TOPICS
Immunization
Guide | Resources |Rituxan
& Flu Shots | Household Contact |
Shingles and
Vaccine | Whooping Cough vaccine?
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Small Pox Vaccination |
Immunizations for Patients With Lymphoma
|Pneumonia |
Glossary
 In
the News
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FDA describes evidence of Flu Vaccine efficacy
in health care facilities
WinPlayer Video
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Yes, Fall season is most likely the time for
survivors and family members to be immunized against the latest strain
of influenza (Flu).
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. One exception being the
spray versions of flu vaccine, which may contain live virus.
Regarding
Rituxan therapy: if you have received Rituxan therapy recently (or
Rituxan-based chemo), 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.
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."
Key Resources:
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NEW For
Guide to Contraindications for Vaccine Use
cdc.gov
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Live Vaccines for me?
So called live vaccines can lead to infection in individuals
with immunity compromised by lymphoma or its treatment. Precautions or
avoidance of live vaccines may also be recommended for close contact
persons, such as family members who share the same household.
Some examples of modified live vaccines
that may be contraindicated (NOT indicated) for lymphoma survivors:
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BCG vaccine |
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Chicken
pox vaccine (also called varicella vaccine)
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Measles vaccine |
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Mixed Respiratory vaccine |
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Mumps vaccine
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Polio
(oral) vaccine |
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Rubella vaccine |
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Shingles vaccine |
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Typhoid vaccine |
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Staphage Lysate (SPL-Serologic Types I and III) |
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Varicella Virus vaccine |
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Yellow Fever vaccine |
See Guide to Contraindications for Vaccine Use
cdc.gov
pdf
Resources on Immunizations
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Children and
Adolescents Immunization/Prophylaxis
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Guide to Contraindications for Vaccine Use
cdc.gov
pdf
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Pneumococcal Infection and Vaccination - a patient's
guide
medic8.com
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Blood draws and shots: tips
for minimizing discomfort
PDF
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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."
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CDC immunization guide:
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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
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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.
NOTE: While the protective effect of a flu shot is
unlikely for those of us who have had Rituxan recently (within 6 to 9
months), we can still protect ourselves by encouraging close contacts to get
their shots.
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).
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Immunization of the Immune compromised
primaryimmune.org.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.
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"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."
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Somebody in Your Household Just Got Vaccinated Against
Smallpox...
What Should You do?
dsf.health.state.pa.us
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October 2008 Rotavirus vaccines: viral shedding and
risk of transmission
thelancet.com
"A review of rotavirus vaccine prelicensure studies shows that viral
shedding and transmission were higher with the old tetravalent
rhesus rotavirus vaccine than with the current human attenuated
monovalent rotavirus vaccine and the pentavalent bovine-human
reassortant vaccine. Immunocompromised contacts should be advised to
avoid contact with stool from the immunised child if possible,
particularly after the first vaccine dose for at least 14 days.
Since the risk of vaccine transmission and subsequent
vaccine-derived disease with the current vaccines is much less than
the risk of wildtype rotavirus disease in immunocompromised
contacts, vaccination should be encouraged." |
Vaccination for Whooping Cough (Pertussis)?
The Tdap and DTaP vaccines appears to be inactivated
(not from live strains of the bacteria) according to the following
source, and therefore could be safe for immune-compromised individuals.
Please, as always, do first check with your medical
provider.
See
http://www.immunize.org/catg.d/p4212.pdf
What kind of vaccine is it?
"DTaP and Tdap vaccines are “inactivated” vaccines. Inactivated vaccines do
not contain live bacteria or virus and cannot reproduce, which is why
multiple doses are needed to produce immunity. For the pertussis component
of DTaP and Tdap vaccines, purified components of the bacterium are grown
and then inactivated. DTaP is for children younger than 7 years and has a
higher concentration of pertussis than Tdap, which is intended for persons
10 years and older."
Shingles
about shingles
CDC
"Almost 1 out of every 3 people in the United States
will develop shingles, also known as zoster or herpes zoster.
Anyone who has recovered from chickenpox may develop shingles the risk
of disease increases as a person gets older. About half of all cases
occur among men and women 60 years old or older.
People who have medical
conditions that keep their immune systems
from working properly, such as certain
cancers, including leukemia and lymphoma,
and human immunodeficiency virus (HIV), and
people who receive immunosuppressive drugs,
such as steroids and drugs given after organ
transplantation are also at greater risk of
getting shingles.
People who develop shingles
typically have only one episode in their
lifetime. In rare cases, however, a person
can have a second or even a third episode.
source
CDC
TREATMENT:
"Several antiviral medicines—acyclovir,
valacyclovir, and famciclovir—are available
to treat shingles. These medicines will help
shorten the length and severity of the
illness. But to be effective, they must be
started as soon as possible after the rash
appears."
CDC
immunization for me? 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.."
Reports
Smallpox immunization for me?
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
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Pneumococcal vaccination. Vaccinate patients at high risk for severe
pneumococcal infections
a.
Administer the 23-valent pneumococcal polysaccharide vaccine to
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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;
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persons aged 5--64 years who have functional or anatomic asplenia;
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persons aged 5--64 years who are living in special environments or social
settings; |
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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). |
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