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:
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chemotherapy
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radiotherapy
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some types of immunotherapy drugs
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some targeted cancer drugs
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long term steroids
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removal of the spleen
The effect of treatment on your 
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:
- live vaccines
- inactivated (not live) vaccines
You shouldn't have immunisations with live vaccines while having cancer treatment and 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 vaccines for. This will depend on the type of cancer treatment you’ve had.
Flu vaccine
Many children have the flu vaccine as a nasal spray. The nasal spray contains a live but weakened form of the flu virus. If your child has cancer, talk to their healthcare team. 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. This isn’t a live vaccine.
Adults with cancer also have the flu vaccine injection if they are having cancer treatment. 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
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)
Your doctor might suggest you have the pneumococcal vaccine if your immunity is low.
There are two different types of pneumococcal vaccine. These are the:
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pneumococcal polysaccharide vaccine (PPV)
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pneumococcal conjugate vaccine
These are not live vaccines. You should have both vaccines (pneumococcal conjugate vaccine 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, people being treated for leukaemia should have pneumococcal conjugate vaccine from 6 months after chemotherapy. Those who have had a should have pneumococcal conjugate vaccine 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
Your doctor may recommend you have the COVID-19 vaccine if you are having . Speak with your doctor about the best time to have 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. Talk to your healthcare team about this before you have any.
Contact with other people who have had vaccines
It’s usually safe for you to be in contact with people who have had live vaccines as injections. But there is a very small risk from people who have had live vaccines taken by mouth or by a spray into the nose.
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:
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inactivated polio
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MMR
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diphtheria
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whooping cough (pertussis)
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tetanus
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BCG (for tuberculosis)
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haemophilus influenzae type b
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meningococcal (MenACWY, MenB, MenC)
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pneumococcal
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human papillomavirus (HPV)
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hepatitis B
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.
Many children have the flu vaccine as a nasal spray. If your immune system is severely weakened such as after a stem cell transplant, you should avoid close contact with children who have had this type of flu vaccine. This is for about 2 weeks following their vaccination.
This is because the nasal spray contains a live but weakened form of the flu virus. So there is a very small chance that the vaccine virus could be passed on to you and cause illness. The flu vaccine injection does not contain a live virus, 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.
There is no need to avoid all contact with a recently vaccinated baby. Ask 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.
There is a far greater risk to a person having cancer treatment if they share a house with a baby that hasn’t had the rotavirus vaccine. The baby is more likely to pick up the virus from other babies and children, which is much more infectious.
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 or 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 aged 60 to 79 are offered the shingles vaccine (Shingrix). This isn’t a live vaccine.
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 reduces the symptoms and side effects if you develop chickenpox.
The companies that make the Varivax and Varilrix chickenpox vaccine have 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 usually have to avoid contact unless the vaccinated person develops a rash.
Some people may develop a rash following their chickenpox 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.
Having immunisations after treatment
At the end of your treatment, your doctor or nurse will talk to you about what vaccinations you may be due and when you can have them.
You can’t have live vaccines until your immune system is working properly. So you may need to avoid live vaccines for 6 to 12 months after treatment. Or 2 years after a stem cell transplant.
Some people may need to repeat the vaccinations they had as a child. This includes those who have had either:
- a stem cell transplant
CAR T-cell therapy
This is because you lose your immunity to illnesses you have been vaccinated against in the past.
The timing of when these vaccinations start depend on the type of treatment you have had. It also depends if you have any side effects such as . It can also vary slightly between hospitals. Your transplant team will let you know.
