Immunisations and cancer treatment
Immunisation includes a number of vaccines that children and adults routinely have to protect against infections.
Your resistance to infection can be low at times if you are having, or have recently had, some cancer treatments. These include:
- chemotherapy
- radiotherapy
- immunotherapy
- targeted drugs
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 information about this on another page of our site.
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 you are 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 doctor how long you shouldn’t have live immunisations for. 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 your medical 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 individual situation and the type of treatment you are having.
Pneumococcal vaccine
Your doctor might suggest that 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 pneumonia or blood poisoning (septicaemia).
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 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.
You should have the vaccine at least 2 weeks before having your spleen removed. Or 2 weeks before starting chemotherapy or radiotherapy.
If you did not receive a pneumococcal vaccination before treatment, you could have it afterwards. But you should wait at least 3 months after cancer treatment has finished. 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
In the UK, people are having either the Pfizer-BioNTech or AstraZeneca-Oxford coronavirus vaccines. The Moderna vaccine will be available later this year.
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 there is no need for it to be delayed because of it.
The Government has created a priority list for people who are in most need of getting 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. And most people in the UK have the typhoid vaccine as an injection, rather than a capsule.
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
- diptheria
- whooping cough
- tetanus
- BCG (for tuberculosis)
- Haemophilus influenzae type b
- meningococcal (MenACWY, MenB, MenC)
- pneumococcal
- Human papillomavirus (HPV)
The exception to these 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, Public Health England say that 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 then more likely to pick up the virus from other babies and children, and that 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. Shingles is also caused by this virus. 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 who has a weak immune system and could become very unwell with chickenpox. For example, children might need to have 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
Having 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 think 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 who make the chickenpox vaccine (Varivax) have specific advice to people whose immunity is low. They recommend that they should try to avoid close contact with anyone who has had the chickenpox vaccine for up to 6 weeks following the vaccination.
However, Public Health England (PHE) explain that the risk of a person developing chickenpox or shingles as a result of contact with a vaccinated person is very low. Avoiding contact is not always possible and practical. They suggest that contact does not have to be avoided 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.
So PHE recommend that anyone with a vaccine related rash should cover up their rash when in contact with a person with low immunity. It should be covered until the rash is dry and crusted. Contact only has to be avoided if the rash cannot be covered.
