for Patients With Lymphoma
|Pneumonia | Glossary
 TOPIC
SEARCH:
memory
cells AND chemotherapy | pneumonia revaccination
 As
always, check with your doctor regarding
the safety and potential to benefit from immunizations of various kinds.
Be
sure to inform your doctor of your medical history, such as a diagnosis of lymphoma,
recent immune suppressing treatments, and also the immune status of
those who live in your household.
Flu
shots (including H1N1 type) are generally recommended for lymphoma
survivors, and immediate family or household guests (close contact
persons). These vaccines are typically made from killed virus, and
therefore cannot lead to infection.
Exception:
spray versions of flu vaccine may contain live virus.
Regarding
Rituxan therapy: if you have received Rituxan therapy recently (or
Rituxan-based chemo), or are scheduled
for same, you may not benefit optimally from vaccination because of the
depleting effect of this treatment on normal b-cells -- which are needed
to create antibodies against virus. Ask your
oncologist for guidance.
Key Resources:
Live Vaccines for me?
Some examples of modified live vaccines
that may be contraindicated (not indicated) for persons with lymphoma or close contact
individuals because they can lead to infection in immune compromised persons:
.gif) |
chicken
pox vaccine (also called varicella vaccine)
|
|
|
measles
|
|
|
mumps
|
|
|
oral
polio
|
|
|
rubella |
|
|
shingles |
|
|
Other
types?
See Guide to Contraindications for Vaccine Use
cdc.gov
pdf |
Resources
|
|
|
|
|
Children and
Adolescents Immunization/Prophylaxis
|
|
|
|
|
|
Guide to Contraindications for Vaccine Use cdc.gov
pdf
|
|
|
|
|
|
Somebody in Your Household Just Got Vaccinated Against
Smallpox...
What Should You do?
dsf.health.state.pa.us
|
|
|
Pneumococcal Infection and Vaccination - a patient's
guide medic8.com
|
|
|
Immunization in persons with compromised immunity cdc.gov
"Severe immunosuppression can be due to a
variety of conditions, including congenital immunodeficiency, human
immunodeficiency virus (HIV) infection, leukemia, lymphoma,
generalized malignancy or therapy with alkylating agents,
antimetabolites, radiation, or large amounts of
corticosteroids.
For some of these conditions, all affected persons will be severely
immunocompromised; for others, such as HIV infection, the spectrum
of disease severity due to disease or treatment stage will determine
the degree to which the immune system is compromised.
The responsibility for determining whether a patient is severely
immunocompromised ultimately lies with the physician."
|
|
|
|
|
|
|
|
CDC immunization guide:
|
|
Guidelines for Preventing Opportunistic Infections
Among
Hematopoietic Stem Cell Transplant Recipients
www.cdc.gov
Recommendations of CDC, the Infectious Disease Society of America,
and
the American Society of Blood and Marrow Transplantation
|
|
|
Glossary of related terms
Attenuated - to reduce the virulence (infectivity) of a pathogenic
microorganism used in a vaccine in order to make it safe or safer.
“Close
contact” [in respect to avoiding exposure] means anyone living in your
household. It also means anyone you have close, physical contact with, like a
sex partner or someone you share a bed with. (Close contact does not mean friends
or co-workers.) CDC
Should I Receive a Flu shot if I've had,
or will soon have,
Rituxan treatment?
Lacking formal studies, no definitive answer
exists. Rituxan depletes normal b-cells for as long as 6 to 12 months and
therefore could have an effect on how well immunizations will work.
The following informal guidance has been
given to at least some patients:
Before Rituxan?
We assume this timing is preferred because your immune system post Rituxan
will be less able to produce antibodies against the bugs.
After Rituxan?
The consensus seems to be that flu shots may not work optimally if given
shortly after Rituxan, but it might still be beneficial, and it's not likely to do
any harm. The time it takes for b-cells to return to sufficient numbers
is not known, and could vary significantly. We speculate that flu
vaccination might induce cellular (t-cell) immunity when b-cells are
depleted. Since Rituxan can deplete memory b-cells (PMID:
15238091), we think you should ask your doctor if past 5- or 10-year
immunizations should be repeated when b-cell levels return.
How long should I avoid exposure
to others who have
been immunized when I'm immune suppressed?
The answer to this question may depend on the type of
immunization. See resources below.
Please consult with your physician, or contact the CDC (800-342-2437).
|
|
Immunization of the Immune compromised
www.primaryimmune.org/pubs/clinic_focus/cf_oct98.pdf
"Due to the potential transmission of live vaccine virus from
vaccinated household contacts to immunocompromised persons, vaccination
of the household contact is sometimes contraindicated. Household
contacts of persons with severe impairment of humoral or cellular
immunity should not receive live, oral polio vaccine (OPV) because of
the risk of transmitting virulent poliovirus and development of
vaccine-associated paralytic poliomyelitis (VAPP).
Instead, inactivated poliovirus vaccine should be used. If live,
oral polio vaccine is inadvertently given to a household member, close
contact should be limited for 4 to 6 weeks after vaccination, the
duration of poliovirus shedding. Increased attention to good
hygiene, particularly hand washing, may also reduce the risk of
poliovirus transmission. The risk of VAPP from household transmission of
poliovirus in persons with selective IgA deficiency, asplenia,
complement deficiencies and phagocytic defects is probably no
greater than the general population although no studies have been done
to assess this.
|
|
|
"The vaccine is well tolerated. Transient pain and redness at the
injection site are reported by approximately 25% of vaccinees. Fewer
than 10% of vaccinees report a mild maculopapular or varicelliform rash,
either local or generalized. Because of the small potential for
transmission of the vaccine virus, vaccines in whom a rash develops
should avoid contact with immunocompromised susceptible persons.
Inadvertent administration of varicella vaccine to individuals who are
immune to varicella has not resulted in an increased number of adverse
reactions."
|
|
|
Somebody in Your Household Just Got Vaccinated Against
Smallpox...
What Should You do?
dsf.health.state.pa.us
|
Shingles immunization? WebMD
"Up to one in ten older patients won't
be candidates for the vaccine because of weakened immune systems due to cancer
therapy, organ transplants, HIV/AIDS,
or other causes. The vaccine contains live but weakened varicella virus
that could overwhelm the immune systems of those patients.."
Smallpox immunization?
Information on Live Virus Vaccines and Vaccinia
cdc.gov
"The smallpox vaccine is not
recommended for people who have weakened immune systems, including people with leukemia or human immunodeficiency virus (HIV) infection or people undergoing treatment with certain drugs or with certain skin conditions. In rare cases, people who fall into these groups can have serious complications from the vaccine."
Immunizations for Patients With Lymphoma, Hodgkin's
Disease, Myeloma and Leukemia
Adapted from: Guide for Adult Immunization, 3rd edition, American
College of Physicians:
Patients who have a malignant lymphoma, Hodgkin's lymphoma, myeloma, chronic lymphocytic
leukemia or related conditions often do not have normal immunity to some infections
because of their disease and necessary treatments. These patients should [often]
receive certain
immunizations to help boost their immunity.
It is also recommended by the CDC that people in close
or direct contact with immune compromised patients receive immunization
vaccines, such as loved ones, family members, and health care providers.
NOTE:
Guidelines are subject to change, and can vary depending on the clinical
circumstances. So, as always, it's best to seek advice on
immunizations from your doctor.
... However, a few types of immunizations - those using live
organisms - can be dangerous and
must be avoided.
... Please keep one copy of these recommendations with your own health records and take a copy
to your family physician. Patients who are currently receiving chemotherapy or radiation
should wait until six months after treatment before receiving immunizations except for
influenza vaccine which should be taken every year. If you have any questions about these
recommendations be sure to discuss them with your Oncologist.
Immunizations for Pneumonia?
Copied from
CDC: Guidelines for Preventing
Health-Care--Associated Pneumonia, 2003
|
|
Pneumococcal vaccination. Vaccinate patients at high risk for severe
pneumococcal infections
a.
Administer the 23-valent pneumococcal polysaccharide vaccine to
|
|
persons aged >65 years; persons aged 5--64 years who have
chronic cardiovascular disease (e.g., congestive heart failure or
cardiomyopathy), chronic pulmonary disease (e.g., chronic obstructive pulmonary disease [COPD]
or ermphysema, but not asthma), diabetes mellitus, alcoholism,
chronic liver disease (e.g., cirrhosis), or
cerebrospinal fluid (CSF) leaks;
|
|
|
persons aged 5--64 years who have functional or anatomic asplenia;
|
|
|
persons aged 5--64 years who are living in special environments or social
settings; |
|
|
immunocompromised persons aged
>5 years with HIV infection,
leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized
malignancy, chronic renal failure, nephrotic syndrome, or other conditions
associated with immunosuppression (e.g., receipt of HSCT, solid-organ
transplant, or immunosuppressive chemotherapy, including long-term
systemic corticosteroids); and persons in long-term--care facilities (IA)
(104--109). |
|
|
